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InvestigatesThe GP CrisisIRELAND IS ONE of few EU countries where the patient load of GPs has increased over the past decade.
Each GP has an average of 100 extra people in their catchment area due to a surge in population that has not been matched by an equivalent rise in doctors here, The Journal Investigates can reveal.
Experts told us that this is exacerbating a primary care crisis, where GPs are firefighting to treat ageing and growing communities who are finding it more difficult to get access to care.
“Over a protracted period… the health of the population will be eroded,” Tadhg Crowley, an associate professor in general practice at UCD, told us.
Ireland’s population grew by over 630,000 in the 10 years between 2014 and 2023.
To maintain the same patient load, GP numbers should have grown by almost 600 in that period, but instead just 176 additional doctors were working in surgeries around the country.
GP numbers fluctuated in Ireland over the past decade, peaking at over 4,800 in 2018 before dropping again. This stood at just over 4,500 clinically-active doctors working as GPs in 2023, according to the latest Medical Council workforce report.
Europe overall is facing a shortage of doctors across all specialisations and the deficit of general practitioners is a particular problem.
Data compiled as part of this investigation by the European Data Journalism Network (EDJNet) reveals that the profession in many countries, including Ireland, is in a difficult situation: The population is growing and ageing, while GPs themselves are ageing and their numbers are struggling to keep pace.
The Journal Investigates is the Irish partner in this cross border investigation, led by Voxeurop. Alongside Ireland, we found that the patient load of GPs in Italy, Bulgaria and France has also grown in recent years.
In the other eight EU countries examined by the team there was a decrease in the number of people per GP.
It is hard to say what the optimum number of patients per doctor is, but Elodie Brunel, vice-president of the Société Scientifique de Médecine Générale in Belgium told our investigative team:
“We estimate 800/900 patients [per year] per doctor is the threshold beyond which it becomes difficult to function.”
Our investigation findings show that most European countries, including Ireland, are operating at a far higher level than this. From latest population estimates, Ireland would need almost 6,000 GPs to meet that threshold.
The shortage comes as Ireland is “in the middle of a health tsunami”, according to UCD’s Crowley, who runs a medical practice in Kilkenny City.
This is not only due to an ageing population but also an obesity crisis which “lends itself to increased chronic disease”. The proportion of GPs decreasing is “only going to add to this health burden”, he said.
Method: The data collected for this article is fragmentary. Each country counts its GP workforce differently, so creating comparable data is complicated. We chose to focus on GPs confirmed as being in practice. In Ireland, this equated to clinically-active doctors that self-reported working as GPs to the Medical Council each year.
In some countries, GPs are not the only doctors who provide primary care. This is particularly the case in Germany (for internists) and Greece (for pathologists). As a result, our graphs don’t show the full range of primary-care providers in these countries. The full investigation methodology is detailed by Voxeurop here.
Using the – very partial – data the investigation team has been able to gather at a European level, it’s possible to sketch a picture of the crisis in several countries.
The causes are numerous and complex, and the situation is becoming pervasive.
“There are shortages of GPs all over the world,” explained Tiago Villanueva, a GP in Portugal and president of the European Union of General Practitioners.
He sees this as a Europe-wide problem, both within and outside the EU.
“It’s not just a problem of pay… and working conditions,” he said, citing Norway and Denmark as examples. Despite a high quality of life and good wages, both of these countries are also facing shortages.
Villanueva mentioned other factors that may play a part. These include the difficulty of the job, long travel times and the fact that shortages are often in poorer and less desirable regions.
A report by the World Health Organisation (WHO) in 2023 also mentions “imbalances in the geographical distribution of primary healthcare professionals, mainly between rural and urban areas”.
In the EU, inequalities in healthcare provision between rural and urban areas are well known and well documented.
The term “déserts médicaux” (medical deserts), although disputed, has become widely used in France to refer to areas, often rural, with poor access to healthcare.
Ireland is no exception, with UCD’s Crowley telling us that the shortage here is not evenly spread:
Rural general practices are in trouble.
That is because many younger GPs want to work in bigger practices and some counties also have a higher percentage of GPs close to retirement, he explained.
