Deprived areas have fewer GPs than well-off ones, doctors warn

Deep End Ireland made a submission to the Department of Health’s ongoing review of general practice. It called for a change in how medical card payments or capitation fees are made to attract young GPs to these areas. File picture

Younger patients in deprived city areas have illnesses more usual for people in their 80s, yet these places have fewer GPs than well-off ones, doctors have warned.

Dr Brid Shanahan is clinical lead with Deep End Ireland, a group of GPs working in the most disadvantaged communities across the country.

“The illnesses someone in an affluent area would have in their 70s or 80s, my patients get them in their 50s or 60s, and they die from it in their 50s or 60s,” she said.

This includes heart disease, COPD, cancers, and mental health problems, including a higher rate of suicide which is sad, she said.

“There should be more GPs per capita in the areas of need, but at the minute, we have the opposite,” she warned.

They call it the inverse care law. Where you most need the care, you are least likely to get it.

The group made a submission to the Department of Health’s ongoing review of general practice.

It called for a change in how medical card payments or capitation fees are made to attract young GPs to these areas.

Currently, only care for the over-70s carries an extra or weighted fee.

“So the older the patient is, the higher the capitation rate, and it dramatically increases from age 70. But a lot of my patients don’t reach 70,” Ms Shanahan said.

GP practices can get a deprivation grant to hire extra staff, such as a counsellor. However, she raised questions about the system’s use of census data to define ‘deprived’.

“We’ve taken on about 600 patients since September, 52% of them are homeless. But we’re not considered a deprived area according to the census,” she said.

This is similar around the country, she added.

"If you look at the census data for Limerick City, it is extremely deprived, and some GPs there got the grant and rightly so.

“But the grant is not enough; what we need is deprivation weighted capitation like they have in the UK.” 

Dr Shanahan welcomed a Social Democrat motion on GP shortages in the Dáil this week that the party says would "improve access, remove costs, and increase capacity".

“Increasing staff really would be huge,” she said.