Investigation Part 1: Doctor shortage causing strife

“If you’re going to be sick out of hours, be a cow!” and “Verbal abuse of staff will not be tolerated”.

These two statements sum up the experience of researching this topic over the past few weeks. The first is a comment from a farmer caring for a mother with dementia. The second is from a recorded message on a southwest general practitioner’s (GP’s) switchboard system. One sums up the frustration of patients struggling to get timely appointments and the other relates to getting satisfactory out-of-hours care.

These comments came to light while taking soundings for this series from members of rural organisations and doctors’ unions. The current shortage of GPs in this country is triggering such problems and also putting doctors at serious risk of burnout. Rural patients are at a further disadvantage, too, because so many rural GPs are now near retirement age with no one lined up to replace them.

Back in 2019, Mullinahone GP Dr John Gilman described the situation related to GP care to Irish Country Living as being “like a fodder crisis 365 days a year” because it “never let up”. Fast forward three years and throw in a pandemic for bad measure and where exactly do we find ourselves now?

The figures don’t make great reading. Some 700 GPs are due to retire in the next six years, according to the Irish College of General Practitioners (ICGP).

“At least 2,000 new GPs will be needed within the next seven years to meet existing demand,” they say.

And more fodder for thought – will these newly trained GPs stay in Ireland when they qualify or will they fly off to other places where work conditions are better?

Then there is the rural-specific problem of GPs not wanting to work in very rural practices because of the isolation and workload this involves. Thirty-three General Medical Services (GMS) vacancies existed across the country as of 1 June 2022.

With so many GPs near retirement age what, then, does the future hold?

This week we have a flavour of patients’ experiences of access to GP healthcare. Next week we’ll get the GPs’ perspective. Patients’ views, as you’ll see on the next page, vary from some satisfaction to long waits for phones to be answered to being told to go to a hospital emergency department with your child as no appointment is available.

We heard also about older people ringing support organisations expressing concern about doctors not doing home visits anymore and begging for help with making online appointments during the pandemic – something they hadn’t the skills, devices or broadband to do.

Most people spoke of being treated well by GPs when they see them so it is obvious that there is great respect for doctors out there, but it’s getting to that stage – of seeing the doctor – that is often the problem. Next week, however, we hear about medical secretaries taking abuse from patients. Last year, one said, not a week went by when one of the practice staff wasn’t in tears due to abuse on the phone.

Carers have had their say too. While they feel supported, generally, it is consistent GP care they want. With locums in many vacant practices for long periods, this consistency of care isn’t always available.

Denis Drennan, Kilkenny ICMSA farmer

Denis’s experience relates to caring for his mother at home until very recently. She is 84 and has dementia.

“If you’re going to be sick out of hours in Ireland be a cow!

“There are nine doctors in the practice I used for my mother’s care and in fairness if you ring during the day you’ll get through eventually, but once it comes to five o’clock in the evening forget about your own doctor or any of the other doctors in the practice who would have access to your medical records being contactable.

“The other side of that is that there are three vets in my practice and if I ring at 2am, one of them will answer the phone. The problem is that out-of-hours doctors don’t have access to my mother’s records, so you’re there trying to explain it all and bringing around a list of medications she’s on and trying to bring them up to speed. Patients should be given copies of their medical records that you could bring with you to the out-of-hours service when you need it. It’s way too complicated as it is.”

Alice Doyle, IFA

“Getting through to our nine-doctor practice in Co Wexford is difficult. There are two lines – one for emergencies and one for other calls. I have been told I’m the 16th caller on that line, then the 15th, 14th etc over a period of an hour and a half. I had to put my phone on speakerphone on the windowsill and do housework while I waited.”

ICA

Kathleen in North Tipperary

“I find it very difficult to get an appointment with my GP since COVID arrived in Ireland.

“On a few occasions I had to do with five-minute phone consultations and I was charged €30 each time. On another occasion I was told there was a two-day wait to get an appointment when I was very unwell. This resulted in having to call an ambulance and being admitted to hospital for tests, which could have been done as an outpatient. All this results in clogging up the hospitals and very ill older persons being left to wait on chairs and trolleys.”

Age Action Ireland

Celine Clarke, head of advocacy and communications, had this feedback:

“The accessing of healthcare is the number one issue that people contact us about. We can see a pattern since 2020 where people are finding it very difficult to register with a GP, sometimes after their GP has retired, or get an appointment with their GP.

“Some are concerned that they may have a health condition that may get progressively worse as they are waiting. They can’t access care in the local community and a lot of these people are not online to the degree that they can conduct their business online.

“We also find that people get really frustrated, saying ‘our GP doesn’t do home visits anymore’. We understand all healthcare providers are under serious pressure and obviously under-resourced and that does then have a knock-on effect for somebody who is in a vulnerable situation.”

Family carers’ response

A call-out for comments about access to services among carers resulted in a generally good experience over the past year of the very-important GP/patient relationship. Any complaints related to locum care:

Carer from the southeast

“I know of two rural surgeries that are staffed by locum GPs, one of which has been running that way for nearly a year. This may not be about access to GP services per se, which are available, but more about access to consistent GP services. The locums are only in position for short periods, so they change frequently and never really develop a strong relationship with their patients. This can cause difficulty and inconsistency with the provision of medical reports.

“A GP who knows a family will have a fuller understanding of their situation than a locum who just has access to summaries on the medical record.”

A mother from Donegal

“I count myself lucky that we have really excellent GPs in our community, but the challenge is access to them. I would be reluctant to look for a GP appointment for either myself or the kids at the moment. I feel like I am being interviewed by the receptionist, asked what the nature of the problem is. I have an issue with that. I understand why it may be beneficial from the practice’s perspective, but I don’t feel it is appropriate.”

Seamus Miggin, a Meath farmer

“I haven’t had any problem so far. I go for regular check-ups and get bloods done by appointment, but if I was sick and wanted a doctor in 10 minutes that might be a slightly different affair. Some people are complainers though, whenever you meet them they’d be complaining about something. There’s a lot in this country that’s working well. It’s important to say that.”

Anne, a rural mother of two

“I had to go to A&E with my two-year-old son who had croup back in spring. He deteriorated at home one particular day and when I rang my GP practice at about 2pm I was told there were no appointments– emergency or otherwise. I was given two options – wait until 6pm until call doc came on, which is about 20 minutes’ drive from me, or go to A&E if it couldn’t wait. We went to A&E immediately as his breathing was so poor. We relayed the experience to the admissions nurse in A&E, almost out of embarrassment for being there. He said that they are seeing a lot of that but, in fairness, I’m not blaming the GPs as they are under huge pressure.”

Sarah, an agri-industry worker

“I rang my GP surgery early in July asking for an appointment with my own doctor to discuss a procedure I am considering and I was told I couldn’t get an appointment with her until the end of August. If I wanted to, I could ring each morning to see if they had a cancellation, though. Granted I know that if I was in pain I would get one of the emergency slots that day, but it seemed like a long wait to see the doctor.”

Melanie, new to rural Ireland

“I’ve been trying to get onto a GP list for three years after moving here. I just got one three months ago after contacting the HSE. Being forced on to someone’s list is not a great start to a doctor/patient relationship. My partner still hasn’t been able to find a GP to take him on.”

Irish Patients’ Association- Stephen McMahon

“It’s a major concern in the IPA that with so many GPs due to retire in the coming years that there are going to be very big [service] holes in certain parts of the country. That has to be urgently addressed now.”