Challenging times for community medical doctors

Irish Medical Organisation, Annual General Meeting, The Europe Hotel and Resort, Killarney, Co Kerry, 24-26 April 2025

Chair of the IMO public and community health committee Dr Íde Nic Dhonncha describes the key pressures on community medicine and what is needed to move forward

2024 was a challenging year for me and my colleagues working in community medicine. While we had hoped to develop and improve our services, we instead had to deal with uncertainty surrounding recruitment and the impact of the changing structures of the HSE. If we are not able to address these issues, then it will become increasingly difficult to maintain the level of service we currently provide (ie, child developmental assessment, school immunisation programmes, disabled drivers scheme, etc).

Pay and Numbers Strategy

At the start of 2024, we had hoped that the long-promised HSE Pay and Numbers Strategy would provide clarity and allow for the much-needed recruitment into community medicine services around the country. However, as it transpired, the strategy shut the door on recruitment and only served to crystalise  existing vacancies. This high vacancy rate in community medical doctors (CMDs) has featured high on the priority list of issues that the IMO community and public health committee has sought to address. Trying to deliver community medical services to patients with fewer doctors on the ground is also something I have grappled with in my day-to-day work as a principal medical officer (PMO). There were approximately 30 funded posts suppressed by virtue of the recruitment freeze and subsequent pay and numbers process – the loss of these posts constituting about 20 per cent of the core whole-time equivalents for CMDs nationally.

HSE structures

The move to the regional health areas and the resultant change in management structures is intended to allow for greater autonomy in decision-making at local level. As a PMO with clinical and operational responsibility for a team of senior medical officers (SMOs), I welcome this local focus. However, clarity around where community medicine will fit into this structure is lacking. As a group, we have specific concerns around not being represented on the Regional Executive Officer leadership team, which is vital to ensure that we can advocate for our services and the patients we serve. There are also concerns around having multiple unclear reporting lines, which have not been addressed in a satisfactory manner to date. There has been some recent engagement on this issue. However, with each passing deadline for implementation, the need to receive clarity on the matter becomes more urgent.

Future

The longstanding pay disparity between area medical officers and other CMDs was finally brought to a successful conclusion in 2023. The focus of the committee then switched to advocating to address the terms and conditions of SMOs with the objective of improving recruitment and retention by making the profession more attractive. The Pay and Numbers Strategy has made this task even more challenging but, as a committee, we are still pushing to improve terms and conditions for CMD members.

Ultimately, there is potential for a bright future for the CMDs if issues outlined above are addressed. Now more than ever, our expertise in preventive child health is essential, as is the care we provide to children and their families, all while maintaining excellence across other service areas. However, to attract doctors into the discipline, existing disparities in terms and conditions for SMOs and PMOs in comparison with similar grades (such as GPs and community ophthalmic physicians, for example) must be addressed. Additionally, a clear reporting structure, which enables community health to have a strong voice in children’s services, is paramount. This would allow CMDs to use their considerable expertise to influence decision-making in the interests of children and their families.