Younger GPs will not put up with ‘mad stuff’ faced by older colleagues, committee hears

Younger GPs will not put up with the long hours and the "mad stuff" that their older colleagues have been prepared to accept, the Oireachtas committee on health has been told.

Dr Tadhg Crowley made the comments as he told the committee on Wednesday that he is a middle-aged GP whose work-life balance is "atrocious", but he is learning from younger colleagues in relation to expectations from the job.

Dr Crowley, who is on the Irish Medical Organisation’s (IMO) GP committee and an associate clinical professor in UCD, warned that a lot of GPs are retiring and the ones that will replace them “are no longer willing to work the hours and the mad stuff that was done in the past and they are right. You can see the ill effects of what it created in people of my generation.”

The Republic needs a 50 per cent increase in GPs, or between 1,220 and 1,660 extra GPs, by 2028 to meet the needs of its growing population, the IMO told the committee, which is looking at GP provision.

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The State has the third-lowest level of GPs in the OECD according to some measures, with a rate of just 0.7 GPs per 1,000 population.

The number of GPs per head of population is 30 per cent lower than in England.

The IMO's director of industrial relations Val Moran said the State needs 1.1 GPs per 1,000 of the population.

He told the committee that the Covid-19 pandemic exposed the fragility of the health service, which had begun long before the pandemic and started with austerity cuts in 2008.

The problems with GPs are “stark”, with doctors being unable to take appropriate sick leave or holiday leave, he revealed.

A recent IMO study found that 60 per cent of doctors were unable to take holiday or sick leave at some stage because of the absence of locum cover, the committee heard.

“The stress and the burnout that associated with that is causing people to leave the GP service earlier and builds on our capacity problem,” Mr Moran said.

The IMO said there needs to be an expansion of grant aid available to practices to take on additional nursing staff and support for a healthcare assistant grade within general practice.

Maternity leave

Castlerea-based doctor Dr Madeleine Ní Dhálaigh told the committee that many female GPs who are pregnant or thinking of becoming pregnant are stressed because they are not guaranteed full maternity leave if they operate in a partnership with other doctors.

There are now supports in place at a partnership level for female GPs to take maternity leave, but finding locums is difficult.

As a result there is “huge stress in pregnancy not knowing whether you can take a week or your full maternity leave. We would have colleagues who have gone back to work much earlier than recommended,” she said.

Many GPs who are planning families will not take up partnerships but remain GP assistants instead because they are guaranteed maternity leave, she added.

Dr Ní Dhálaigh also said: “We want to attract our emigrated personnel back and encourage our highly trained personnel not to leave in the first place.

“We need to support our young GPs in their decision to join partnerships, have a mentorship model. These could happen if the will was there.”

In its submission to the committee, the Irish College of General Practitioners (ICGP), the professional body for general practice in Ireland, said GP surgeries needed a "much-expanded workforce" with more practice nurses and administrative and IT supports.

It had recommended the establishment of a working group on the future of general practice, but this has not happened yet.

The ICGP, which has had responsibility for GP training in the State since October, is increasing training places from 258 in 2022 to 350 by 2026, but this is not a “quick win”, it warned.