More training places key to GPs shortage

Doctors in counties like Meath are struggling to cope with three times more patients than their European counterparts, on average, and twice as many as their colleagues in the west of Ireland - and the result has been serious pressure on patient lists in many local surgeries. This county already suffers from a serious shortage of GPs that is getting more acute with each passing year, and some rural areas may be left without a vital doctor service in years to come, putting elderly and vulnerable patients at risk, unless action is taken by the health authorities. As this newspaper reported last week, the situation in Meath has deteriorated even further this year and the Health Service Executive (HSE) is having considerable difficulty filling posts, especially in rural areas of the county. Oldcastle is the latest local town where the problem has manifested itself as the HSE attempts to fill a third GP post in the town. Several other local centres have seen similar difficulties in recent years, including Slane. The problem is a multi-faceted one. Rapid population growth - such as has been experienced in Meath - and greater life expectancy are generating heavier demands on the existing GP service. Best international practice suggests there should be about one GP for every 1,500 of the population but, in Meath, the figure is closer to one GP for every 2,880 of the population, way above the EU average. A large number of Meath"s 60 GPs are also coming close to retirement age. Indeed, around 40 per cent of the Irish GP population is due to retire within the next five to 10 years, it is reckoned. Now, some patients are being turned away as GPs close their patient lists and are having to travel long distances to other towns in order to avail of a service. Most GPs are agreed that the key to counteracting Ireland"s growing shortage of community doctors is increasing the number of training places available. However, the HSE has been accused of not providing the funding needed for a badly needed expansion of the number of trainee GPs from 121 to 150, despite a pledge to do so. According to the Irish College of General Practitioners (ICGP), the Buttimer Report recommended that there be 150 training places available by this year, but the college reckons that even 150 places is not enough to stave off a significant shortfall which the ICGP estimates will be 551 GPs by 2015. However, hundreds of doctors who want to become GPs - as many as 500 are believed to have applied for training places annually in recent years - are being denied the chance, and patients in places like Meath are ultimately suffering as they cannot get access to a doctor. The UK, which is having similar difficulties in tackling a GP shortage, has now closed its training programmes to international students, so some Irish doctors who want to become GPs are opting to emigrate to places like Australia to get their job of choice, and are unlikely to return in the short-term. This is a serious issue that impacts on all strata of the community and one that demands attention from both the HSE and the Dept of Health. While much attention has been focused on the crisis in our A&E units and hospital waiting lists in recent times, this question has been neglected for far too long. The sick and elderly in our society depend on an efficient and effective primary care service, which under-pressure GPs are providing as best they can at the present time, but the stresses are already appearing in the system and now is the time to fix them before patients" safety is compromised. As more GPs retire and the population continues to grow, this is an issue that can only get worse. A co-ordinated strategy now needs to be put in place to identify how many new GPs are needed countrywide over the next two decades and where they are required. Additionally, funding must be found to create sufficient trainee GP places as is deemed necessary to avert this looming crisis which is likely to see more rural areas, in particular, lose their local doctor within the next decade.