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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.”
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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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