Life as a GP in rural Ireland: ‘We are at crisis point’

“The Government announced a new bypass for Macroom recently. I’m afraid GPs have been bypassing Macroom for some time now,” says local GP Dr John O’Riordan, reflecting on the current shortage of doctors.

The general practitioner says the primary healthcare service in the town and the surrounding catchment area has reached “crisis point”.

He is one of seven GPs in the mid-Cork town who, together with a GP in Ballyvourney and one in Coachford, cover a catchment area of an estimated 20,000 people under the SouthDoc banner. This includes providing out-of-hours cover at weekends, something that has a major impact on recruiting and retaining doctors.

“We would service a big area from west of Ballyvourney around by Kilnamartyra and Ballingeary and Inchigeelagh to the south and back by Kilmurry and Lissarda into Farnanes and then north around by Dripsey, Coachford, Rylane, Carrigadrohid up to Clondrohid. So it’s a huge catchment area,” he said.

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“With nine doctors on the rota, we end up working one Saturday in nine – the HSE has tried to get some locums for Sundays and sometimes that works out but sometimes you might find out on a Friday that they haven’t been able to get anyone so you end up working Sunday as well.

“You start on Saturday morning at 9am and you’re on until 11pm and it’s the same if you are working a Sunday so that’s two 14-hour days, so you are quite exhausted and then come Monday morning, it starts all over again when you have to come into the practice.”

Dr O’Riordan compares the situation facing GPs based in Macroom with others operating under the SouthDoc banner such as those in Ballincollig who, as part of the Cork city rota with more doctors, end up having to work fewer Saturdays where shifts last no more than six hours.

Lifestyle issue

“The new GP contract was supposed to resolve the problem for rural GPs but to be honest, it isn’t a money issue, it’s a lifestyle issue and we just haven’t been able to attract new GPs because of the out-of-hours rota, it’s just not compatible with modern life. People want a work-life balance.”

The consequence is that Dr O’Riordan and his colleagues have had to close their practice to new patients – both private and medical card holders – for the past four or five years as they were struggling to cope with their existing patient list.

“It’s very hard to refuse people especially new people coming to an area with children who need to be looked after but my colleagues and myself felt that the situation was unsustainable and we had no choice but to close the list so we could give our existing patients the sort of service they deserve.”

Because new arrivals can’t get into their local clinic during the day, they opt instead to come to SouthDoc’s out-of-hours clinic which adds to the burden on already overworked GPs, he adds.

“Some days our receptionist would say that she could turn away six or 10 patients.”

The issue came to a head recently when local Cork North West Fianna Fáil TD Aindrias Moynihan raised the matter in the Dáil, pointing out that some newcomers to Macroom are having to travel up to 60km, often to where they previously lived, in order to see a GP.

Dr O’Riordan believes the situation for Macroom and similar towns can be resolved but it needs political will and some funding from the Department of Health and the HSE, along with a willingness to amend the SouthDoc roster.

“The problem could be solved if there was some reconfiguration of the out-of-hours system because then I certainly could attract younger GPs if I told them they didn’t have to work weekends and only work two nights a month but there has to be a political will and some extra funding to do that.”