‘No doctor, no village’ still holds true

Thanks to an ageing tractor cab transported on a trailer and a flock of rather obstinate sheep ambling along the main road, I was almost late for a meeting in October of the Rural, Island and Dispensing Doctors in beautiful Mulranny, Co Mayo.

Traffic is generally not an issue in this part of the county. Following an overcast morning, the sun shone and the view over Mulranny Bay was spectacular, with the purple-heathered hills, the sweeping strand and the sparkle of sun on the deep blue Atlantic.  

The organisation of the meeting and the quality of the presentations were in keeping with the setting. During the course of the weekend, as well as several excellent clinical presentations, the assembled GPs heard the welcome news that a case recently taken by a GP against the HSE regarding the rural practice allowance (RPA) had been won, and the RPA in question was to be reinstated. 

We also heard the personal and moving story from another GP in the west who has been struggling without the RPA since taking up his post five years ago in an area as remote as any to be found on this island of ours. This is a story being repeated all over the country at present, from Donegal to Wexford, and the current problems are not confined by any means to rural practices. 

General practice is facing a crisis with manpower, morale and the sustainability of practices all under pressure. GPs have risen to the challenges facing them in the past few years but are now truly stretched to breaking point, with rural practices faring worst in terms of remaining in existence. Removing distance coding was a hugely inequitable step and quite simply must be reversed. Rural practice allowances are another necessity when keeping a small remote practice viable and the ongoing threat to them is of grave concern.

A few weeks after this meeting, a deputation of nine GPs from all corners of Ireland made a trip to Leinster House to voice their concerns and explain how much Irish GPs want to be part of the solution to many of the problems facing the health service. General practice offers excellent care, convenient to the patient and is excellent value. A large number of TDs and senators attended the meeting. Whether this will translate to action remains to be seen.

In early December, a public meeting in Corofin, Co Clare heard passionate stories from several patients who spoke out in support of their local rural GPs. All TDs from Co Clare attended and promised that both the retention of RPAs and reversal of distance coding were issues that would be resolved in the near future. Another meeting is scheduled for this month. As the election nears, the pressure is on our public representatives to deliver vital resources which are needed to maintain safe and equitable primary care to all patients in our communities.

A spirited meeting of GPs in Mayo just before Christmas again discussed the crisis in rural practice, among other topics, and an open letter to the Minister for Health following this has called on him to address this issue urgently.

There are many other issues to be resolved in Irish general practice – the need for adequate sick leave, the need to support single-handed practitioners and smaller practices far more robustly with nursing and managerial subsidies; the complete revision of the STC list; policy on management of nursing home patients, and the need to address the entire outdated notion that a contract which is 24/7 is acceptable to any working person.

We understand that a new contract is to be drawn up, but there is no definite date that will see this delivered to us, and rural GPs cannot wait until this happens. Irish GPs and in particular our rural colleagues need action now if we are to have any chance of sustaining and keeping the general practitioners we have, not to mention recruiting future GPs to these posts. 

As things stand, more and more newly qualified GPs are leaving our shores. Not all of them have a ‘travel bug’, as has been so ludicrously suggested. They simply have a need to be appreciated and appropriately paid for doing a wonderful job for the patients they care for. 

Without an immediate rescue package, more and more rural practices in Ireland will see their doors closing and the most vulnerable members of our society will lose a vital service to which they are fully entitled. 

Those patients who are elderly or very infirm and live alone in isolated areas with no access to transport will suffer most from any shrinking of rural general practice service. We cannot allow this happen. The time for action is now and the few measures needed, as outlined above,  will allow a little breathing space as we await the outcome of negotiations on a new GP contract. 

Ireland’s GPs are highly qualified, highly motivated and care deeply for our patients. We deserve the chance to be allowed to continue our excellent service.