Newly published research funded by the Health Research Board and the Irish College of GPs has examined GP emigration from Ireland through analysis of international data. The study ‘GP emigration from Ireland: an analysis of data from key destination countries’ was published recently in BMC Health Services Research.

The study attempts to quantify GP emigration from Ireland by presenting secondary data on GP emigration from Ireland to Australia, the United Kingdom, Canada, and New Zealand. These are the key destination countries for doctors (including GPs) emigrating from Ireland. Of note the study could not quantify doctors returning to Ireland from abroad, as Irish citizens would not need to notify authorities.

The authors state: “Source countries, such as Ireland, must get better at monitoring and responding to emerging trends in GP emigration and factoring them into GP workforce planning models and policies.”

The study indicates that without a central register of GPs in Ireland, it is difficult to accurately measure emigration rates, and with no measurement of Irish-trained GPs returning to the Irish workforce, it is also difficult to give an accurate picture of the emigration and migration trends.

The study highlights the historical pattern of GP emigration, particularly to the UK, with a cohort “who could be encouraged to return to practice in Ireland in the future”. Policies to encourage return migration of Irish-trained GPs “could form part of Ireland’s strategy for addressing the GP workforce crisis”.

The study mentions that in 2021-2022, 42 GPs from the entire GP workforce (equating to approximately 1 per cent of all GPs) emigrated to the countries studied, while there were 144 new GP graduates that year. In addition, the authors had no visibility of GPs returning to Ireland from these countries. The number of GPs who emigrated in 2022-2023 was substantially reduced, indicating the variability of these data from year to year. Inability to account for GPs returning to Ireland renders the true picture incomplete, as acknowledged by the authors. “Ireland must begin to capture and publish this data to enable the development of an accurate and up to date picture of patterns of GP emigration, GP return and GP retention and to strengthen GP workforce planning.”

The CEO of the Irish College of GPs, Mr Fintan Foy, said: “This is a significant piece of research, which highlights the challenges of retaining our GPs in Ireland, and the gaps in our knowledge for workforce planning. While we would wish all our GPs to stay and work in Ireland, we are heartened by the relatively low level of GP emigration, particularly in recent years, and indicators that this continues to decline.”

He added: “The College’s own career intentions surveys (2023) show only 14 per cent of trainees and 18 per cent of graduates are considering emigration, while the HSE-NDTP reports a retention rate of 87 per cent for 2016-2021 graduates.”

The Chair of the College’s Board, Dr Deirdre Collins, said: “It is essential to put this research in context. While it cited emigration rates having a 30 per cent impact on workforce, the study authors are clear this calculation comes with significant caveats and they could not account for returning GPs. We urgently need more data collected on the return rates for Irish-trained GPs.”

The study’s researchers were Dr Holly Rose Hanlon, Dr Eidin Ni She, Dr John-Paul Byrne, Dr Susan M Smith, Dr Andrew W Murphy, Dr Aileen Barrett, Dr Mike O’Callaghan and Dr Niamh Humphries.

The study can be read here: https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-024-12117-2

Like the Republic of Ireland, general practice across the border is also experiencing a huge range of challenges. Almost one-in-three GP practices in Northern Ireland has been forced to seek crisis support services from the General Practice Improvement and Crisis Response Team in the last four years, according to findings of a report on Access to General Practice in Northern Ireland, by the Auditor General Dorinnia Carville. The report examines myriad challenges that have contributed to these crisis conditions and highlights an urgent need for strategies to resolve them.

Commenting on the findings, Ms Carville stated: “For most people, GPs are their first point of contact with the healthcare system and the gateway to other services. Today’s report reflects the extreme pressures GP practices are facing. These pressures have been driven by a combination of long-term trends, such as an ageing population and growing waiting lists in secondary care, and more recent issues such as the impact of the pandemic.”

The report also states that between March 2022 and March 2023, a total of 13 practices in Northern Ireland either returned, or gave notice to return, their contracts. Despite alternative providers being put in place, most of the arrangements are temporary. Additionally, the urgent need for locum practitioners has resulted in Trusts paying up to £1,000 (€1,167)/day in some instances, which is anticipated to distort the locum GP market.

A number of factors can be attributed to the current situation, and the report identifies views raised from the health sector around perceived financial risks and the continued difficulties in securing an adequate and sufficient clinical workforce. It also highlights particular challenges around GP workforce retention. The total number of GPs did rise by around 9 per cent between 2018 and 2023, however, the report warns this data masks changing patterns of GP work, which indicate there has been an overall decrease in whole-time equivalents. Despite efforts to increase the workforce by expanding the number of GP training places, the report found many of the new training places had been taken up by international medical graduates, who are less likely to remain in Northern Ireland after graduating.

The recent report also examines the roll-out of multi-disciplinary teams (MDTs) in Northern Ireland, which was launched in September 2018, with a planned incremental roll-out across over five years. The data notes that by March 2023, MDTs had only been fully introduced in one of the 17 GP Federation areas across Northern Ireland, and partly introduced in seven others. A lack of available, qualified staff was identified as a key constraint in the roll-out.

Ms Carville added: “Measures taken to date have largely been short-term, which can be costly for public finances. At the same time, progress on delivering more meaningful transformation, such as the planned roll-out of MDTs to work alongside GPs, has been significantly delayed. Ultimately this results in patients not receiving the timely support and access to treatments that they need. It is important to note that there are no quick or easy solutions. What is essential now is the development of sustainable long-term plans to address the significant challenges facing GP services in Northern Ireland.”

The full report is available at www.niauditoffice.gov.uk.

The healthcare technology company Clanwilliam Group has officially launched its new AI-powered app Pippo, which is anticipated to influence positively an array of practical issues involving patient interactions in general practice. The platform optimises administration tasks in particular by simplifying processes for patient requests such as appointment booking and ordering repeat prescriptions. According to Clanwilliam, a reduction of approximately 40 hours was noted in administrative duties during a pilot of the app that was rolled out across GP practices across Ireland last year.

The technology has been designed with rigorous security standards and ensures end-to-end protection of patient data. It is also compatible with existing GP practice management systems such as Socrates and Helix Practice Manager.

Commenting on the full launch of Pippo, Ms Eileen Byrne, Managing Director of Clanwilliam Ireland, said: “With its capacity to deliver seamless, secure, and efficient interactions between GPs and patients, the rollout of Pippo is an important step forward on this journey of transforming healthcare. By increasing the efficiency of GP patient interactions including appointment booking, payments, and refilling prescriptions in a simple and easy-to-use way, we’re helping to unlock significant benefits for both doctors and patients.”