34th Annual Conference of Rural, Island and Dispensing Doctors

Female GPs’ careers ‘flatlining’, conference hears

Many female GPs find their career progression “flatlining” and general practice must do more to highlight and advance the professional and personal benefits of partnerships, the ICGP President told the 34th Annual Conference of Rural, Island and Dispensing Doctors in Athlone on 5 October.

Dr Mary Favier said female GPs often work as GP associates and assistants in their 30s, particularly with childcare in mind and enter their 40s “to find they are still stuck where they were 10 years ago”.

The Cork GP said she had gone to the recent GP trainees conference “with a narrative very much ringing in my ears that I believed myself, ‘they are not interested [in becoming partners], they don’t want to do it, they are just different’.

“I couldn’t quite understand why they were different from me, but what I came away with is, and there were 35 of them in the workshop … we have actually let them down somewhat in their training, in how we have made them understand general practice.

“They don’t get what it is to be a GMS doctor, they don’t truly get what it is to be a partner, they don’t understand the financial differentials, they don’t understand that you can actually hire much better childcare [arrangements] if you earn €30,000 or €40,000 more a year and you are not up against the clock on the creche…”

She said young women had “never been normed into self-employment”.

“Society doesn’t teach them about entrepreneurship, we teach our boys that: They are the very issues we need to now go back to and address with our trainees…and this probably applies to some of the young male trainees as well, they are just not taught this stuff.”

Established GPs were doing themselves no favours in terms of retention and succession, by “always going on about the paperwork, we are always whinging about something”.

Other than referral letters, there “should really be no other piece of paperwork you are doing that doesn’t earn an income”.

“And these are the messages we are not sending out to those young GPs,” said Dr Favier.

“Similarly what they don’t understand is…for those of us in good partnerships, partnerships become like family, partnerships are about cutting each other slack and so that your childcare arrangements are actually easier, the sick child is easier when you are in that ‘family’ and they don’t understand those benefits and it is our responsibility to tell them.”

This will be “an important piece of work” for the College and the IMO, she said.

The rural doctors’ conference, chaired by Mulranny GP Dr Jerry Cowley, included an eclectic range of presentations on clinical and medical political issues, attracting GPs from across the country.

‘Pop-up’ clinics undermining general practice standards – Harty

‘Pop-up’ GP clinics have emerged in parts of the country “creaming the easy consultations” and not operating to “the professional standards we would normally apply to our general practice”, Dr Michael Harty TD told the annual conference of Rural, Island and Dispensing Doctors.

“That has a detrimental effect, not only on the GPs, but on the out-of-hours services as well,” he told delegates in Athlone.

“And now we have corporate entities who are filling the vacuum in general practice, and you may have your view on corporate entities and it certainly is an exit strategy that many GPs are quite happy to take up as it gives them an opportunity to exit general practice in an orderly fashion. But one would have to wonder, is a corporate entity structure increasingly evident in Irish general practice best for general practice and best for the patients?”

Dr Harty said the FEMPI cuts “tore the heart” from general practice, but “some sustainability” was returning due to the IMO’s deal with the Government.

He said around 60 per cent of practices are not taking on new patients in a bid to manage workload.

Dr Harty said there is a “committed workforce” in the specialty, “but they have to be given the supports”.

The conference also heard from IMO President and Longford GP Dr Padraig McGarry, who revealed that just 10 GMS GP contract holders are under 30 and 78 under 35, while 671 are over 70-years-of-age.

Speaking to the Medical Independent, Dr Harty warned of some ‘pop-up’ medical services charging significantly below usual GP rates and “hoovering up the easy bits of general practice… but if you go in depressed or your asthma is out of control, there is no continuity of care, they have no access to your notes.

“The HSE don’t seem to be policing them. My understanding is if you are portraying yourself as a GP you need to be on the specialist register.”

Moves to end STC payments to co-op GPs

There have been moves by the HSE to cease payment of special type consultation (STC) fees to GPs in out-of-hours cooperatives, the Chair of the National Association of GP Co-operatives informed delegates at the annual conference of Rural, Island and Dispensing GPs in Athlone.

Dr Ken Egan said that in Westdoc “we don’t allow the co-op take our STCs, we insist the STCs go to us, the doctors who do the work, so that is a big difference in what is going on – I am just telling you that to draw it to your attention.

“There is a general move to get rid of paying for STCs, there has been a review of co-ops done, people came over from England…they were recommending that there would be no STCs, but that there would probably be an hourly payment and I for one seriously objected to that and told them there’d be a collapse of the co-ops if we went to an hourly rate, because the STCs encourage people to come in and do some work… [it is] brimming around and hopefully it won’t happen.”

Dr Egan said co-ops receive about €12 million in STC monies.

The Ballindine GP also drew attention to changes in visa rules, which have added to difficulties recruiting doctors to ‘red-eye’ shifts.

“I personally feel we have to stop paying for the red-eye,” added Dr Egan.

Also speaking at the conference, Chair of the IMO GP committee and Stranorlar GP Dr Denis McCauley said: “When there are different rotas getting a red-eye subsidy and there are others that are not, that is wrong.”

35 people accessing bionic rehab suit in Donegal

Thirty-five people in the Donegal area are accessing a medical rehabilitation exoskeleton acquired by the local No Barriers Foundation, heard the 34th Annual Conference of Rural, Island and Dispensing Doctors .

Clonmany GP Dr Frank Fogarty, medical adviser to the Foundation, told the conference the initiative was the brainchild of physiotherapist Mr Johnny Loughrey. The exoskeleton was acquired last year at a cost of €160,000 with €40,000 raised by community events and the remainder through State and European grants.

“Our aim is to try and get specialist neuro-rehabilitative equipment available in the communities. I work in Donegal, it is not Dublin 4, we are in a very isolated area and our aim is that basically these sort of cutting-edge technologies should be available for everybody.

“We have 35 people at the moment actively walking in our suit every week – and that is 35 people with spinal injuries, strokes, MS…Our vision is to see the possibilities and not the problems and also to see the person and not the wheelchair.”

The HSE has not yet adopted the technology, delegates heard.

“I think it will change, but it will only change from the bottom up…,” commented Dr Fogarty.

The No Barriers Foundation, which is not-for-profit, has employed a full-time neuro-physio and personal assistant. Suitable candidates pay a physio fee of €60 per session.

According to the Foundation, studies have provided preliminary evidence on the efficacy of exoskeletons on cardiovascular health, energy expenditure, body composition, gait parameters, level of physical activity, and quality-of-life.

Mr Gerry McCabe demonstrated the exoskeleton at the conference.