Rural areas hit worst by crisis as overrun GPs turn away new patients
Almost half of the country’s GP practices are operating at maximum capacity and cannot take on new patients, a Sunday Independent investigation has found.
Enquiries by this newspaper to doctor surgeries across the country show 44pc of those surveyed are unable to see new patients. A smaller number (42pc) said their doors are open for new patients to join their practice.
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The remaining practices did not know if they could take on a new patient or said they would have to consider an application before making a decision on registering a person seeking medical care.
Experts have warned these constraints negatively impact how doctors are able to treat current patients. It also makes it harder for those without a GP to seek help when they fall ill.
The Economic and Social Research Institute (ESRI) warned that the lack of availability has an impact on patient care, leading to congested waiting rooms in surgeries and backlogs in hospital emergency rooms.
“Where GP supply is low, patients may not receive the care quickly or from their regular doctor,” ESRI researcher Brendan Walsh told the Sunday Independent.
“If patients cannot join a GP list locally, they may be forced to travel long distances for care, or use the Emergency Department to receive care.”
Rural areas in the east and south west of the country, and Dublin’s commuter belt, are worst hit by the GP shortage.
Patients’ and doctors’ groups said findings of the investigation show the stark reality greeting patients in waiting rooms across the country. They said it shows the expansion of free GP care to children and the elderly in recent years is increasing the pressure on doctors and making the profession less attractive for new entrants.
They added that with 700 GPs expected to retire in the coming years, coupled with the expansion of the free GP care from children under-six to children under-12 in the next three years, the crisis is set to worsen in the immediate future.
Over the past month, the Sunday Independent contacted 336 GP practices, approximately one third of surgeries nationwide, to gauge the number which have shut their doors to new patients. Each practice was asked if they are taking on new patients, with 148 responding “no”.
When practices which were unsure of their availability are excluded, more than half (51pc) of practices were not open to seeing new patients.
Dublin’s commuter belt (counties Laois, Louth, Kildare, Meath and Wicklow) has the fewest available GPs, with 56pc of practices there unable to take on a new patient. Half of the doctors in Dublin’s suburbs and commuter towns cannot take on a new patient.
Leinster and Munster also showed poor availability.
When Dublin is excluded from Leinster, fewer than a third of doctors (32pc) there confirmed they have space for new patients.
According to our survey, no doctors contacted in Co Laois can take on new patients. In counties Carlow and Longford, 80pc of surgeries responded “no” when asked if they were taking on new patients. In Kilkenny, 75pc of surgeries said they are full, with the remaining practices surveyed asking to assess prospective patients before registering them. More than half of GP surgeries in Tipperary (54pc), Kerry (53pc) and Limerick (52pc) cannot see extra patients.
The Irish College of General Practitioners (ICGP), the professional body for general practice, said a “perfect storm” is brewing that will force families to attend overcrowded emergency rooms or travel greater distances to see a doctor.
ICGP spokesman Dr Liam Twomey, a GP in Wexford, said doctors are under increasing time constraints when seeing patients: “GPs have noticed an increasing trend of patients attending out-of-hours services in evenings and weekends to be seen by a GP, and it means that some have to attend overcrowded A&E services in local hospitals when they cannot access a local GP.
“We are entering the perfect storm: a growing population with fewer doctors, against a background of greater complexity of care, greater demand, and a Government policy to expand free GP care despite the lack of doctors to meet growing demand.”
The ICGP called for a doubling of the investment in primary care and an increase in the number of GPs being trained every year.
Irish Patients’ Association director Stephen McMahon said this pressure impacts those already registered with a doctor, as well as prospective patients. A shortage of doctors threatens how thousands of people will have access to a GP in future for routine appointments and procedures.
Responding to the investigation, Health Minister Simon Harris said a programme of investment and reform is under way to address the GP crisis, referencing a new €210m agreement with the Irish Medical Organisation to ensure the sustainability of general practice. The agreement includes proposals to extend free GP care to children aged between six and 12 on a phased basis, starting next year.
“The agreement will also allow for additional measures for GPs in rural areas and in areas of urban deprivation. We are now providing a significant number of GP training places. I have no doubt that these new measures and this new funding will help ensure young people continue to enter the profession,” he said.
Fianna Fail health spokesperson Stephen Donnelly said “years of failed Government policy” was contributing to the shortage.
Recent research by Trinity College shows the introduction of free GP care to under-sixes four years ago led to a 28pc increase in practice visits by that age group.
“This is a crisis,” Mr Donnelly said. “Doctors have been treated with contempt since Fine Gael came into power. It is about time there was meaningful engagement with GPs.
“There are ways to address this. They need to start with accelerating the reversal of FEMPI [Financial Emergency Measures in the Public Interest] cuts, get more practice nurses in surgeries to relieve the pressure GPs are under and give them access to proper diagnostics and facilities.”
More than half of the GPs in 14 counties are already operating at maximum capacity. In just one county, Leitrim – which has the fewest number of surgeries and smallest population – did all the GPs surveyed say they had capacity to take on more patients.
In Connacht, one third (33pc) of practices surveyed said their books are closed for new registrations. More than half (52pc) can take on a patient. Sligo fared worse here with two thirds of practices surveyed (67pc) saying they were full.
In Ulster, 52pc of doctors have the ability to take on additional patients. Just 30pc said they are full.
Nationally, 8pc of doctors said they would like to assess a patient’s healthcare needs before agreeing to register the person with their practice. Another 6pc of practices did not know if they were able to take on more patients.
We make 350 phone calls to get national picture on healthcare
The Sunday Independent made more than 350 phone calls to GP practices over the past month to shed light on the availability of doctors in every community across the country. Our aim was to demonstrate what issues patients encounter when trying to access medical care.
Each practice was asked: “Are you taking on new patients?” In some cases we were met with a straight response. When we were told “no” there would often be an apology.
Sometimes, another practice would be suggested by the person answering the call. When we heard “yes” this would be followed by some chat about opening hours and how to register before our reporter resisted disclosing personal details and politely brought the conversation to an end.
In other instances the practice sought personal details. “Is it for yourself? Who am I speaking to? Where are you living? Are you a private patient or medical card holder?”
To deal with such questions it was necessary to exchange information.
Our undercover journalist posed as somebody who was new to the area. He was a prospective private patient looking to register with a local GP practice.
This element of subterfuge was justified as the only accurate way of verifying the response a member of the public would receive. The investigation was carried out in a manner similar to a secret-shopper survey.
Not every call to a practice was successful. In some cases the doctor was away, out on call or nobody was available. However, on 336 occasions a Sunday Independent journalist spoke to somebody and posed the question.
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