A targeted plan to address the chronic shortage of GPs in rural Ireland was outlined at a conference in Athlone last week, where Irish Rural Link hosted an event highlighting the challenges of rural healthcare.
Seamus Boland, chief executive of Irish Rural Link said healthcare in rural Ireland had become a major issue for elderly people in particular.
“We need to find solutions to these challenges by dealing with the problems facing rural Ireland when it comes to healthcare, which is a bit of a Cinderella when it comes to the overall health system,” he said.
Professor Robert Scully is the country’s first established professor of rural and remote medicine at University of Galway, which will introduce a four-year graduate entry medicine programme in September, with a strong focus on rural and regional healthcare needs.
He delivered the keynote address where he said the solutions to rural healthcare challenges were not to be found solely in health.
Professor Scully described rural healthcare as a ‘thorny and complex issue’ and said joined up thinking was required across a number of government and social agencies to address the problems being encountered all over Ireland.
“Access to services and staff remains the key challenge in what is a problem that is not unique to Ireland,” he said.
“The GP workforce deficit is down to a number of issues including but not limited to our growing population, the ageing GP workforce, and the fact that people are living longer with more complex care needs.
“We are improving our rate of training GPs, going from 193 in 2018, which was way below the 518 recommended to meet demand, to 350 last year so we are moving in the right direction.”
Professor Scully said the aim of the new graduate course at the University of Galway was to train doctors in rural medicine and to incentivise them through further training to remain in rural communities.
Professor Robert Scully, the first Established Prof of Rural and Remote Medicine, University of Galway.
Lack of GP cover
Although numbers are increasing, one speaker on a panel discussion pointed to a chronic lack of GP cover in rural Ireland.
Vicky Ward of Family Carers Ireland told of a woman in her village of Sixmilebridge in Co Clare who is forced to make a four-hour round trip, across the county border, every time she needs to see her doctor.
“This lady is in her 60s and spent four and a half months looking for a GP in Clare but none would take her as she is a medical card patient, despite two GP practices based in the village,” she said.
“She has chronic health issues including heart failure and diabetes and when she attended an out of hours GP service, the doctor on call refused to give her a prescription for her insulin, saying she would have to get it from her own GP.
“She is now registered with a practice in Co Limerick but this requires a four-hour round trip involving taxis, trains and buses and a journey that she simply isn’t able for.”
Increasing expectation
Martin Daly, Fianna Fáil TD for Roscommon Galway and a rural GP for over 30 years, said rural healthcare couldn’t be talked about in isolation as there were capacity issues throughout the healthcare system.
The former Irish Medical Organisation President said the work of a GP had become more complex.
“There is an increasing expectation from the general public as to what healthcare should deliver and the work of a GP has become a lot more complex through their management of chronic diseases such as cardiovascular, diabetes, stroke and asthma.
“This is all work that needs time and support through the necessary admin and nursing staff,” he said.
Vicky Ward said access to GPs was a big hurdle for family carers, who regularly put the health of their loved ones before their own needs.
“Every issue for the general public is compounded for carers and we find that the people caring for loved ones won’t seek medical attention themselves unless they absolutely have to,” she added.
“The simple act of attending a doctor’s appointment can require respite cover and that isn’t an option for many carers with a chronic shortage of respite care available.
“And yet it has been proven that family carers are saving the Government the same amount of money it takes to run the HSE each year.”
Former TD and retired GP Jerry Cowley told the conference that when he stepped down after 40 years serving the community in Mulranney, Co Mayo, it was impossible to fill the post.
“When I retired and my job was advertised, there was only one applicant who didn’t show up for the interview,” he said.
“Problems on the ground continue unabated in rural single-handed practices. Providing temporary locums is a sticking plaster solution put in place by the HSE to fill rural practice vacancies that no one else will fill permanently.
“In those areas where the GP practice is on the verge of closing because they are struggling with only one doctor, a second GP– funded by Government – needs to be put in place to ensure these essential services in rural Ireland can continue.”
A workshop held during the conference asked delegates to come up with solutions to the many challenges facing rural healthcare.
Challenges identified included transport issues, such as financial capacity to pay for transport and logistical issues in the lack of a Local Link or other public transport option in rural areas.
An increased population from overseas was also cited as putting pressure on existing healthcare services, with the age restriction on GPs over 66 not being allowed to treat medical card patients another difficulty raised.
