Article: Lack of GPs threatens Ireland's Future

The_Conductor

http://www.irishtimes.com/newspaper/health/2009/1027/1224257487010.html


MEDICAL MATTERS: I HAVE long felt this country has suffered by way of not having a health policy think tank like the King’s Fund in Britain. Such an independent body would serve a valuable purpose in evaluating healthcare trends and by “test-driving” health policies brought forward by political parties, writes MUIRIS HOUSTON

We are fortunate, of course, to have the ESRI, but given its broad brief it would be unreasonable to expect it to focus on health matters. However, last week it produced a major report into future healthcare needs and demands.

Projecting the Impact of Demographic Change on the Demand for and Delivery of Healthcare in Ireland says the population will increase from 4.2 million in 2006 to 5.1 million in 2021. It lays out the changes we can expect across a number of areas, including the demand for long-term care and the projected cost of medicines over the coming 12 years.

Not surprisingly, both the demand for, and cost of, long-term care will soar as the percentage of the population aged 65 and over rises from 11 to 15.4 per cent. The rise in life expectancy in men is especially striking. The report predicts demographic change will increase total GP consultations by a third by 2021. There will be a 40 per cent increase in consultations by men between now and then, much of it driven by a steep increase in consultations by older men.

But the existing number of family practitioners is already inadequate: we have 52 GPs per 100,000 population compared with much higher ratios in most other European countries. In addition, the increasing feminisation of medicine, combined with a tendency for younger graduates in general to want to work fewer hours, means the shortfall by 2021 poses a real threat to patient care in the community.

If our GP numbers are to rise to the EU average of 87 GPs per 100,000 population by 2021, we will need to recruit another 1,800 GPs. However, at present, just 121 GP training places are offered every year. This needs to be ramped up considerably, according to the ESRI.

“A failure to expand GP supply would have knock-on effects which could include price increases, longer waiting lists and an increased burden on emergency departments in hospitals as patients seek alternative modes of care,” the report warns.

As it is, there is anecdotal evidence of people in certain areas in the Republic not being able to access medical care. And in parts of Canada, many people are unable to find a GP with whom to register, with a knock-on effect on access to childhood immunisation and other preventive health practices.

Non-acute conditions become emergencies in this scenario, leading to a greater pressure on the very hospital services governments think would be better placed in the community.

Prof Brendan Drumm has been consistent in enunciating a policy of increased health service provision outside of hospitals. How will he respond to the ESRI report which clearly shows that the projected shortfall in GP manpower poses a serious threat to this basic plank of healthcare reform?

Dr Stephen Thomas of the Centre of Health Policy and Management at Trinity College Dublin, who wrote the paper on GP shortages, warned that a failure to act could even threaten current levels of service in the community.

At a time when the health budget is to be curtailed by more than €1 billion for next year, with an inevitable drop in patient services, any expansion of training will stick in the craw of the Department of Finance.

Its reflex response will be no, no and no again. Yet doing nothing will leave a huge hole in the health service in the not too distant future.

Involving nurses, pharmacists and other healthcare professionals in primary care teams may help ameliorate the GP manpower problem, but primary care teams themselves are crying out for investment to allow them to move from a virtual state to being functioning units in the community.

Frankly, it is disturbing to see the one part of the health service that works efficiently and with high levels of patient satisfaction brought to its knees by inaction. The blindsiding of medical representative organisations under the guise of competition law is hard to understand. And not talking to those at the frontline at a time of national economic crisis makes no sense.