Like every other doctor in the State, Diarmuid Quinlan, one of eight doctors in a general practice in Glanmire on the outskirts of Cork City, has experienced a difficult start to 2023.
Quinlan finds it difficult to say whether the entire Irish health service is in a worse state now than it was five years ago, but he has no doubt that primary care is less able to treat people in the community.
“Five years ago, if you rang our surgery here in Glanmire on the day, we could have seen you on the same day. That frequently doesn’t happen any more – all our available appointments are often gone by lunchtime,” he said.
Every part of the health service is struggling, Quinlan believes. “I don’t send people into hospital unless they need to be admitted and I tell them to expect a long wait to be admitted,” he said.
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Irish general practice is experiencing a workforce crisis
The reasons for the deterioration in GP services include, he said, the Government’s decision in 2015 – taken by Leo Varadkar when he was Minister for Health – to expand free GP care to cover all children under six.
It led to a 30 per cent increase in the number of daytime and out-of-hours appointments sought by parents, while the proposed extension of medical cards to children aged between six and nine will increase demand from 640,000 more people.
“For all sorts of reasons, the shortage of GPs due to retirement, increases in the population, increased workloads because of Covid, the increased number getting medical cards, all of these have soaked up any additional surge capacity we had,” he said.
Overcrowding in emergency departments (EDs) happens in many countries, but the 12-hour average in the State from registration to admission is “very long”, particularly for older patients, Dr Quinlan said.
The HSE and the Irish College of General Practitioners are rapidly expanding the number of GPs in training, but this is a medium-term solution that will take time to make a difference, he said.
More money must be spent quickly on GPs and GP nurses: “We currently have 4,200 GPs. That’s low for a country with a population of five million – Ireland has 29 per cent fewer GPs per head of population than England and fewer again than Canada and Australia.”
Everyone agrees that the numbers of GPs should rise by 40 per cent, but the numbers of GP nurses, healthcare assistants and phlebotomists also need to double. “Irish general practice is experiencing a workforce crisis,” he said.
The ability of people to get same-day GP appointments five years ago “took a very substantial workload from the emergency department – now we can’t and that contributes to greater numbers going to the emergency departments,” he said.
Extra investment in primary care is needed to cut ED numbers and to reduce the numbers in hospitals needing trolleys, said Dr Quinlan, who is the Medical Director of the Irish College of General Practitioners.
The failings in the State’s primary care services were identified by the Organisation for Economic Co-operation and Development (OECD) in its Economic Survey on Ireland 2022.
Patients are more at risk of dying or suffering poor medical outcomes if they spend more than six hours in emergency departments, even if they are subsequently discharged, the OECD report noted.
The OECD report also found “avoidable” hospital admissions in the State are too high for conditions such as asthma and chronic obstructive pulmonary disease, which should be largely treatable by GPs.
Dr Quinlan acknowledged that the HSE has invested in chronic disease management in a bid to let GPs better manage people with such conditions so they do not end up in casualty.
However, the programme currently only covers medical card holders and should be extended to everyone, he said, adding that the distinction being made between people suffering similarly is “an inequity” that needs to be addressed.