Last year, the Irish College of GPs (ICGP) found that counties with large urban areas – Dublin, Cork, Galway, Limerick and Waterford – had among the highest GP numbers per population. Co Monaghan and Co Meath had the lowest.
Some EU countries are responding with incentives such as in Romania and Belgium where subsidies exist to encourage family doctors to set up practice in areas of shortage.
Ireland is not unique with its ageing population. Across Europe the population – estimated at 449.2 million in 2024 – is growing but it is renewing itself at a much slower rate.
A recent OECD report found: “The proportion of people aged 65 and over in the EU has risen from 16% in 2000 to 21% in 2023, and is expected to reach almost 30% by 2050.”
This, it stated, is due to longer life expectancy and lower fertility rates and is “likely to lead to a sharp increase in demand for healthcare and long-term care”.
The ageing of the population also holds true for doctors themselves, across all specialisations.
The report Health at a Glance: Europe 2024 states: “The ageing of the physician workforce is a growing concern in many EU countries, with a substantial proportion of doctors nearing retirement age and a non-negligible number already beyond it.”
Over one third (35%) of doctors across EU countries were over 55 in 2022.
This is no different in Ireland, with a substantial proportion of GPs (32%) close to retirement age, according to 2023 data from the Medical Council.
The World Health Organisation set out a number of solutions for combating shortages in its 2023 report.
This included prioritising general medicine in higher education through internships or training sessions, improving salaries and working conditions as well as gaining a better understanding of healthcare delivery.
Increasing the number of GPs being trained is often a solution proposed by governments, according to Villanueva of the European GPs’ union “because if you increase supply, you offset demand”.
But he told our investigation partners Voxeurop that this approach needs to be accompanied by measures that make the profession more attractive to aspiring young GPs and ensure that the workforce is retained in the long term.
“If you don’t make the profession more attractive, then you may inject more doctors into the system but they won’t go into general practice.” Instead, he said:
They’ll choose another speciality or they’ll leave the country.
Research published at the end of last year looked at just that – GPs who have left Ireland – and concluded:
“There is a significant stock of Irish-trained GPs abroad which perhaps represents a potential cohort of GPs who could be encouraged to return to practice in Ireland as part of Ireland’s strategy for addressing the GP workforce crisis.”
Crowley told us targeting those who have emigrated is crucial: “Why are we not looking after our graduates who move abroad?”
Citing the expenses of setting up a practice, including the legal implications, he suggested offering grants to “encourage these GPs to come back and set up in areas” of shortage.
In addition, Crowley said the number of doctors on the GP training programme from Irish-training universities needs to be examined, as he felt with graduates coming from outside Ireland, “there’s a higher likelihood that they will go back abroad again”.
In response to a recent parliamentary question on the GP shortage, Minister for Health Jennifer Carroll MacNeill said that “a number of measures have been taken in recent years to increase the number of GPs”.
This included the annual intake of doctors into the GP training programme increasing by 80% in the past five years, with 350 places made available from 2024.
The minister also mentioned an increase in the annual expenditure for general practice in recent years as well as the introduction of a grant support for additional staff capacity as well a practice staff maternity leave support. She said:
These measures make general practice in Ireland a more attractive career choice for doctors.
Recruitment of GPs from abroad also started in 2023 under a joint HSE and ICGP programme. 114 such GPs were in practice as of October, according to the minister, and funding has been provided to recruit up to 250 more GPs from outside Ireland to the country this year.
But expert Tadhg Crowley said the government needs to look at multi-annual funding and say: “Right, this problem is going to get worse and worse. We need not to be firefighting.
“We need to look at how are we going to increase the number of GPs trained from Irish universities, and then making sure that when the person has done some traveling, that they want to come back to our health system to work.”
Are you impacted by the GP crisis? We want to document how people across Ireland are struggling to access primary care. Find out more here>>
This investigation was led by Voxeurop alongside other members of the European Data Journalism Network (EDJNET), including The Journal Investigates.
Reporters / Editors: Maria Delaney (The Journal Investigates) & Adrian Burtin (Voxeurop) • Additional Reporting: Patricia Devlin • Main Image Design: Lorcan O’Reilly
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I wonder would mass immigration have anything to do with it, no probably not!
@Brian Hunt:
That’s crazy talk,wash your mouth out with soap!
