THE HEALTH SERVICE is never far from the headlines and will be front and centre during the general election campaign.
One issue that regularly comes up is General Practice – the number of GPs working, and retiring, in Ireland; the fact many GP practices are stretched to capacity and can’t take on new patients; and the struggle to attract and retain GPs.
The introduction of universal free GP care by 2028 is a goal set out in Sláintecare, a 10-year plan to reform the entire health service.
Earlier this month the government announced that six and seven-year-olds will receive free care from this year onwards, and that free GP care will be extended to all children under the age of 13 in the coming years.
The Irish Medical Organisation (IMO) is among the groups to label this plan unrealistic, saying GP services are already at “breaking point”.
As part of a recent debate on RTÉ Radio 1′s Saturday with Cormac Ó hEadhra, Fianna Fáil TD Jack Chambers was critical of Health Minister Simon Harris.
Chambers stated: “Simon Harris announced last week more free GP care for everyone in the audience, what is he doing to actually attract young GPs to come back and work in our system? What is he doing to attract young specialised consultants to actually return to our hospital system?”
Regina Doherty, Minister for Employment Affairs and Social Protection, defended her Fine Gael colleague, saying 1,000 more GPs are currently working in Ireland than five years ago.
So, is she correct?
During the debate Doherty said: “We have 1,000 more GPs in Ireland than we had five years ago so [Harris] certainly must be doing something to attract them to come back into the profession.”
It’s difficult to ascertain exactly how many GPs are working in Ireland for reasons outlined below, but let’s take a look at the figures.
TheJournal.ie contacted Doherty’s office to ask for the source of her claim. One of the minister’s advisers said she was referring to the number of GPs on the Medical Council’s specialist register – something that was not stated in her original remarks.
The specialist register includes doctors who have completed higher specialist training.
There is no central register of GPs working in Ireland. However, figures can be gathered from the Medical Council, the Irish College of General Practitioners (ICGP) and the HSE Primary Care Reimbursement Service.
Let’s look at those three sets of figures – in 2020 and in 2015.
There are currently 3,909 GPs on the Medical Council’s specialist register.
As of January 2015, five years ago, this figure was 2,608.
This is an increase of about 1,300 doctors on this particular list, but it does not necessarily mean there are 1,300 extra GPs working in Ireland today than five years ago.
The ICGP, the national professional body for general practice, said finding out the exact number of GPs who work in Ireland is “not a simple question to answer”.
The ICGP estimates there are 3,496 GPs currently in general practice in Ireland. A spokesperson said the number is difficult and time-consuming to compile and was unable to provide a number for 2015 in recent days. However this report, compiled by Trinity College Dublin, stated that 2,932 GPs were working in Ireland in 2015.
The figure was reached by combining the Irish Medical Directory GP database and the ICGP ‘find a GP’ list. Comparing these two figures, there has been an increase of 564.
A spokesperson for the ICGP noted that GPs are “contracted under the General Medical Scheme (GMS) to treat Medical Card patients, and those entitled to free GP services and the GP card”.
“They are independent contractors with their own practices – mostly in partnerships – most have both Medical Card lists and private patients,” they stated.
The IGCP spokesperson added that some GPs are registered as members of the ICGP but may be abroad, still in training or retired. As well as this, the organisation estimates that up to one-quarter of GPs are working part-time (some are doing research or teaching).
The HSE Primary Care Eligibility & Reimbursement Service (PCERS) annually reports on the number of State GP contracts held in Ireland.
There are 2,974 such contracts in Ireland as of this month. This figure was 2,889 in 2015 – an increase of 85.
These figures are not the same as the number of individual GPs working in Ireland; there may be multiple GPs working in a practice that holds a contract.
Specialist register
The minister’s adviser cited the Medical Council’s specialist register as the source of her information.
A spokesperson for the Medical Council explained that this is a ‘live’ register and, as such, the figure fluctuates.
“The figure at annual retention [which happens in July for reporting reasons] can differ to other times in the year as doctors who retire, leave the jurisdiction, move roles or areas of practice etc throughout the year, often come off the register at annual retention,” the spokesperson said, adding that this also applies to trainees who qualify or move specialties.
“The register of medical practitioners is a ‘living’ database. Each working day doctors are entered on, removed from or transferred between the divisions of the register. For this reason comparison between reports based on registration data must take account of this ‘living’ nature of the database.”
As of July 2019, 4,899 doctors told the Medical Council they were working as GPs and 3,467 of them were on the specialist register.
When it was pointed out to Doherty’s office that the increase in GPs on the specialist register did not equate to the same number of new GPs working in Ireland, her adviser said: “If a certain amount of doctors are not working, that would always be the case – even five years ago – so the increase still stands. The trend is the most important thing here with a significant increase in GPs in the last five years.”
Why is it difficult to calculate the figures?
A report published by the HSE in September 2015 entitled Medical Workforce Planning: Future Demand for General Practitioners 2015-2025, outlined the number of GPs registered with the Medical Council as well as the number of doctors with GMS contracts five years ago.
It also explains why it is difficult to get an exact figure of the number of GPs working in Ireland.
The report states that the population of doctors working in general practice in Ireland is diverse and made up of several cohorts including the following:
1. Career GPs who are based in Ireland, and who work permanently in the health service, either full or part-time. They may or may not be on the specialist register.
