‘My patients and I appear to be a nuisance to the hospital system’

General practice has changed since my father began his career in the late 1970s. When Dr Murphy snr applied for his first post, more than 70 GPs applied and every one of them wanted that job.

When he retired five years ago, a small handful of GPs showed an interest in taking over his busy country practice. Dozens of GP posts now remain unfilled for want of a single applicant.

Why should this be the case? Surely being a GP in Ireland is a lucrative and attractive profession?

On the surface, the main reason would seem to be one of staffing. Although we are training more GPs than ever, we seem to be training them for export. And many older, well-established GPs are joining them.

The sector is facing a serious manpower crisis which is already impacting on patient care and safety. These GPs are leaving because they feel they have no choice. Faced with massive funding cuts and a wider health service environment which is no longer patient-focused, they are leaving in search of professional fulfilment as much as financial gain. The cuts that have decimated general practice since 2008 have disproportionately hit GPs.

An almost 40 per cent cut in gross practice income from State services (medical cards, etc), with no reduction in overheads (far higher in the urban setting and for new practices) and huge demands on GP time, has led to many practices trading insolvently with many GPs not able to draw income. Patients are still prioritised in general practice without waiting lists, but at the cost of huge stress to doctors and staff and increasingly at the risk of patient safety.

Small businesses

GPs are not State employees but rather small businesses whose biggest client is the

Department of Health

. For most of us, our private income is now being used to fill the gap left by the 40 per cent cut mandated by our biggest client, effectively subsidising the provision of State services.

The loss of distance codes and rural practice allowance, along with removal of payment for housecalls, are destroying rural practice.

Managing barely viable businesses has become a far bigger stress than treating thousands of patients and has taken over from the vocation of fixing people.

The shortage of funding in general practice is just one of the barriers to GP recruitment and, in some ways, possibly the simplest to fix. Just invest in general practice.

However, even if we had all the GPs we needed, unless they can work effectively, they might as well be abroad. There is a huge impediment to efficient general practice in this country. Money can’t fix all our problems and it seems investment definitely can’t fix the Health Service Executive.

In my dad’s time as a GP, interactions with the hospital services were patient-focused. If Dad needed to get someone straight into a hospital bed, he could phone the local admissions department and the patient would be admitted and a consultant would review their case.

The GP’s opinion on the health of the patient was respected and trusted by the hospital staff and by the specialists. In contrast, my week is spent in conflict with the HSE over many aspects of my patients’ care.

I spend hours every week advising patients to expect huge delays in getting appointments or in being admitted. Hospital appointments? Two years. Physiotherapy? Nine months. Free counselling? Seven months (not available to those over the medical card limit).

Dumping ground

I waste valuable time rewriting patient referral letters to make them “stronger” at the request of hospital secretaries. My patients and I appear to be a nuisance to the hospital system. More and more often, I send patients to emergency departments which have become dumping grounds for everything that can’t wait two years for an outpatient appointment.

We spend 90 per cent of the health budget on this model of hospital care. We spend just 3 per cent on general practice which provides same-day access to a doctor for millions of patients.

Without an immediate injection of both financial and human resources, the general practice that my father’s generation of doctors worked so hard for will be a thing of the past and Ireland will be the poorer for it.

Dr Sinead Murphy practises at the Galway Bay Medical Centre