@Kevin Byrne: Oh, look, the journal pulled a sneaky one and let the “bot” skip the queue. Who would have guessed?
@Brian Hunt: Hopefully the Journal or another News outlet will investigate the rise in Leprosy and Aids in Ireland, or maybe dancing with the stars is more important.
@Paul Gorry: Is everyone you don’t agree with a ‘bot’? How does that even work? Weird…
@Jonn: Silly comment, wake up!
@Brian Hunt: if you read the article, then you wouldn’t have to wonder, and would know that various factors are at play
@Paul Bannon: Also scurvy, TB and Bubonic Plague.
@Paul Bannon: The last case of leprosy in Ireland was in 2013 by a Brazilian.
@Kevin Byrne: you’d be first in line you being Russian an all..
@Brian Hunt: No, not at all. They still have one of the best patient to dr ratios in eu, cant blame immigration on everything despite some sectors love to do nothing else but….
@Kev Kerr: So nothing to do with mass immigration Kev, I know I can always rely on you for your wise counsel……not!
@Brian Hunt: obviously population increase is A factor, but one of many
@Brian Hunt: it is one of many factors. Many of those arriving have major medical needs, mental trauma, pre existing illnesses etc. All are given medical cards. As there is no medical assessments at point of arrival it is difficult to quantify. This coupled with the fact that many doctors who train in Ireland leave shortly after finishing their education, both Irish and international students.
Sure ALL OUR IRISH Educated Doctors and Nurses are forced to emigrate thanks to FF, FG, GGP, Liebour and rest of the Mafia in the Dail because none of them are credible to run the country anymore. We lack serious leadership in this country because all I see this place is going down the drain fast by blaming all the Irish people for a lot of the problems this country is facing but the politicians are never to blame because they’re immune from being blamed.
@Kevin Byrne: 1st troll on this article, Kevin. Congratulations..
@Kevin Byrne: great input there kev
@Kevin Byrne: Every day, all day. You’re the most boring c¥nt I witness all week. Sad little bl1t3h
@Tommy: and guess who will replace the country doctors ?
Indian doctors already acting as lords and masters in our hospitals.
@Dominic Leleu: but then, why can they do it and our Irish one can’t. I know a doctor that is going to retirement and can’t find replacement… why ?
Over 10% taken in in under 10yrs is alot, before you consider the housing crisis
Everything Conor McGregor said in the White House on Ireland and immigration is 100% true, regardless of your opinion of the man himself!
@Jonn: McGregor is very fond of the White in any house, but I get your point, john.
@Jonn: no it wasn’t true, and if you’re relying on someone like McGregor to be your messenger, then there is something seriously wrong with the message
@Kev Kerr: it is true you’re just stuck in your cave with your fake leaders here in Ireland we need a Voice somebody who actually stands out for the normal people of Ireland, as our politicians are just a bunch of liars and everybody knows that the country is going downhill drastically services, immigration money being squandered, and you’re actually backing up these people using our money you should be ashamed of yourself
@Jonn: I wouldn’t put any stock in anything said ahead of or between a pair of rap ists.
@Bren: just because I don’t agree with McGregor, and consider him to be a scu mbag, doesn’t mean that I am a government supporter. There are lots of other politicians who are not in power
@Kev Kerr: You’re an echo-chamber of the government!
Interesting that a journalist can say this today but many people have mentioned the country didnt have services to meet the demands due to the hugh growth in immigration over the last few years only to be branded far right.
@Kevin Byrne:
The trick is to identify as a non gender frying pan at the end of your comment. That confuses the lefties.
@Paul Keenan: hasn’t helped for sure but the reality is that the Irish have been useless for a long long time. IMO it’s pretty granular argument that glides effortlessly through the megaphone but really amounts to little, I know so many people who now travel abroad for healthcare, can’t get specific treatments etc. our government managers do this to maximise profits for the exchequer. We have nothing because of How horrible Irish people are to each other.
@Thesaltyurchin: its not a “granular argument” its simple supply and demand and there has been an explosion in demand for not just GPs but other services etc and the demand is purely driven by population growth
@Paul Keenan: Sorry but its driven by bad services, population growth is just more fuel to burn, at least all the bluster maybe makes us do something about the cr@p infrastructure.
