Niamh Cahill speaks to the CEO of the Irish College of GPs, Mr Fintan Foy, about recent developments at the College and the need for ‘consolidation’
Nothing stands still at the Irish College of GPs. In fact, in recent years, change has been a constant for the organisation.
Most recently, the College brought its three-decade tenure at Lincoln Place in Dublin 2 to a close with a move to more spacious premises at nearby Hogan Place.
“I’m sitting in my old office now and today is our last day here. We close the doors of the building today,” the College’s CEO Mr Fintan Foy told the Medical Independent (MI) in a recent interview.
The College was 40 years old in 2024. Staff now total around 180, with numbers having tripled in the past five years. It reflects the significant transformation the College has undergone during this period.
As well as the location move, the College has contended with increases in GP trainee numbers, the transfer of GP training from the HSE, and a major rebranding process.
Mr Foy recognises that for the College to ensure its ongoing commitment to members through education, training, and standards, it must constantly evolve and seek new ways to improve and support its 4,700 members.
Mr Foy joined as CEO in February 2017. Despite significant challenges – including the Covid-19 pandemic – he told this newspaper that his time at the College has been among his most fulfilling professional experiences.
“The last seven years have been the happiest of my career. It’s fascinating and challenging, but both the colleagues here and the GPs are a very nice group of people.”
Training
It has been nearly four years since the legal transfer of GP training from the HSE to the College began.
That process is now complete, according to Mr Foy, who added that the College enjoys a good relationship with the HSE, which continues to fund training.
“There are challenges around the location of some of the training, as in where the teaching is done and we’re working with the HSE to upgrade some of those facilities. With 350 [GP trainees] coming in now and last year, we’re making sure we have enough scheme directors, trainers, etc.”
There are currently close to 700 GP trainers and around 1,300 trainees in the programme.
A key area of focus is to accommodate the rising numbers of GP trainees. In 2024, the College increased the number of training places to 350, up from 285 places in 2023 and 258 places in 2022.
“We had an intake of 350 last year and we will have an intake of 350 this year. The big challenges for the College are to make sure we have the resources to deliver and maintain standards, both on the clinical side, on teaching, and on the non-clinical side, which is the administrative support and technical support,” he said.
“There will always be challenges in GP training – it is such a huge entity. But I think, from my perspective and from the board’s perspective, we are very happy with where it’s at [currently], other than having to make sure it’s properly resourced.
“We had 1,800 applications for training this year. There is a big demand. You would like to see that continuing for as long as possible. The whole process of getting from 1,800 to 350 is quite complex.”
Workforce
According to Mr Foy, approximately 14 per cent of the GP workforce are aged 65 and over.
The lack of GPs to provide care to communities in certain areas nationally, particularly in rural locations, has been a significant problem over the past decade.
Ensuring there are enough in every community and that GPs are encouraged to work in more isolated, remote areas has been a strain on the profession.
Offaly-based GP Dr Velma Harkins recognised the difficulty and helped to create the International Medical Graduates (IMG) Rural GP Programme to ease the burden on rural communities.
The two-year initiative was developed by the College to respond to significant difficulty maintaining resources in rural areas and to help boost the GP workforce in isolated regions. The first intake of doctors occurred in February 2023.
Doctors from South Africa, Canada, Sudan, Nigeria, the Middle East, and India are currently taking part in the programme under the supervision of established GPs.
Some 119 IMG GPs were in practice as of November 2024 and funding has been provided to recruit up to 250 more GPs to Ireland this year, according to the Department of Health.
Mr Foy explained that doctors were recruited “with the intention of placing GPs in rural Ireland”.
The candidates all trained as GPs in their home countries and undertake an immersion programme when they come to Ireland. They are observed, monitored, and provided with education and support. At the end of the process, they sit the MICGP exam. If they pass, they can enter the specialist register of the Medical Council and take up a GMS list.
“We’re beginning to see people coming out the other end and thankfully they are staying in the community. But I suppose it will be another five or six years before we can say if that’s been a success.” However, he stressed the initial indications are positive.
The College is seeking solutions to support older GPs to “reduce their clinical commitment, but not cease their clinical commitment”, he added.
Mr Foy said it is hoped the IMG programme will allow GPs in rural areas to get locum cover and to take holidays.
“You would hope that would enable people to stay in practice for longer periods of time. But it will take a while before we see the real output of that.
“Between the IMG programme and the increase in GP training numbers, you’d hope by maybe 2030 to 2032 we will be close to having enough GPs to replace those who are retiring,” Mr Foy stated.
The trend toward more varied career paths and flexible schedules is reshaping the structure of general practice.
“While it has an impact on capacity, I think flexible working may keep a greater number of GPs in practice over a longer period of time and maybe prevent them from leaving altogether,” Mr Foy said.
“I think it’s great we have GPs who have an interest in research, teaching, and so on. It’s the reality now and it’s something we have to work within to ensure we have a sufficient number of GPs in practice to look after patients. That whole area of workforce planning is very important.”
Ensuring there are enough GPs in Ireland means that retention must be closely monitored, he warned.
“When trainees come out of their four years, are they going into clinical practice and are they staying in clinical practice?”
Answering these questions requires effective workforce planning – an area closely monitored by the College’s research and policy unit.
“There are mechanisms in place to see GP activity, identify areas or regions with poor GP cover… particularly in rural Ireland.”
