'A national crisis': Doctors and patients on how GP shortage has affected them

'A GP not seeing people could be a matter of life and death for someone'
'A national crisis': Doctors and patients on how GP shortage has affected them

Nenagh GP Dr Pat Harrold: “We’re at breaking point...and it’s a national crisis.” Photo: Don Moloney

Clare towns seeing impact of GP shortages

Some towns in Co Clare are seeing the impact of GP shortages, with many practices, including those in the larger towns, not taking on new patients.

Former TD Dr Michael Harty, who has a practice in Kilmihil, approximately 18 miles south-west of Ennis, says shortages have been “coming for a long time”, while Shannon GP Dr Yvonne Williams stated that most doctors in the area have not been able to take on new patients for some time, though the demand continues.

Shannon has a population of more than 9,700, is the home to one of the country’s airports, and has four GP practices located in the town.

However, Jamie Walsh has been unable to register with a GP since he moved to Shannon from Dublin in February.

“I was trying to get a GP because I’m going to be transitioning,” Jamie explains.

Jamie Walsh who has been trying to find a GP in Shannon since moving down from Dublin earlier this year. He has to regularly travel up and down to Dublin to see a GP which also means booking time off work and paying for public transport.
Jamie Walsh who has been trying to find a GP in Shannon since moving down from Dublin earlier this year. He has to regularly travel up and down to Dublin to see a GP which also means booking time off work and paying for public transport.

I’ll need a GP down here in order to get my bloods done, and my GP will have to inject me with my hormone blockers and stuff, and they’re all saying there’s no room at all in any of them, and the waiting lists are months long.” 

Currently, Jamie still regularly travels up and down to Dublin to see a GP, which also means booking time off work and paying for public transport.

“I even tried Ennis and stuff, just to see if I could get somewhere. I know it is a bit further to travel, but it would be easier, but they’re all packed up as well.” 

Since moving down, Jamie has been “ringing around” and has filled out application forms for practices.

“The hope is there that I’ll get a GP down here, but it never seems to work out, so it gets very frustrating.”

 The 23-year-old currently needs to see a GP every month and requires regular checkups to monitor hormone levels and bloods.

If I start missing it, it can obviously mess up my whole body because my hormone imbalance would be off then.” 

Jamie described the situation as “very stressful”.

“Once you start going to a GP, you get to know them and everything, so it’s kind of hard to not be able to get one and get comfortable enough with them.” 

Dr Yvonne Williams in Shannon says every GP in the town has had their list closed for “quite some time”.

“Compared to 10 years ago when I first started in Shannon, it’s become increasingly difficult year on year, and particularly in the last three to four years,” she said.

Last year, GPs in the area had to provide cover for one another during time off, as they could not source locums.

Meanwhile, she described the demand as “relentless”, with about 20% of their workload currently taken up by Covid and post-covid related issues on any given day.

The workload has increased dramatically and the patient demand for services from GPs has increased dramatically and the longer the waiting lists in the hospital, the greater knock-on effect that has in general practice," she said.

“The working conditions are very, very difficult at the moment, and patients will find that a lot of GPs have their practices closed; they have to wait longer to get to see their doctors — they might have to wait days or a week because the appointments are booked up.” 

Single-handed practices, she says, are no longer viable.

“In terms of the future of a single-handed GP maintaining a practice in the smaller towns and villages, it has become almost impossible.

There is no young GP coming out who will sign up to the contract as it is.

Dr Michael Harty in Kilmihil, West Clare, is also currently not taking on new patients and is the only GP in the village.

Dr Harty had campaigned on the ‘No Doctor, No Village’ platform.

“Unfortunately, I’m really at capacity so I can’t take on any more patients,” he says.

You could have 10 or 20 people looking to join the practice on a weekly basis because of a number of retirements in the area and also a lot of people are moving back to rural Ireland, and they’re having difficulty finding GPs.” 

Dr Harty receives calls from people in Ennis who are asking to join his practice — which is approximately 18 miles away from his practice.

“People coming from 10, 15, 20 miles away, skipping over practices that are full, asking if I can take them on, so it is an issue, and we have a lot of people moving back now to live in rural Ireland.” 

He said the shortages have been “coming for a long time”, and with more GPs expected to retire in the coming years, it will be a “huge blow” particularly for more rural areas.

Dr Michael Harty: “You could have 10 or 20 people looking to join the practice on a weekly basis." Picture: Gareth Chaney/Collins
Dr Michael Harty: “You could have 10 or 20 people looking to join the practice on a weekly basis." Picture: Gareth Chaney/Collins

“When a GP retires and isn’t replaced, it’s a huge blow to that community, and we have seen that happen on a number of occasions recently,” Dr Harty said.

“If your GP doesn’t retire, you don’t notice the problem. If your GP retires, then you certainly notice the problem.” 

One woman, living in Ennis, says she has been trying to register with a GP for some time.

In the 2016 census, Ennis had a population of over 25,000 and remained the largest town in Munster. It is located between two cities — Limerick and Galway — and currently has 13 GP practices.