@Paul Keenan: we’re training 200 GPs a year mate, even if all immigration stopped yesterday we’d still be having this problem. Saying the demand is driven “purely” by population growth is just misinformation and if I were you I’d read up more on an issue before forming such a strong opinion.
All them fffg voters don’t care. Neither does fffg. A match made in hell, methinks.
@Paul Gorry: HSE is payin nothing to the trainee nurses – is simply a modern day slavery that government allows.
No wonder nobody will ever want to become a nurse or a doctor in this backward county.
How can they keep getting away with it is unbelievable.
@Lei tatt: what is the going rate for college placements for other courses. Nurses used to get paid when they were training however the nurses union wanted the qualification to be college based rather than work based, can’t have it both ways.
The HSE bears full responsibility for this and until we abolish it completely, nothing will change. The primary reason for the GP shortage in Ireland is that the HSE’s contract terms and payment structures are unattractive, discouraging both new and existing doctors from working in general practice. The HSE sets artificial price caps on the amount of money that GPs can charge patients. This means many doctors simply can’t afford to stay in business or have no incentive to expand their practices. GPs are paid the same rate regardless of demand. Even as patient numbers rise, GPs can’t increase their fees to match the extra workload. In less populated areas, where patient numbers are lower, GPs can’t charge enough to make a living, so they either move to cities or leave the country entirely.
@William Jennings: fifteen years ago the only part of the Irish health system working was gps, enter into government the labour party and woke ideology and hey presto that’s broken too.
@Ger McCarthy: Yes, I couldn’t agree more. When Labour got into government with Fine Gael, they expanded the medical card scheme. This proved to be the final nail on the coffin of Irish healthcare as even GPs weren’t reliable or efficient. It sounded great on paper, more people could access subsidised healthcare. However, this move failed to address the underlying structural issue, the lack of GPs to serve an increasingly large patient base. This led to an increase in demand without any corresponding increase in supply. GPs found themselves overloaded with medical card patients, and because their fees were capped, they couldn’t increase their income to compensate for the increased workload. They believed in the delusional idea of “socialised” GP care, despite nothing in life being free.
@William Jennings:
Leftists are mor#ns, they build nothing and destroy everything, but the Irish only have themselves to blame,they keep voting for them!
@William Jennings: I agree with you. I was unlucky enough to end up in hospital last week. 3 days in a+e with a heart/blood issue. The poor doctors and nurses were brilliant. Flat out working the whole time. To say we’ve a third world system is an understatement. They should all be paid hundreds of thousands to put up with the conditions they’ve to work in. To say the treatment on patients is inhumane is an understatement. Thank you to all the staff.
@Tony Murphy: “To say we’ve a third world system is an understatement”. I think you need to travel more
@William Jennings: €70/ Gp visit and €30 for nurse to take bloods?
@William Jennings: No, we should not price people out of the ability to get healthcare and put market economics into people’s ability to live. That is cruel. While I’m sure there are a lot of structural problems with the HSE that lead to this, I am still doing the research on this topic, every single medical professional I’ve seen interviewed isn’t making a living because of the /housing crisis/ and wants to move away /because they’re overworked/.
@William Jennings: the demand on GPs is an inevitability of the fact that people are getting sick and are asking for help. If you price them out of it by allowing GPs to raise said prices, they’re not exactly going to stop getting sick – theylljust avoid the doctors until they end up in the emergency room or die. By preventing people from accessing this healthcare, You’re just pushing the problem from our overwhelmed GPs to our overwhelmed hospitals. Or pushing people into the cemetery. The demand will always be there. We need to address the issues with supply.
Population increases means their should be more GPs. The fact there are not means the government planned for this.
Government acts like we’re still in the 2000s.
Another ‘benefit’ of mass illegal invasion…
@Kieran Conroy: but who is to blame the government? Of course in my eyes they are asleep at the wheel as per usual, only in it for their own interests, as everybody knows but everybody is afraid to say it and speak the truth, time for changing in Ireland out with all these corrupt politicians.
@Kieran Conroy: the vast majority of the population increase is due to the economy, and the jobs created as a result. Nothing to do with an “illegal invasion”
@Kieran Conroy: the problems with health and housing already existed before “mass immigration” stop stirring up hate
@Mike B: Maybe these problems did already exist but they have been made much worse with the mass illegal invasion of mainly young men who should be handcuffed and deported TODAY. All of them. Every last one.
