The crisis in GP cover is getting worse — it's time to act before it's too late
If GPs remain unable to get locum cover, the day will be here soon when many GPs will have to put up a notice that the practice is closed on their week off.
Do you know if your GP was able to take two weeks off in the last 12 months?
Were they one of the many GPs nationally who worked remotely from their Covid isolation when they could not get a Locum?
Did they get time off afterward if they needed it for delayed recovery?
Have they been able to take any other necessary illness leave in the last 12 months?
Had they got to the stage of considering resignation due to the serious difficulties getting Locum cover for their maternity leave?
What about you? Have you moved house and not been able to register with a GP?
Were you able to register with a GP for pregnancy care?
Did an elderly parent move in with you but have difficulty finding a new GP?
Were you able to get your baby registered with a new GP for childhood immunisations, if you had changed address?
If you have a medical or GP visit card, you are one of the lucky ones — the HSE has an obligation to assign you a GP once you have been unable to register with three GPs.
A response to a Parliamentary Question of Catherine Murphy TD last December showed that in 2017, the HSE had to arrange a GP for 1,859 people.
In 2019, that had risen to 2,989, and by 2021 it increased again to 5,133. We do not know how many more thousand people who do not have a medical or GP visit card had to continue trying to register with a GP.
The patient’s difficulty and the GP’s difficulty are two sides of the same coin.
The Irish Medical Organisation (IMO), in its 2022 pre-Budget submission, told us: “59% of GPs stated that they were unable to take time off due to difficulties in sourcing locum cover while 66% said they been unable to take sick leave.” (The ‘locum’ is the doctor covering for your GP when he/she is off work).
It is time for our Government and Department of Health to ensure that no more is a GP unable to take basic essential leave due to lack of locum GP cover.
One possible solution to this is for the department to consider the option of creating a state-employed locum pool.
This could be on a regional Community Health Organisation (CHO) basis with placement then by the CHO Primary Care Unit Office in GP surgeries subject to contract-determined area of work for the Locum GP.
Given that the GP would be a State employee, this could be expected to be attractive to ensure the retention of qualified GPs in areas and counties that otherwise are challenged in this regard.
While it is well recognised that in recent years GP graduates (if they have not emigrated) appear to prefer working in urban centres — often cities, the possibility of employment ‘pull factors’ including maternity leave and associated regional location (and hence not having a city mortgage) should not be under-estimated.
This would be especially so if family supports and commitments were also considerations.
Were the State to offer employment to all GP graduates as locums, it could be considered that this may ultimately halt the attrition of qualified GPs who, with time, may then wish to move to the benefits and autonomy of business-ownership/partnership in a practice long-term.
A UK headline at the start of May asks ‘Where have our GPs gone?’, could that happen here?
Yes, it could.
If GPs remain unable to get locum cover, the day will be here soon when many GPs will have to put up a notice that the practice is closed on their week off.
Then, after more time has passed, it would not be hard to understand that some GPs felt that it was time to change job, that enough was enough.
Even if that meant winding down the practice they had established and built up.
Not just the younger GP; the older GP who has put off retirement because there was no-one taking over will feel they have given it long enough.
If there is no GP cover, it won’t help our accident and emergency departments either.
In reply to a Parliamentary Question in March from Brendan Howlin TD regarding GP locum availability, the Minister for Health detailed the contribution made by the State in covering the locum cost and also that, where necessary, a GP can contact the local relevant HSE offices re assistance in securing locum cover.
We no longer have the luxury of leaving it at that.
The above is one suggestion, one proffered solution. Should there be a more appropriate alternative open to us, then a state-sourced locum pool would of course prove unnecessary.
- Dr Catherine O’Donohoe is a GP in Adamstown, Co Wexford. Medical Council Number 22441. This article is written in a personal capacity.