The woman, who does not want to be named, had been going to a family GP in Limerick, but after her first child was born, it became too difficult to travel.

I went on the hunt just before lockdown to get a GP in town, and I didn’t think it would be that hard, but every surgery I rang, they wouldn’t even entertain the conversation,” she said. 

She had tried a few different practices in the town, and following some failed attempts, she eventually registered with the practice her husband attended following help from a family member.

“She [the family member] may as well have been asking them for the winning Lotto numbers,” she said. "She just begged and got us in."

Due to give birth to her second child any day now, she has had just three appointments with her new GP since January, including one to confirm her pregnancy.

She said she had up to two check-ups cancelled due to her GP seeing only “high-priority” patients, adding that it can sometimes feel as though you are “begging” for an appointment.

Meanwhile, earlier this year, her mother was diagnosed with a terminal illness in another county. Earlier diagnosis, she says, could have meant a different prognosis.

“GPs not seeing people could be a matter of life and death for some people," she added.

No room on lists of Carrigaline's 30 GPs

Ellen O'Regan

Located just outside Cork City, Carrigaline is the largest town in the county, with a population of more than 15,000.

There are 30 GPs working in the area, but those who are struggling to get in the door of any practice would argue it’s still not enough.

In 2018, Gordon Reid decided to bring his mother from Scotland to Ireland, to live with family here, who gave her end-of-life care until she passed away last month at age 101.

At the time, she was so frail that she had to be transported by air ambulance, and Scottish doctors had told the family she only had a few weeks left.

Mr Reid tried to register his mother with his own family GP, to be told they were not taking on new patients. 

He heard the same from six other practices in Carrigaline whom he contacted. It took two months to obtain a medical card, and eventually have Ms Reid compulsorily allocated to their family GP.

“Our difficulty and concern was not only that we might need to call the GP to attend to my mother,” says Mr Reid. 

Our greater concern was that GP registration acts as the "gateway" to other services, such as public health nurses, palliative care services, and occupational therapy.

“We managed to hire a bed and mattress privately, but still had no access to the other services. We were just looking after her ourselves and really just praying she wouldn't get ill. 

"It was very, very worrying, and very nerve-wracking.”

Mr Reid believes registration with a GP should be a right for all patients.

I was shocked that it was possible, in the Irish health system, for a very frail 98-year-old, who was acknowledged to need a lot of support services, to be unable to register with a GP. 

"We urgently need a system here like that in Scotland, where registration with a GP is a right for all patients,” he says.

Noreen White O’Loughlin recently moved home from Dubai, where she had lived for 20 years. She has been trying for over a year now to register with any GP in Carrigaline, with no luck.

Ms O’Loughlin has ulcerative colitis, and the only way she can get seen by a doctor is through the after-hours South Doc service.

“Touch-wood, I haven't had any really bad issues that I've needed to see someone, but if something happens I can’t ring a GP like I could in Dubai. It’s shocking.”.

Ms O’Loughlin jokes that it was easier to get in to see an Irish doctor in Dubai than here.

“There are so many GPs in Carrigaline, I can't believe I can get into one of them. 

I have a little dachshund, he was sick the other day and I was able to get him an appointment straight away, and I cant get one for myself.

Dr Jeetandera Rathi is a GP in Carrig Medical Centre, and says the main issue is the cumulative effect of increased workloads with “astronomical” shortages in the workforce.

“The under-6s came in several years back, and recently chronic disease has been moved more and more into primary care, which I think is the right thing to do, but we don't have the necessary workforce,” said Dr Rathi.

“There are at least 50 practices in Cork City and peripheries that are looking to hire a GP, and they can't. I myself have been looking to employ a second doctor for six months,” he said.

"Until we increase our own capacity to train more people in Ireland, we need laxity in the rules to actually be able to employ doctors from the EU or other countries, that we just don't have here,” he added.

Dr Jeetandera Rathi has been unable to recruit a second GP for his practice for the last six months.
Dr Jeetandera Rathi has been unable to recruit a second GP for his practice for the last six months.

Dr John Murphy of Bridge Medical Practice has been practising as a GP for 40 years, and has had to make the difficult decision this week, for the first time, to stop taking on new families as patients.

Dr Murphy said the employment contract for GPs, which has not changed since he first started practising, is “totally unfit for service”, and makes general practice a very unattractive career.

“The job of a GP has been rendered extremely difficult from the point of view of life balance,” he said. 

"It’s completely inappropriate for anybody who wishes to work part time, and it’s also extraordinarily difficult for anybody to get maternity or paternity leave. 

Large numbers of people are prepared to do locums around the place, but to take on a GMS contract and commit to a community is not a very attractive option at present.

“Unless we change the role of the general practitioner, this problem is going to continue to get worse.”

North Tipperary GPs overstretched as colleagues retire

Maeve Lee

In Templemore, Co Tipperary, Dr Joseph Hennessy recently retired from his practice and, following two recruitment campaigns, the HSE has been unable to find a replacement.

A group practice in the town has taken on Dr Hennessy’s panel of patients on an interim basis, while private patients were also advised of the need to source a new GP.