@Kev Kerr: Yea. Right…LOL
@Kieran Conroy: the information is freely available on line. All you need to do is search for it
@Kev Kerr: but what are they doing
@Chutes Idiot: you have been peddling this multi account trolling for far too long now – time to wake wakey and find something more productive to do with your time
@john o connor: what do you think they’re doing? They’re working, in all sorts of roles, in hospitality, healthcare, tech, the list goes on
And I hope people don’t find a surprising this country has been run so badly for so long, that it’s inevitable that this was going to happen. The politicians are living in the clouds and I’m glad Conor McGregor stood up yesterday and spoke some truth about it we need a voice here in art and somebody to express how the population feels rather than a bunch of clowns Acting on our behalf the so-called government a bunch of liars destroying Ireland, changes drastically needed and I hope the people of Ireland will stand up now for our rights
Labour party take a bow,
That’s because they allowing to many people into the country who are also going to GPs
Yet telling the world, Conor does not speak for us
Stop flooding the country with chances, who all get medical cards then.
@Gary Condren:
I go to the local pharmacy every month and pay €80 for various medications. This is the maximum payment under the drug payment scheme. Every time I go I’m surrounded by foreigners getting whatever they need. 3 Euro please… 4.50 please … I feel like a mug in my own country.
Another thing not exactly helping is GPs expanding their services into Aesthetics. People in need of medical care cant get an appt for a week because slots are booked up with Botox and Chemical peels.
@Brendan Whyte: i imagine it’s barely a fraction of the system, but it frustrates me massively that every time i have a cold or a sniffle, I have to make an in person appointment with my doctor in order to get a sick note for my job.
That is a noddle scratcher, what changed? Mmmmmm
GP’s are useless , they open the book to describe a medications , they are brainless to diagnose a cancer or MS, self immune disease, they are waste of time and money ,waiting list at consultants are months long , because of the GP slow minds
@sakk sa: stop visiting your local witch doctor.
@Kieran Menon: https://www.theguardian.com/society/2008/apr/13/nhs.cancer1
@sakk sa: the GPs aren’t like that because of some uncontrolled stupidity, the GPs are like that because they’re overwhelmed and because the system overwhelms them further.
All the immigration stuff aside + the fact we only train 200/250 GP’s max a year(the same amount retire or take that time off sick every year) there are very few GP’s who work 70 hours a week anymore (why should they). Very few single handed practices are left where they do work those hours which would actually be the equivalent of 2/2.5 GP’s these days. As many female GP’s are joining as male GP’s and female GPs usually marry upward socially (I.e. other doctors) and therefore don’t need to work the income or the hours that a single doctor household would. (This is a generalisation but in population cross sections even if this was true 30 percent of the time, which it is, all the lack of hours working means less patients seen). The scary truth is we are in a MASSIVE crisis….getting worse
@N.F. Court: great comment. Add to this the increase in demand, from more people with medical cards, immigration, people having more disposable income to pay, older population etc and we have arrived at the current situation. Demand is only going to increase so more training places are needed to meet it.
You can’t even get a GP in an urban centre as none are taking on new patients
We need to address the root cause issue and that is it needs to be made easier to get into medicine in Ireland, there needs to be more financial help for students in order to study and make this a career.
It’s nothing to do with immigration or any other crazy conspiracy theories. It’s to do with the fact that it’s extremely hard to get into medicine and some people would rather prefer to be a YouTuber instead.
We need to increase the GP training places much more. The primary medical degree takes 6 years of hard work and study followed by 4 years GP training, balancing work and exams. Unless we improve the working conditions for doctors we will lose valuable staff , one of the best in the world.
Do I (a) read and attempt to comprehend this article or (b) jump to the comment section and say something about ‘mass immigration’ and ‘open borders’?
@Jack Hayes: do both, influx of people is mentioned though… And not for the green green grass I’m afraid….
My GP showed me his patient number. Between him and his wife, they have 33,000 patients to provide care to. We absolutely need initiatives to entice GPs to come to Ireland, whether Irish graduates or not!
Good luck if looking for a GP outside Dublin, midlands just impossible.
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