Ensuring the strength and viability of general practice   

Chair of the IMO GP committee Prof Tadhg Crowley explains why, without reform, general practice will struggle to meet the needs of a growing and ageing population

General practice is the foundation stone of the Irish health service, the vital first point of contact for patients of all ages and backgrounds. In 2025, the IMO, building on the achievements of the 2019 and 2023 GP agreements, continued to advocate strongly for the sustainability and future of this essential service.

However, the challenges facing the specialty remain acute. Critically low GP numbers, rising patient demand led by demographic change, and increased transfer of unresourced work from the secondary care system, threaten to undermine access to, and continuity of, GP care for patients in communities across the country.

The IMO has consistently warned that, without fundamental reform and sustained investment, general practice will struggle to meet the growing and ageing population’s needs. That warning became even more urgent this year.

A system under strain

In June 2025, the Economic and Social Research Institute (ESRI) published its health service capacity review examining future GP service requirements. Demand for GP consultations is projected to increase by up to 30 per cent by 2040. To meet this need, the ESRI estimates Ireland will need an additional 943 to 1,211 GPs, representing a 24 to 31 per cent increase in the current workforce of approximately 3,900.

However, incentives to encourage young GPs to take up GMS lists and existing GPs to expand are sorely lacking within the system.

As we noted in our press release responding to the report: “We have a severe lack of younger GPs and those who do enter the specialty are hampered by a range of factors – in particular, the costs associated with setting up and running a practice.”

Increasing GP training places is a positive development; however, without parallel investment in practice supports – in particular, premises and staffing – newly qualified GPs will be deterred from taking on GMS contracts and establishing new practices.  

GP roadshows

A recurring theme of the 17 IMO GP meetings held around the country in 2025 was the transfer of unresourced work from secondary care into the community. This must stop.

The IMO position is clear: General practice requires specific resources to deliver the community-based care and ‘shift to the left’ that is repeatedly promised in health policy documents.

E-health

Another feature of the IMO GP roadshow meetings was the e-health agenda. GPs have been at the forefront of adopting new technologies and have invested significant resources in practice management systems and digital patient records. The IMO welcomes the new e-health developments and indeed many of these were set out in the 2019 GP agreement.

However, while the e-health agenda brings opportunities, it also brings significant risks. At the 2025 AGM, members carried motions reaffirming that all new e-health developments must be designed in consultation with GPs through the IMO and not reduce patient-facing time. Digital transformation in health will only succeed if it enhances rather than detracts from the clinical relationship at the heart of general practice.

Clinical programmes

From a new services perspective, the IMO has been clear in our public statements, including our Budget submission, that the expansion of chronic disease management and a comprehensive women’s health programme in general practice, as committed to in the Programme for Government, are good medicine and good policy. Adequately resourced, such programmes could mark a sea change for services to patients in general practice. 

The path ahead

The strategic review of general practice has been mooted for some time now and we expect and demand that 2026 is the year that this is published.

The State must then engage with the IMO on delivering the much-needed reform that will help power general practice in the years ahead. If we are truly to achieve the goal of reforming our public health system, then it is clear that Ireland’s healthcare future rests on its ability to strengthen general practice. However, without genuine partnership and adequate investment, Ireland risks widening rather than closing existing health inequities.

The IMO’s commitment is to the independent contractor model, which has served general practice well. GPs working together in partnership deliver the best possible care for the patients in their communities.

We see a need for an assistant GP grant, which existing practices could utilise, with the caveat that the assistant GP must be offered a full partnership within a three-year time frame. In the event that no partnership is formed, then the grant would be repayable in full to the State. Such a system would help encourage partnerships and practice expansion, as well as bringing younger GPs into the GMS system.

In tandem with this, tax incentives for investment in existing GP infrastructure and new builds are needed.

Last year underscored that Ireland’s GP workforce crisis remains unresolved. The IMO continues to engage constructively with policymakers, but stresses that incremental measures are insufficient.

Comprehensive reform is needed to ensure general practice can fulfil its potential as the hub of accessible, community-based healthcare.

This includes:

▶ Workforce expansion through sustained increases in training and retention supports.

▶ Fair contractual reform that recognises workload intensity, increased patient demand, and rising operational costs.

▶ Funding for additional GPs to establish and join existing practices.

▶ Capital investment in premises, digital infrastructure, and rural sustainability.

▶ Expansion of chronic disease and a dedicated comprehensive women’s health programme in general practice, with appropriate reimbursement.

These priorities are essential both for the specialty and for patients, whose access to timely, local care depends on a strong GP system.