In terms of solutions, a joint strategy between the HSE and the National Transport Authority was proposed to tackle the accessibility issue for patients attending appointments by public transport.
It was also suggested that consultant- led clinics be held in regional towns on a monthly basis, to limit the need for patients to travel into the main urban hospitals.
The expansion of existing mobile screening services was also proposed to extend GP care to more remote areas that are no longer served by a practice.
Telehealth consultations, where doctors treat their patients over the phone, were also mooted, with Dr Deirdre Forde, a GP and menopause specialist based in Athlone, advocating the approach which she says serves many of her patients very well.
“I am based in Athlone but I have patients coming to me from as far as Achill Island so I can deliver telemedicine over a platform that is GDPR compliant and erases the conversation instantly, protecting patient privacy and guaranteeing confidentiality,” she explained.
“I’m also a big advocate of educating people in their own health stats, their numbers. If they know what the right blood pressure rate is and have an idea of their own, if they know what their cholesterol is, then they’re informed and can give that information to healthcare professionals.”
Professor Scully agreed that telemedicine had a huge role to play in rural healthcare and said he had used it to great effect during his tenure as a rural GP in the Scottish Hebrides.
“Telemedicine should as a matter of course be offered alongside the option of an in-person consultation,” he added.
“A scheme is currently in place on Clare Island and Inishbofin where patients are being monitored remotely to save them the journey in to the mainland to attend hospital appointments, unless that is in their best interests.
“I also agree that bringing GPs to patients is a hugely efficient way to treat people and in more rural areas, a medical group setting can become a social occasion so certainly open clinics do merit consideration.”
The Irish College of General Practitioners is the representative body for education, training and standards in general practice.
Research carried out by ICGP, where population data has been matched with Medical Council data, shows that the GP workforce is not expanding fast enough to meet growing demand.
Medical Council Workforce reports from 2023 show a 3.1% increase in population, while the increase in GP number was only 0.6%.
The counties most affected by GP workforce not keeping pace with population increase include Clare, Laois, Leitrim, Kildare, Kilkenny, Meath and Monaghan.
ICGP has 4,500 members and associates comprising over 85% of practicing GPs in the Republic of Ireland and 1,191 GPs in training.
A targeted plan to address the chronic shortage of GPs in rural Ireland was outlined at a conference in Athlone last week, where Irish Rural Link hosted an event highlighting the challenges of rural healthcare.
Seamus Boland, chief executive of Irish Rural Link said healthcare in rural Ireland had become a major issue for elderly people in particular.
“We need to find solutions to these challenges by dealing with the problems facing rural Ireland when it comes to healthcare, which is a bit of a Cinderella when it comes to the overall health system,” he said.
Professor Robert Scully is the country’s first established professor of rural and remote medicine at University of Galway, which will introduce a four-year graduate entry medicine programme in September, with a strong focus on rural and regional healthcare needs.
He delivered the keynote address where he said the solutions to rural healthcare challenges were not to be found solely in health.
Professor Scully described rural healthcare as a ‘thorny and complex issue’ and said joined up thinking was required across a number of government and social agencies to address the problems being encountered all over Ireland.
“Access to services and staff remains the key challenge in what is a problem that is not unique to Ireland,” he said.
“The GP workforce deficit is down to a number of issues including but not limited to our growing population, the ageing GP workforce, and the fact that people are living longer with more complex care needs.
“We are improving our rate of training GPs, going from 193 in 2018, which was way below the 518 recommended to meet demand, to 350 last year so we are moving in the right direction.”
Professor Scully said the aim of the new graduate course at the University of Galway was to train doctors in rural medicine and to incentivise them through further training to remain in rural communities.
Professor Robert Scully, the first Established Prof of Rural and Remote Medicine, University of Galway.
Lack of GP cover
Although numbers are increasing, one speaker on a panel discussion pointed to a chronic lack of GP cover in rural Ireland.
Vicky Ward of Family Carers Ireland told of a woman in her village of Sixmilebridge in Co Clare who is forced to make a four-hour round trip, across the county border, every time she needs to see her doctor.
“This lady is in her 60s and spent four and a half months looking for a GP in Clare but none would take her as she is a medical card patient, despite two GP practices based in the village,” she said.
“She has chronic health issues including heart failure and diabetes and when she attended an out of hours GP service, the doctor on call refused to give her a prescription for her insulin, saying she would have to get it from her own GP.
