Rural Tipperary town fears bleak future after loss of GP

The name of Dr Marguerite Madigan, who is due to retire in mid-January, is much on the lips of the people of Bansha in south Tipperary. Comments such as a “superb doctor and a lovely person” are commonly heard.

Saying that she will be hugely missed, Liam Bergin, who was principal of a local school for almost 20 years, remembers his own debt. “She was the person who sent me for very early cancer diagnosis. She was proactive about sorting it out.”

His words came as 300 of Dr Madigan’s friends and neighbours ignored inclement weather on Friday night, brought out by worries that not a single application has been received to fill the gap that will soon be left.

“A GP gets to know you over a period of time, they get to know all the families and they’re conscious of family histories, and that’s something not all locums would be able to read into as quickly,” Bergin says.

According to Liam Quirke, “Dr Madigan is a savage loss to the parish”. Neighbours clap and cheer in agreement.

Dr Pádraig McGarry, a doctor in Longford and chair of the Irish Medical Organisation’s GP committee, paints a bleak future for villages such as Bansha – 24 places like it around the State are without full-time GPs, although some have locums. Many more will face similar problems in time.

“If things continue, rural Ireland will become a museum piece, visited at weekends,” he says. “Its existence will be fondly remembered over a pint at the local. Unless there is a degree of certainty and security, nobody will apply for those positions.” More than one GP in five is over 60, with a flood of retirements due in the next few years, McGarry warns.

“The loss of a GP is just one last nail in the coffin of the village of rural Ireland. These were very sought-after jobs over the years, and suddenly, now nobody is applying for them because the practices are no longer viable without the supports.” He blames cuts made by the Health Service Executive.

In the past, a GP’s surgery in a village such as Bansha would have attracted a rural practice allowance worth €20,712. Following the cuts, this fell to €16,212. Now, the allowance is no longer on offer to a replacement for Dr Madigan.

Andrew O’Halloran says he had organised the public meeting after he had heard the village could lose their full-time GP. “We’re looking for a doctor in that surgery full time. With the support of the community we can keep it open.”

The practice has about 500 medical card holders and 1,500 private patients on its books. Moving elsewhere in search of a GP is not practicable, speakers say, as doctors in nearby towns are “full up”.

Bansha lost its post office recently. A local pub and the funeral home went, too. Losing its GP would take the “heart” from the village, O’Halloran says Six other villages in Tipperary face similar problems in coming months.

Minister of State for Agriculture Tom Hayes tries to offer reassurance. “The rural practice allowance is a discretionary allowance. It is at the discretion of the HSE. It can be negotiated. Over my dead body will this practice close here in Bansha.” A local committee needs to be set up, he says, to negotiate with the HSE in coming days.

The GP position would be advertised again in the near future. Immediately, representatives were chosen from among the attendance.

Independent TD Michael Lowry warns that the new HSE rules are “so restrictive that no place” in rural Ireland will qualify. “The reaction that I got from them was that, ‘Yes, we want to keep the doctor in Bansha, [but] we’re now worried if we change the criteria to suit Bansha that we’re setting a precedent and we open the floodgates for the rest of rural Ireland’.”

Questioned about Bansha, the HSE says it is “very much aware” of the pending vacancy, but points out that GP numbers in Ireland are increasing, not falling. In 2009, it had contracts with 2,000 of them. Today, the number is more than 2,400.

Rural Practice Allowance guidelines for remote rural areas such as Bansha have been reviewed, it accepts, but the new rules do not affect existing holders of the allowance, the HSE tells The Irish Times. The purpose of the new guidance is to ensure consistency, transparency and fairness in decision-making in respect of the relevant discretionary provisions of the GMS [General Medical Services] contract."

On November 1st, there were 20 GP vacancies nationally, it says. Eight of them are in rural locations with populations of fewer than 1,500, including in Sligo, Mayo, Wexford, Clare, Galway and Tipperary.

“Each of these lists has either a locum GP or neighbouring GP who has taken over the list and is providing the full range of GP services to patients,” a HSE spokesman adds, emphasising that the HSE is in talks with the IMO.

However, the HSE’s assurances about GP numbers is not accepted by Chris Goodey, the chief executive of the National Association of General Practitioners (NAGP), who says that 915 GPs are expected to retire or emigrate in the next three to five years.

“The vacancy figures vary. We know a lot of GP practices have closed down, for example Feakle in Clare, so they don’t count them any more because they’re now closed. We have the best-trained GPs in the world. Other countries are targeting them to recruit them.”

Increasingly, young GPs do not see a way of earning a living for themselves in rural Ireland, warns Conor McGee, president of the GP association and a GP trainer, who also has a full-time practice of his own in Co Clare.

“I’ve a huge concern that there’s really good people coming through, they’re very well trained, very motivated, they care, they’re up to date – and way too many are leaving the country straight off.

“New Zealand, Australia, Britain, Canada, Qatar – all these places, when they are short of GPs they come to Ireland to recruit because they know coming over there’s a pool of well-trained, capable people.”