GP practices in West Cork close their lists to new patients due to shortage of doctors
The ESRI projected Ireland needs 943 to 1,211 more GPs by 2040, and an additional 761 to 868 GP nurses.
Most GP practices in West Cork are closed to new patients, a problem GPs say is also growing in rural parts of Clare, Kerry, and other counties, as they call for creative thinking to remove obstacles not of their making.
Doctors are not surprised by recent reports from the Economic and Social Research Institute (ESRI) and Department of Health on shortages. They have called for action to help patients in need.
Dr Paul O’Sullivan works at the Marino Medical Centre in Bantry in West Cork. It still offers same-day appointments, but does a “careful triage” to see if anyone can wait, due to time pressures.
“That would be the same issue with all the practices in West Cork — most practices in the area have actually closed their lists to new patients,” he said.
“It is becoming a bigger issue because people moving to the area find they just can’t get on a GP list.”
The rise of remote working has seen many people move out of cities. He estimated the population in nearby Kealkill village had likely doubled.
“It’s welcome but it puts pressure on existing medical services in the area,” he said.
A big barrier for young GPs he has interviewed is the Southdoc out-of-hours service. They are reluctant to take on night-time house-calls to remote areas for no extra pay.
As a GP trainer, he has worked with the Kerry scheme. He has seen similar problems dog recruitment efforts in Dingle and elsewhere.
“It is a universal problem,” he said.
Patients and rural doctors would benefit from expanded hospital services regionally, he said, adding they work closely with Bantry Hospital.
“We would be involved in obstetrics, we’d see lots of paediatric problems — here or in Southdoc — which would end up in Cork University Hospital emergency department normally [in city practices],” he said.
Doctor shortages in Clare, east and west, were also highlighted in the Department of Health analysis, as in West Cork, East Limerick, West Waterford and across Tipperary.
Dr Liam Glynn, a GP in Ballyvaughan, argued for a new approach to attract doctors to rural communities and towns.
“To me, the right care in the right place is as close to where you live as possible,” he said.
A strong primary care system means, he said, “it’s more cost-effective and we know it delivers more higher-quality care".
GPs working in rural areas often need a wider range of skills than their city-based peers. This is extremely rewarding but challenging, both GPs indicated.
Chair of the rural general practice committee at the Irish College of GPs, Dr Glynn was not surprised by the analysis finding older doctors are delaying retirement.
In some places, the HSE had to ask medical card patients to move practices when a GP retired without a successor.
“The solution is not to be closing down practices, but to make them attractive places to work and ensure they continue to exist in the rural communities,” he said.
He welcomed funding for specialist GP fellowships in rural areas, but said more than the six on offer are needed.
“I think it’s really important we don’t go down that road of closing down these practices that have delivered high-quality care for decades to rural communities,” he said.
“What you want is GPs who are very familiar with their practice population.”
The Ballyvaughan Medical Centre was funded to hire a medical translator to help treat about 500 Ukrainian patients in the area. Moves like this are vital, he explained. In his view “there is no one silver bullet” solution.
Irish College of GPs board chair Dr Deirdre Collins echoed this.
“We need a real focus on rural- and urban-deprived general practice, and the support of the HSE in helping GPs who wish to set up new practices in areas of expanding population,” she said.
She pointed to other external issues — the growing population and more people living longer.
Labour’s health spokeswoman Marie Sherlock raised the shortages in the Dáil. She said low-income areas in cities also needed just as much help to attract doctors.
“We know that GPs serving the most disadvantaged communities in Ireland encounter higher health needs among their patients,” she said.
“Yet shockingly, we have a lower ratio of GPs in deprived communities compared to more affluent areas.”
The ESRI projected Ireland needs 943 to 1,211 more GPs by 2040, and an additional 761 to 868 GP nurses.
The department’s analysis showed by 2030, about 2.2 GP graduates will be trained for each GP retiring. Other schemes, such as international medical graduates in rural areas, are expanding.
Dr Glynn noted the four-year GP training course now has 1,191 trainees, a 22% increase since last year.
He would also like to see bursaries for rural students to study medicine, so they might return home and work as doctors.
A shift in focus at medical schools was also needed, he suggested.
Medical students at the University of Limerick, where he lectures, do 25% of their clinical training in GP practices, the highest proportion nationally.
In the meantime, patients are relying more on private healthcare.
People who can afford it can now get online GP appointments with their health insurance company.
Other walk-in GP clinics have mushroomed, some running seven days a week. However, many do not accept medical card patients.
In addition, Southdoc and Shannondoc have said they now see more patients at night or weekends who do not have a GP at all.
These all meet patients’ immediate crisis needs, but GPs worry it is not the same as the safety net of having your own doctor.
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