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Christmas is a time for giving and receiving. A time to be kinder, more open-hearted, caring, and compassionate. I guess this is why I almost said “yes” to a family that came to the surgery, one week before Christmas, asking if they could join the practice as their GP was retiring. I had said “no” to similar requests throughout the year. My rationale was clear and I usually had no trouble explaining it. “We simply cannot fit any more into our day. We have been trying to recruit another doctor to help us out, but have not been successful. We will put your name on a list and contact you if we do get another doctor.” Perfectly reasonable and understandable, but as they left I felt a sense of sadness. The words of Truman Capote came to mind. “It’s bad enough in life to do without something YOU want; but confound it, what gets my goat is not being able to give somebody something you want THEM to have.” I felt mean and poor and powerless. More Scrooge than Santa. Giving feels good and not having anything to give feels bad, especially as it was the season of goodwill.
Many people did not receive GP care this Christmas. This is because there are not enough GPs in the country to meet the demand. Those who retire, immigrate, or transfer to other specialties are not being replaced. There is a crisis in general practice and no one but the GPs seem to understand this, despite the fact that it has been stated repeatedly on every media platform since the beginning of the FEMPI cuts more than six years ago.
Most of my GP colleagues are working more hours than ever and still not keeping pace with the increasing demands of the job. Appointments are fully booked days in advance. Emergencies are accommodated as quickly as possible and provided with immediate care only. Non-urgent referral letters and reports are taking up to two weeks to complete, with most of these being done at weekends, squeezed in between family and leisure commitments. Practice meetings and revision of clinical and management protocols have been put on hold, unless absolutely necessary, as was the case with the Meningitis B vaccination protocol in December. Meanwhile, fixtures and fittings need replacing. Autoclaves, blood pressure monitors, and computer hardware, needs to be upgraded. Patients are living longer, developing more complex medical conditions, have increasing expectations of their doctor and hospitals are continuously transferring workload to general practice. With no funds and no workforce the challenge of running a practice far exceeds the means.
Recently, 800 GMS patients in a neighbouring town received letters from the HSE to say that their doctor was retiring, with an enclosed “Change of Doctor” form and a list of eligible doctors in the locality. The GMS list had been advertised previously, but had no applicants. The doctors in the town have stated that they cannot accommodate an additional 800 patients. Fifteen or 20 years ago, there would have been serious competition for this GMS list. Today, no doctor is willing to take it on.
What is wrong with the younger GPs, people ask. Why are they not queuing up for such an opportunity? Do they not have an obligation to pay back in service, what they received in education? Would this not go some way towards solving the crisis? There is nothing wrong with younger GPs. But there is a lot wrong with the state of Irish general practice. In general, GMS lists come without a premises and Ireland does not have a cost-rent scheme, which would allow a GP to invest in one and rent to the HSE, based on the number of GMS patients, as is the case in the UK. There are no start-up grants for the technology or equipment required to furnish a new practice. Staff costs will be partially funded, but the GP, as employer, will be responsible for their management, employer PRSI, and redundancy packages. Holiday, study, and sick leave are not guaranteed. Meanwhile, clinical standards need to be upheld, requiring up-to-date health and safety statements, clinical waste management protocols, vaccine storage and delivery protocols, repeat prescribing protocols etc, etc.
General practice is in crisis and no one is listening. The medical papers are full of advertisements for GP principals and assistants and no one is applying for them. Nero continues fiddling and Rome burns. This is no country for young GPs. I feel sorry for people who did not have the services of a GP this Christmas, but I also feel sad for GPs like myself, who know the value of personal care, but cannot offer it to those in need without compromising both our own health and the health of those we already care for.