Templemore is located between the towns of Roscrea and Thurles with a population of over 1,900 people and is well known for being the location of the Garda Training College.

It is close to the Limerick-Dublin motorway, and neighbouring Thurles recently gained university status with the country’s newest technological university, the Technological University of the Shannon: Midlands Midwest, which includes a network of campuses in Athlone, Limerick, Ennis, Clonmel, and Thurles.

Nenagh GP Dr Pat Harrold: “There’s no signs of it getting any better.” Picture: Don Moloney
Nenagh GP Dr Pat Harrold: “There’s no signs of it getting any better.” Picture: Don Moloney

With the closure of Dr Hennessy’s practice, the town now has one GP practice — the group practice.

According to the HSE, this practice has recruited a new GP who commenced on September 1. This will mean that there will be three doctors available within the practice.

Dr Hennessy had approximately 750 medical-card patients, in addition to a number of private patients.

Locals had called for an extension of six months to find a new doctor and established a community action group to “save” the practice, which officially closed on October 1.

When asked what he is going to do now that Dr Hennessy’s practice has closed, one patient said: “That’s the problem, we don’t really know what we’re going to do.

“You can’t get in anywhere else…Thurles is nine miles away; Roscrea is 12 miles away.” 

The man, who wished to remain anonymous, said that “the word on the street” is that if you do approach a GP in the surrounding areas, you are placed on a waiting list.

From checking with friends and family, they’re being told there’s a waiting list. We’re going to have to travel I would say, to get a doctor." 

After being diagnosed with haemochromatosis, the man has had to attend his GP regularly to give blood.

“I’m in constant pain now for living for so many years without knowing I had hemochromatosis. My joints are starting to go against me big time. My hands are in bits...now, where do I go?

“I won’t be able to drive because my hands freeze up.” 

Locals have taken it upon themselves to see if they can fill the post, he said, with people contacting family and friends who are doctors and living abroad.

Approximately 23 miles from Templemore, Nenagh has a growing population of almost 9,000 people, according to the last census.

 Nenagh GP Dr Pat Harrold: “I’ve a great practice, great patients, but it’s just the sheer workload.” Picture: Don Moloney
Nenagh GP Dr Pat Harrold: “I’ve a great practice, great patients, but it’s just the sheer workload.” Picture: Don Moloney

The North Tipperary town has a total of three secondary schools and seven GP practices, the majority of which have at least two GPs.

Nenagh GP Dr Pat Harrold describes the current shortage of GPs as “a national crisis”.

“Every single day we’re turning people away who are looking for a GP,” he says.

“It’s Templemore today, it’s Nenagh tomorrow — it will be somewhere else. 

It’s a national crisis and needs to be tackled nationally. We’re well short of GPs in Ireland. 

Dr Harrold says GPs are currently “at capacity”. “We’re at breaking point actually,” he adds, “and it’s a national crisis.” 

“We need more practice nurses, you need more GPs in training, you need more intern posts in hospitals, you need more investment in infrastructure, you need more doctors. 

You need more staff, basically, and you need incentives to be in rural areas.”

 He is worried about the current situation which he believes is “very close to meltdown”.

There’s no signs of it getting any better.” 

Another GP in the North Tipperary area, who does not want to be named, says they currently do not have the capacity to take on new patients and have had their books closed for at least two years.

“I’ve a great practice, great patients, but it’s just the sheer workload,” said the GP. “Appointments are constantly full.” 

Since the retirement of Dr Hennessy, the GP says their practice has seen an increase in the number of people looking to register, with approximately a dozen people who currently have no doctor contacting the practice on a daily basis.

There are some people who phone the practice two to three times a day looking to be taken on as patients with some individuals doing so incessantly.

I hate saying no…for my own sanity, I have to say no. Unfortunately, there are a number of patients who are phoning incessantly, and they will not take no for an answer. 

Linda O’Brien, a member of the Templemore action group said that people are “very upset” by the closure of Dr Hennessy’s practice.

“They’re up in a heap and they’re up in arms and they’re all very upset," she said. 

To see the over-65s nearly in tears, it’s absolutely shocking, and mental health patients — they don’t know whether they’re coming or going.” 

Previously a private patient of Dr Hennessy, Ms O’Brien said she suffered a stroke last year and currently does not have a GP.

“It’s shocking and I mean, there’s people in worse scenarios now than me — I’m fit and well again.” 

Now, she said, there are “loads of people” who do not have a GP.

As someone who has worked in a nursing home for many years, Kathy McGrath said she wants to give a voice to the elderly.

Ms McGrath noted the “upset” among older people in Templemore amid the changeover, while others raised concerns about the number of patients being moved.

The main feeling in the area from the older people that I’m talking to and stuff — and I know about the older people — they’re very, very upset.

A member of the community action group, Ms McGrath also noted that GPs in surrounding areas do not appear to be taking on new patients.

“You can’t get in and as for the private patients, there is nowhere. It’s overcrowded everywhere.

“The doctors are full-out. That’s it. There’s no places.”

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