“She is now registered with a practice in Co Limerick but this requires a four-hour round trip involving taxis, trains and buses and a journey that she simply isn’t able for.”
Increasing expectation
Martin Daly, Fianna Fáil TD for Roscommon Galway and a rural GP for over 30 years, said rural healthcare couldn’t be talked about in isolation as there were capacity issues throughout the healthcare system.
The former Irish Medical Organisation President said the work of a GP had become more complex.
“There is an increasing expectation from the general public as to what healthcare should deliver and the work of a GP has become a lot more complex through their management of chronic diseases such as cardiovascular, diabetes, stroke and asthma.
“This is all work that needs time and support through the necessary admin and nursing staff,” he said.
Vicky Ward said access to GPs was a big hurdle for family carers, who regularly put the health of their loved ones before their own needs.
“Every issue for the general public is compounded for carers and we find that the people caring for loved ones won’t seek medical attention themselves unless they absolutely have to,” she added.
“The simple act of attending a doctor’s appointment can require respite cover and that isn’t an option for many carers with a chronic shortage of respite care available.
“And yet it has been proven that family carers are saving the Government the same amount of money it takes to run the HSE each year.”
Former TD and retired GP Jerry Cowley told the conference that when he stepped down after 40 years serving the community in Mulranney, Co Mayo, it was impossible to fill the post.
“When I retired and my job was advertised, there was only one applicant who didn’t show up for the interview,” he said.
“Problems on the ground continue unabated in rural single-handed practices. Providing temporary locums is a sticking plaster solution put in place by the HSE to fill rural practice vacancies that no one else will fill permanently.
“In those areas where the GP practice is on the verge of closing because they are struggling with only one doctor, a second GP– funded by Government – needs to be put in place to ensure these essential services in rural Ireland can continue.”
A workshop held during the conference asked delegates to come up with solutions to the many challenges facing rural healthcare.
Challenges identified included transport issues, such as financial capacity to pay for transport and logistical issues in the lack of a Local Link or other public transport option in rural areas.
An increased population from overseas was also cited as putting pressure on existing healthcare services, with the age restriction on GPs over 66 not being allowed to treat medical card patients another difficulty raised.
In terms of solutions, a joint strategy between the HSE and the National Transport Authority was proposed to tackle the accessibility issue for patients attending appointments by public transport.
It was also suggested that consultant- led clinics be held in regional towns on a monthly basis, to limit the need for patients to travel into the main urban hospitals.
The expansion of existing mobile screening services was also proposed to extend GP care to more remote areas that are no longer served by a practice.
Telehealth consultations, where doctors treat their patients over the phone, were also mooted, with Dr Deirdre Forde, a GP and menopause specialist based in Athlone, advocating the approach which she says serves many of her patients very well.
“I am based in Athlone but I have patients coming to me from as far as Achill Island so I can deliver telemedicine over a platform that is GDPR compliant and erases the conversation instantly, protecting patient privacy and guaranteeing confidentiality,” she explained.
“I’m also a big advocate of educating people in their own health stats, their numbers. If they know what the right blood pressure rate is and have an idea of their own, if they know what their cholesterol is, then they’re informed and can give that information to healthcare professionals.”
Professor Scully agreed that telemedicine had a huge role to play in rural healthcare and said he had used it to great effect during his tenure as a rural GP in the Scottish Hebrides.
“Telemedicine should as a matter of course be offered alongside the option of an in-person consultation,” he added.
“A scheme is currently in place on Clare Island and Inishbofin where patients are being monitored remotely to save them the journey in to the mainland to attend hospital appointments, unless that is in their best interests.
“I also agree that bringing GPs to patients is a hugely efficient way to treat people and in more rural areas, a medical group setting can become a social occasion so certainly open clinics do merit consideration.”
The Irish College of General Practitioners is the representative body for education, training and standards in general practice.
Research carried out by ICGP, where population data has been matched with Medical Council data, shows that the GP workforce is not expanding fast enough to meet growing demand.
Medical Council Workforce reports from 2023 show a 3.1% increase in population, while the increase in GP number was only 0.6%.
The counties most affected by GP workforce not keeping pace with population increase include Clare, Laois, Leitrim, Kildare, Kilkenny, Meath and Monaghan.
ICGP has 4,500 members and associates comprising over 85% of practicing GPs in the Republic of Ireland and 1,191 GPs in training.
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