THE WORLD IS not a particularly rosy place for Irish general practitioners at present.
Diminishing returns, over-work, a State contract which is commonly accepted to not be fit for purpose, and the exodus of Ireland’s brightest new medical minds to more lucrative positions in other countries has the profession at crisis point. It’s commonly accepted that a GP staffing crisis is imminent. No one wants to do the job.
Yet, the new head of the National Association of General Practitioners (NAGP), Ireland’s GP union, is just 29 years of age.
The reason? It’s because 29-year-old Maitiú Ó Tuathail has had a long-term goal of becoming his rural community’s (he’s from Leitirmóir, in the Connemara Gaeltacht, 50 miles west of Galway) GP in residence for years.
While that ambition hasn’t changed (he’s currently based in Rathfarnham in south Dublin), a conversation with Ó Tuathail shows he has no illusions about the sheer scale of the issues facing Ireland’s health services.
“My plan was always to replace the current GP in my home place when he retires. I’ve been through six years of college and four years of training in order to achieve that. But the system is absolutely dysfunctional as it stands,” he tells TheJournal.ie.
The guy I’m hoping to replace, who’s in his 60s, he’s after working a 56-hour weekend from Saturday morning to Monday evening. As a 29-year-old I don’t even know if I can do that. The demands on GPs are completely unrealistic.
Ó Tuathail points out that two of the GPs in his home locality have recently quit. Not retired, quit. Due to the strain on their physical and mental health, among other things.
“GPs have to go through years of, horror I would describe it as, to qualify. So it’s not like they’re not resilient. So if they’re quitting that should be raising red flags,” he says.
One of the main issues facing the profession is the current contract GPs have with the State. It dates from 1970 and is, as the department itself would probably admit, not fit for purpose in an era of modern medicine.
‘Insulting’
“This contract, it was designed for a different era. Where the practitioner is referred to exclusively as ‘he’ and ‘him’, because it was expected he’d be a man. It’s archaic. But the problem is we don’t know what the future plan is,” says Ó Tuathail. “We don’t know if we’re heading for universal primary care, the SlainteCare report (on the future of the Irish health service) hasn’t been in any way implemented 12 months later. The current contract is frankly bananas. The whole system is totally fractured, broken. And people don’t want to work in that system.”
He cites recent examples of care he himself has been forced to give – telling a woman suffering from migraine he could refer her publicly for an MRI, and wait two years for an appointment, or advise her to do it privately and pay €300; referring a nursing home patient to hospital where their care will cost €1,000 a night because he, as a GP, is not allowed to administer intravenous antibiotics.
“It’s insulting. Ten years of training and we’re not allowed to work properly as doctors, to achieve our potential. The most basic tests, we’re not allowed to do,” he says.
Regarding the issue with locums in Ireland, where inflated rates are paid by the HSE to agency staff to cover hospital shifts around the country, Ó Tuathail agrees it’s an example of the short-term thinking of Ireland’s health services.
“The locums situation is because the HSE will pay ‘whatever’ in order to ensure cover,” he says.
Meanwhile a GP gets a set amount of money from the HSE and has to cover all resources. Since Fempi (Financial Emergency Measures in the Public Interest) in 2008 we’ve had our resources down 40%, but with the same overheads. Now I’m hearing from GPs that they’ve to take out loans to cover their tax bill. They can’t take a day off. The HSE should be funding locums to cover GP services, as they already do in the hospitals.
Fempi has to go. It already has for all other public servants. But GPs are told it has to happen for us with terms and conditions. Fempi has to be the first thing to go. But even that just puts us back to where we were in 2008. Then the contract has to come next. We just want to be treated like equals.
Stalled discussions
He says he’s “disappointed” that discussions on the contract have stalled once more (“there’s no movement – two years later and we’re already two months behind”). However, he does believe that Health Minister Simon Harris is “genuinely concerned at the state of the health service”.
“He’s young, only a year older than me, he’s energetic. But I’m not sure our issues can be solved by one person. And I think he fundamentally doesn’t understand general practice, and that’s worrying,” Ó Tuathail says. “If there’s to be reform then he has to gain that understanding.”
He says that he doesn’t believe the “political will” is there to bring about change in the health service, to enact SlainteCare. “We need to reorient the service to focus on primary care, not the hospitals. As the saying goes, for every dollar spent on primary care you’ll save four in the long run.”
Regarding the issue of the possible result of the Eighth Amendment referendum on 25 May, Ó Tuathail stresses that the NAGP is taking a neutral stance on the vote.
But regarding Harris’s previous suggestion that any abortion service will be GP-led – that’s something he doesn’t believe is viable.
“We’re not in a position to provide a GP-led abortion service. I don’t believe we can do it. No other country in the world does it, to the best of my knowledge,” he says.
We haven’t got the resources, like ultrasound machines even.
The bottom line is we don’t have the resources, and nowhere else expects its GPs to do this. I don’t think that GPs can provide it, and I don’t think a GP surgery is the place for it.
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