2. Non-career doctors who are based in Ireland and contribute to general practice provision; for example:
3. Doctors not normally resident in Ireland who travel to Ireland regularly (usually for a number of weeks at a time) to provide short-term cover for out-of-hours services/relief for annual or other leave. These doctors may or may not be on the specialist register. They are most commonly recruited through Irish medical employment agencies.
“For this reason, it is difficult to be definitive about the exact number of doctors who contribute to the general practice workforce,” the report states.
Figures in 2015
Doherty referred to “five years ago” in her comments, with her adviser later stating that she was referring to the Medical Council’s specialist register. So, how many GPs were working in Ireland five years ago?
At the end of 2015, 4,479 doctors registered with the Medical Council listed general practice as their primary area of practice. Of this 3,179 were on the specialist register.
However, we’re going to look at the figures at the start of that year, exactly five years ago – the time frame in the original statement.
As of January 2015, the Medical Council’s figures showed that a total of 4,685 registered doctors who had worked in the previous 12 months (ie not inactive or retired) stated general practice to be their primary area of practice.
Of these, 2,608 (56%) were on the specialist register, 38% were on the general register and 6% were on the trainee register. Less than 1% were on the specialist register but not registered as GPs. This latter group would comprise doctors who are on a different specialist register (for example Occupational Medicine) but who work primarily in general practice.
Doctors registering with the Medical Council are asked to state if they have worked in Ireland in the preceding 12 months.
The report states that, if doctors who worked outside Ireland only are excluded (81 on the GP specialist register and 388 on the general register) as well as those who were on the trainee specialist register, approximately 3,923 doctors worked in general practice in Ireland in 2014.
However, the report notes that this figure of 3,923 is “an underestimate”.
“The Medical Council records are based on the registering doctor identifying the specialty in which they practice for most of their professional time,” the reports states.
The document adds that NCHDs who provide short-term GP cover for out-of-hours services and holiday relief, and doctors whose main area of practice is in another specialty but who work part-time in general practice (as outlined above) are not included in this number. Therefore, “it is not possible to accurately identify this underestimate”.
The report states: “In the absence of a comprehensive register of GPs, we consider the data from the Medical Council’s workforce intelligence reports for 2012 and 2013 registrations as well as more recent registration information, to be the best available data on the current configuration of the GP workforce in Ireland.”
The report also looks at figures compiled by the ICGP and HSE at the time.
In January 2015, 3,799 doctors were registered on the ICGP-run professional competence scheme. Of these, 2,772 were also ICGP members. While it is a legal requirement that all doctors on the Medical Council register maintain professional competence, it is not mandatory for a doctor practicing in primary care to be a member of the ICGP, the report notes.
It adds that the HSE Primary Care Reimbursement Service (PCRS) collects data on the number of General Medical Services (GMS) contract-holders and those GPs delivering state-funded primary care services such as Cervical Check, Heartwatch and a range of childhood immunisations.
“Since 2012, in order to obtain a General Medical Services (GMS) contract, a doctor must be on the GP specialist register. The number of GMS contract holders as of April 2015 was 2,418. While the GP principal within a practice will hold the GMS contract, other doctors employed within that practice may deliver care to GMS patients. It is not currently a requirement that these doctors be on the specialist register,” the report states.
It adds that, at the time, an additional 462 GPs who do not hold GMS contracts are registered to provide services under alternative programmes, such as the Primary Childhood Immunisation Scheme, Heartwatch, the Methadone Treatment Scheme and National Cancer Screening Services.
The total number of GPs on the PCRS database five years ago was 2,880, significantly less than the total number of GPs registered with the Medical Council. The report estimated that the remaining 1,000 or so doctors who practiced in primary care at the time did not hold any type of state contract.
“As very few doctors practice exclusively in the private sector, we have made an assumption that these doctors work as part of teams in general practices where the principal holds a GMS or other state contract. These doctors may be GP assistants.
“The PCRS does not hold data on the Medical Council registration of GPs holding state contracts. Therefore, we do not know how many of these 2,880 GPs hold specialist registration,” the report explains.
Doherty stated this: “We have 1,000 more GPs in Ireland than we had five years ago so [Harris] certainly must be doing something to attract them to come back into the profession.” Her adviser later said she was referring to the number of GPs on the Medical Council’s specialist register.
According to the Medical Council, the number of GPs currently on this register is 3,909. As of January 2015, five years ago, this figure was 2,608.
This is an increase of about 1,300 doctors on this particular list, but it does not necessarily mean there are 1,300 extra GPs working in Ireland today than five years ago.
According to ICGP figures, there are approximately 3,496 GPs currently working in general practice in Ireland, up from about 2,932 in 2015 – an increase of about 560.
There are 2,974 State GP contracts in Ireland as of this month, according to the HSE. This figure was 2,889 in 2015 – an increase of 85.
These figures are not the same as the number of individual GPs working in Ireland; there may be multiple GPs working in a practice that holds a contract.
There is no central register of GPs working in Ireland and, for the reasons outlined above, it is difficult to ascertain how many GPs are currently working here. Therefore, to claim that there are 1,000 more GPs working in Ireland than five years ago cannot be backed up.
Therefore, our verdict for this is UNPROVEN.
As per our verdict guide, this means: The evidence available is insufficient to support or refute the claim, but it is logically possible.
Includes reporting by Stephen McDermott
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