The ‘invaluable contribution’ of community medical doctors

Chair of the IMO public and community health committee Dr Íde Nic Dhonncha outlines the ongoing challenges facing community health medicine

Community health medicine remained central to the Irish healthcare agenda throughout 2025. The IMO committee worked on a number of issues during the year.

Our members worked tirelessly in delivering vaccination programmes, including the delivery of the HPV catch-up programmes. This vital lifesaving work is often overlooked, focusing as it does on prevention rather than cure, yet it has a great impact on improving health outcomes. It is my hope for 2026 that the work of community medical doctors (CMDs) will be recognised for the invaluable contribution they make to the nation’s health.

In addition to the work above, in many instances around the country, the second-tier child health clinics – as part of the National Healthy Childhood programme, delivered by CMDs – are the first port of call for children with developmental and sometimes complex needs.

These children are seen in a timely fashion and, nationally, we see 24,000 new referrals of children between 0–6 years annually. The CMD is often the first clinician to assess and manage these children whilst they are on waiting lists for therapies, children’s disability network appointments, and assessment of need.

SMO/SAMO/PMO pay claim

The IMO has lodged a pay claim of 15 per cent under the ‘local bargaining’ clause in the Public Service Pay Agreement for these pay grades. They have been underpaid relative to other medical posts for some time, and the non-implementation of a 2008 pay award due to the financial emergency meant that this loss of relativity has never been addressed.

It is high time now that the State recognised the contribution of CMDs for what it is and ensured the sustainability of the grades and the service.

Despite their wide-ranging responsibilities and contributions, both CMDs and public health senior medical officers (SMOs) remain relatively poorly remunerated compared with other doctors delivering community-based care (for example, community ophthalmic physician roles, and GPs).

We have seen a trend in recent years of SMO positions being seen as short-term positions and retention of doctors has become a real problem. In order to address this, it is vital that terms and conditions improve.

Role of the SMO paper

The committee believes that there are a number of issues which must be addressed in relation to the role of the SMO. One of these is salary and it is hoped that the pay claim will go some way to addressing this.

However, there are also wider issues with regard to career progression, training, and the future of the role.

With this in mind, the committee is working on a paper across both public and community health with a view to highlighting the breadth and depth of work being done by SMOs all around the country.

The paper will also note areas where there could be future development, subject to the necessary resources being provided and agreement with the IMO.

It is clear that there are many issues facing community health medicine and I look forward to working with my colleagues in the year ahead to help deliver real improvements for the specialty.