Medical Matters Today about 80,000 patients will attend the 3,300 general practitioners on the island of Ireland. They will have their woes listened to, their reflexes tapped, blood pressures measured, receive down-to-earth advice, prescriptions and about 3,500 will be referred on to other specialists. Good solid bacon and cabbage medicine that is always there when needed.
The general practitioner service has been part of the colour and stability of life in Ireland that can trace its organisation back to the Poor Laws. In Northern Ireland, general practitioners have served their communities quietly and impartially by providing continuity and comfort in distressing and awful times. People expect this.
Of the 80,000 consultations that take place today, more than 90 per cent of people will be satisfied with the interaction. Most patients choose a GP because the practice is around the corner and, increasingly, because of the range of services that are supplied.
Patients display enormous loyalty with people working in Dublin still consulting their general practitioners in Kerry, Roscommon or Tyrone when they visit at the weekend or on holidays.
The growing middle class population in Ireland is attracted as much by practice-provided services as by a personal relationship with a a single doctor.
There are problems with access to general practitioners, with it being three times easier to find a GP in Monkstown than in Jobstown. Minister McCreevy's award of a non-means-
tested medical card to the over-70 age group means the GP in Monkstown gets four times more money for an over-70 patient than the GP in Jobstown. A political stroke that further disadvantages practices in poor areas.
The Irish College of General Practitioners has said it will advocate on behalf of patients who need a voice. Who better to do it than the GP?
There has been a steady decline in the number of house calls, especially in urban general practice. Older general practitioners extolled the virtues of visiting patients in their own homes where they could gather social and domestic information that explained a lot.
Many GPs now see it as an expensive use of time and the decline is likely to continue with exceptions for frail and terminally ill patients.
Many GPs do not now work full time and have other interests in education, occupational health and family. Probably 90 per cent of the newly trained GPs in the country are female which is introducing another dynamic into medicine.
Despite training more GPs than ever, it is difficult to fill general medical services (medical card) posts with young general practitioners. The current State contracts for GPs are inflexible and do not take enough notice of changes in working patterns. Over half the graduating junior doctors will apply for training in general practice. The training is generally recognised as good. Applicants know that it equips the doctor for a variety of other careers in medicine including general practice.
When 300 new doctors were asked by the Medical Council if they intended practising as general practitioners, only 47 said they wanted to become GPs. We probably need about 120 GPs per annum to fill vacancies and to respond to the increasing demand for services. New doctors say they want control over their medical work.
Unfortunately, general practice is seen as one of the disciplines that allows doctors insufficient control over their lives.
These worrying changes are coming at a time when the Government is extolling the virtues of primary care and is trying to move general practitioners from working alone to team work, a move that is supported by the Irish College of General Practitioners. It all sounds like a good idea but to date the process has been starved of funds. Strategy does not see patients or put bread on the table.
General practice and primary care have few champions within the political system. Some of the GPs elected as independent TDs to Dáil Éireann and the single MLA elected to the Stormont Assembly have gone forward on hospital-based rather than primary care issues.
The GP has always been around, local, dependable and in tune with the community. It is a tough, rewarding but often lonely life in rural as well as urban areas. As GPs we must, however, work with patients to achieve a balance between demand and service. Moving from bacon and cabbage to McDonalds is too much.
Dr Tom O'Dowd is professor of general practice at Trinity College and a practising GP