Being able to go to the family doctor on a day when you feel unwell is something most Irish people take for granted. But a growing number either cannot afford to do so, or cannot find a doctor to see them on the day due to a shortage of GPs in their area, writes Eithne Donnellan.
This manpower crisis in general practice, which has been no small contributor to the much publicised difficulties in hospital accident and emergency units, is evident on the ground in a number of areas.
In the Mulhuddart area of west Dublin, according to a report published last year, there is not a single GP for a population of some 10,000 people. Here it can take people days to get to see a GP. And in Dublin's north inner city there is only one GP for about every 2,500 people compared to the national average of one for every 1,600. The ratio in the UK is about one GP per 1,200 citizens.
The GP shortages however are not confined to the capital. In recent years there have been difficulties finding GPs for practices in Roundstone in Connemara, Listowel in Kerry - where it took around three years to fill a post - and Ballymore Eustace in Kildare where it took two years to fill another vacancy.
Then there are areas where there are GPs but they are "closing" their lists to both public and private patients because they feel they cannot safely look after any more patients.
Dr Martin Daly, chairman of the Irish Medical Organisation's GP committee, said he knew of a mother of two asthmatic children who went to 13 different practices in Galway before she could find a doctor who would take her on last year. And she was a private patient.
One may wonder how things have come to this. Hadn't anyone foreseen these problems? According to Dr Eamonn Shanahan, chairman of the Irish College of General Practitioners, there are a number of factors at work. The most obvious is the fact that the population is growing, but there has been no significant increase in the number of GPs.
Unless the number in training increases dramatically the situation will get even worse. Of the estimated 2,400 GPs working in the State 1,000 are due to retire over the next 15 years. But this year we will only train 98 GPs - admittedly a small increase on the previous two years when 84 were trained.
In addition, a recent study of 223 GPs working in Galway, Mayo and Roscommon found almost 60 per cent of them wanted to retire before the age of 65. If doctors begin retiring early in significant numbers, the situation would become more acute.
A further issue is that the majority of places on GP training schemes are being taken by female doctors, who may wish to take time out or work part-time if they have children.
Dr Shanahan says funding will have to be provided for more GP training places. He also says the ICGP has been looking to sit down with the Health Service Executive since it was established in January to discuss imaginative solutions to the current crisis, such as incentives for GPs to set up in deprived areas, but no meeting has yet been arranged.
The lack of a modern medical card contract, as well as the high cost of setting up in general practice are disincentives to young doctors entering general practice, Dr Daly adds.
He fears many Irish GPs will be lost to the UK where the NHS will pay them a salary of £100,000 for a 30-hour week with no out of hours commitment, provide a full pension, and impose no set- up costs on them. If the Government had funded its own primary care strategy, published in 2001, things might be different, he argues.
It promised to provide one-stop-shop primary care centres across the State with round-the- clock GP cover as well as other services.
Dr Daly claims the strategy is now "dead in the water"
because it has been "starved of funding".
The failure to train sufficient numbers of medical students every year to meet the needs of hospitals as well as communities will be on the minds of doctors gathering today for the three-day annual conference of the ICGP in Galway.
Other issues for them will be the doctor-only medical cards promised by Minister for Health Mary Harney, which they say they need to be consulted about before they are introduced, and the failure to improve IT systems in the health sector.