Mr Foy pointed out the College is in regular contact with the HSE and National Doctors Training and Planning on these issues. “From our research, the issue of emigration is not that significant…. It’s part of your right as an intern to go away for two or three years to Australia or New Zealand… but a big percentage of doctors are coming back. In our case they’re coming into general practice or going into other specialties.”
He added that general practice is still viewed as an “attractive career” despite the issues facing the sector.
Burnout
Burnout is one of these, according to Mr Foy. General practice has changed immensely over the last decade. The introduction of the structured chronic disease management programme has been a positive initiative, he added. However, the increasing medical complexity associated with caring for an aging population means that GPs are under growing pressures.
“The population has gone up. GPs are seeing sicker people. There is a positive to that. But it is more stressful and more demanding on their time. So from a members’ perspective, I think that’s something we have an obligation to support them on,” he maintained.
“If someone wants to work in clinical practice for three days and wants to then do other things, I think that helps to reduce burnout and stress levels.”
However, Mr Foy said burnout is still a significant concern. The College is actively working to address the issue through initiatives such as a monthly wellbeing webinar.
“I think if we were to focus on anything as a College over the next 12 to 18 months, I think it is supporting GPs in that context.”
Overseas work
The Malaysia Ireland Training Programme in Family Medicine or MINT FM, as it is known within the College, began around six years ago.
“All our overseas activity is focussed on Malaysia now,” Mr Foy outlined.
He said the College had a programme on maternal and child health in Dubai, which “ended during Covid”, with the pandemic severely impacting overseas work.
MINT FM is a four-year training programme based on the Irish GP training model. It is delivered in Malaysia by the College in partnership with the RCSI and University College Dublin. Online medical education company iHeed provides the e-learning platform.
“That started in October 2019 with 32 trainees and by July this year we’ll have over 500 trainees in the programme,” Mr Foy revealed.
Dr Paula Greally, an Irish GP originally from Galway, has recently been appointed as the new Clinical Director of the programme.
“It’s been a real success… there’s a great benefit of mutual learning and hopefully in time there will be research from both sides. It’s still in its early stages.
“From a Malaysian perspective, it’s been successful because we’re producing family medicine specialists… it’s been very successful and is recognition of the quality of the Irish training programme.”
Ongoing education
Continuing medical education (CME) and small group learning (SGL) are the “bedrock of general practice”, Mr Foy said.
However, both areas have suffered from deficits in funding. For several years SGL has struggled to expand due to a lack of additional resources, Mr Foy admitted.
There are many parts of the country in which newly established GPs are unable to access SGL.
The groups provide GPs with access to a collegial meeting and educational platform. New GP updates are delivered within small groups. But they also serve as a monthly coming together of GPs where support and advice can be received from colleagues.
“We’ve received no increase in funding from the HSE for CME in a long, long time, but yet the GP population is increasing,” Mr Foy explained.
“The College is offsetting some of those funding deficits, but we do have an issue around GPs when they come out of training not being able to access CME groups.”
He said the College and its Director of CME Dr Illona Duffy are constantly exploring ways of best facilitating and supporting CME.
“CME… provides an invaluable resource to general practice and I think it’s very important for the retention of GPs, having that support network and mechanism. But it’s an area we haven’t seen any increase in funding for a long time and it is one of our key focuses of attention in 2025 and 2026.”
He said Covid-19 badly affected CME as GPs could not meet in person.
“I think Illona has done a wonderful job in getting it back up to where it was. But there is a big demand for it.”
Separately, work is ongoing in modernising the e-portfolio platform through which GPs can meet their professional competence requirements. The new update aims to make it easier for GPs to monitor and upload their activity.
“A lot of work has been going on in the background to modernise the e-portfolio. A new e-portfolio will be launched in mid-May and that’s to make it easier for GPs to access and upload data. It has a more modern interface. That whole area is significant and important for the College and there’s been significant investment in IT and support,” Mr Foy said.
Work is also underway within the College’s Network of Establishing GPs to turn the Signposts to Success handbook into an online resource.
Future
Alongside the development of its new website, the College recently underwent a name change. This was the third rebranding in its 40-year history. According to Mr Foy, it was undertaken because the Irish College of General Practitioners, or ICGP, “was quite a mouthful and the public didn’t identify with it either”.
“Those who advised us felt the Irish College of GPs was catchier and easier to identify with. Our website has rebranded and when we move into our new building that will reflect that we are the Irish College of GPs.”
Following all these developments, Mr Foy believes now is the time for “consolidation”.
“You get to a point where you have to consolidate,” he said.
“So much has happened in the last three or four years with the transfer of training and last year we had WONCA Europe, which was a huge effort to manage, but was very successful. We’ve increased the number of trainees and we’re moving to a new building now, so certainly the second half of this year will be consolidation, making sure we have the resources in the right place to deliver what needs to be delivered.
“I think there will be a greater focus on membership services and what we can deliver for the members and the new building is part of that. But we’ll also need to invest in education and modernise certain aspects of what we deliver for members.
“We have a great team here and people work very hard. But people can only work so hard – you have to be careful not to keep pushing people and ensure that what we deliver is of the highest quality. Sometimes you need to slow down a little bit to make sure we can do that.”
The 32 faculties within the College are currently being reviewed and structural recommendations will be made, it is hoped, by the end of the year.
The current College strategy runs until 2026, and work will begin next year on its successor document. While change is important, Mr Foy also says there are elements of the College that should be preserved.
“There’s a lovely collegial atmosphere and it’s important that we never lose that.”
Leave a Reply
You must be logged in to post a comment.