GPS IN IRELAND are in the midst of a manpower crisis and those who are running busy practices are worried that vulnerable patients may be falling through the cracks.
Speaking to TheJournal.ie this week, the Secretary of the National Association of General Practitioners (NAGP) Dr Keith Swanick, said the fabric of general practice has been “dismantled” in the last few years.
“We have a manpower crisis and never have people been so vulnerable now in my opinion. But there was always a sanctity there, the pillars of the State have fallen but no matter how bad thing are, when people came into their GP, their trusted person, close the door there was a cocoon there, there was a safety net,” he said.
No matter how vulnerable somebody was, if they didn’t have money or whatever, they could leave their worries at the door and vent their problems. That has been jeopardised now, that uniqueness is going because there’s not enough doctors. And because the doctors don’t have enough time. That is leading, I think, to an increased suicide rate in this country. Patients can’t ventilate, they have to get it off their chest to somebody.
Three quarters of all GP trainees are planning not to open their own surgery in Ireland, as many head to places like Qatar and Canada where both the money and the work-life balance is better. According to the doctor, the UK’s National Healthcare System (NHS), which is looking for thousands of GPs, is “poaching our best”.
Managing depresssion
Swanick believes that GPs manage most of the depression in this country. In his own practice, in Bellmullet in Mayo, where he sees up to 60 patients a day, he said he only refers around 10% of patients with depression to psychiatric services.
They don’t need to go. Mild to moderate depression can be managed in the surgery. Having a chat, maybe a bit of medication, referring to the local counselling service, we have a psychotherapist who comes to the surgery. We have a chat and when they walk through the waiting room afterwards nobody knows what they were talking about. There’s a stigma associated with going to the psychiatric clinic.
“80% of a diagnosis is in the history so you have to have the time to listen to a patient,” he added. “Are we missing potential patients who are suicidal because we’re rushed off our feet?”
Focus on primary care
On Friday, Swanick addressed the Association of Former Parliamentarians in the Seanad to explain the depth of the crisis in general practice and offer suggestions on reform that he is already implementing in his own practice and in the local district hospital.
At his practice, services like osteoperosis scanning, ultrasound and cardiac investigations are offered to patients who otherwise would have to travel to the nearest major hospital or join a long waiting list to get.
“Our ethos is very focused on preventative community-based care for the patients we serve,” he said in his address. “Despite the current rhetoric about the need for more of this, in reality there are no incentives for GP’s to provide these services in the community – with the result that many GPs typically refer people to hospital for these type of investigations which could be performed and delivered so easily, closer to home and outside the acute hospital setting.”
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