Sir, - The extract from Dr Robert Collis's book The State of Medicine in Ireland was a very appropriate introduction to Dr Muiris Houston's description of single-handed general practice in Ireland (The Irish Times, July 23rd). In a number of ways, little has changed since the late 19th century.
After 25 years in a single-handed rural general practice in Ireland, and without any established time-off rota for 20 of those years, I feel I am reasonably well informed to make a few relevant comments.
It may not be generally appreciated that general practitioners practising alone in remote areas are contractually obliged to their health boards to provide medical care for their patients 24 hours a day, 365 days a year. In the event of their illness the responsibility for providing a locum doctor lies with the doctor who has just fallen ill. Surely this runs counter to any concept of natural justice for doctors and must mitigate against good patient care.
It is now well recognised that extended hours on duty, whether for airline pilots, train drivers, or others with the safety and welfare of the public as their remit, must not exceed certain hours of duty. However, this does not appear to apply to general practice.
Posts for single-handed general practice - and in some instances single-handed consultant appointments - continue to be advertised by the health boards of this country.
The Medical Council has been entrusted with the role of regulating the profession to ensure the highest standard under all conditions. It has stated publicly that natural justice for patients is at all times the minimum standard. However, in its anxiety and fervour to protect our patients from negligent doctors, it appears to turn a blind eye to these excessive hours of duty which are contractually obliged for single-handed general practitioners. In recent correspondence with the Medical Council I failed to have this problem addressed to my satisfaction. Indeed, it took almost a year for a reply to my correspondence concerning these critical difficulties in general practice. Finally the council agreed that my letter "raised important issues".
In an attempt to address the issue of excessive hours on call and all the difficulties which that burden brings, general practitioners throughout the country have carefully examined the co-operative system of providing out-of-hours cover, which is used in many European countries. Such a system is now in place in the Kilkenny/Carlow/South Tipperary areas and is working very well. GPs practitioners in Co Clare have organised themselves into such a group, and are ready to activate this system. However, funding from the GMS is not forthcoming in the foreseeable future. It has been suggested to us by the GMS that further assessment must take place before matters can proceed further, but little regard seems to have been paid to the vast experience in the Scandinavian countries and throughout the UK, where this system has been working with extreme satisfaction both for doctors and patients for many years.
So, relief from the onerous burden of 24-hour cover, 365 days a year is not yet at hand. Why are we expected to continue in a system that is patently unsafe for all concerned? - Yours, etc.,
Dr John O'Dea, Clareville House, Ballyvaughan, Co Clare.