At the front end of the emergency department crisis, GPs’ surgeries and pharmacists are working around the clock to cope with the surge of patient demand and prevent as many as possible from having to attend hospital.
Their services are already stretched thin, but with the rise in winter virus infections, like flu, Covid-19, and respiratory syncytial virus (RSV), GPs have said there is a “quagmire of illness and suffering”. They also believe that post pandemic, some people may have forgotten how to manage and cope with minor illnesses at home.
Madeleine Ní Dhálaigh from Kelly Henry Medical Centre in Castlerea, Co Roscommon, who sits on the Irish Medical Organisation’s GP committee, said her practice was inundated with patients with respiratory viruses.
“We’re working right through until 7.30pm in the evening to get through the workload,” she said.
“Yesterday the administration staff told me that there were 50 messages left on the phone within 45 minutes. And we have patients who are finding it difficult to understand why we’re not getting back to them within an hour.”
“We’re in an absolute quagmire of illness and suffering. Something has to be done to incentivise young doctors – like start-up grants and tax relief measures – who’ve emigrated, to come back. We have an increasingly ageing GP population, and we’re not able to replace the GPs that are retiring.”
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Monaghan-based GP Illona Duffy and her colleagues at Swan Park Surgery have been running rapid respiratory clinics, or five-minute appointments to rule out anything more serious in patients attending with symptoms like coughs, sore throats and sore ears.
“Last week we had two doctors doing that. It means that there’s no battling, because all patients are getting seen, which is brilliant. But ultimately we would hope it settles down because it’s unsustainable in the long term.”
The ability to provide cradle-to-grave care for patients is a “lovely” aspect of her job, says Duffy, and she has no regrets about choosing it as a career. However, general practice medicine is “relentless” with “no quiet days”.
“I come in here at 8am. The surgery officially starts at 9am, but I start going through blood test results and letters. People forget about that. They think: Oh sure, they’re only seeing patients until 5.30pm. It’s a very rare day that I leave at 6pm.”
“It’s trying to keep up with the paperwork, the forms that have to be filled. If someone needs housing, a GP letter is needed ... if someone needs care ... Schools and gyms look for letters from us. Also, medical legal reports and insurance reports, they take hours to do.”
She adds: “Your lunch is spent looking at hospital letters, which are becoming more and more risky. The hospital will often come back and say something like ‘GP to follow up on this report’, so you have to read these letters very carefully because we’re liable if something is missed.”
The public are “much less tolerant” when there are no appointments available, Duffy adds.
“Patients know us and it’s very difficult if they stop you in the supermarket when you’re packing your groceries because they’re cheesed off when they can’t get an appointment. People are very much less tolerant. Complaints are good, they make you think about what you’re doing, but not when people are abusing staff.”
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Early retirement is a consideration for Dr Denis McCauley (59), chairman of the GP subcommittee of the Irish Medical Organisation (IMO), who is also a coroner in county Donegal.
“I can’t work at this rate much longer,” Dr McCauley said.
“It is stressful because there are more people to be seen than you can see. If you can only see 40 people today, and you have 60 people to be seen, it’s about triaging who needs to be seen and who can be seen tomorrow instead, and that’s stressful for a young GP because they don’t have the experience. For us more experienced GPs, it is still tiring and it’s getting harder.”
Dr McCauley, who practises at Millbrae surgery in Stranorlar, Co Donegal, says working at pace while the surge in respiratory viruses continues means many issues could be missed in patients.
My working week at the moment, I walk in at 9am and I put my head down and I start dispensing and I don’t put my head up again until 6pm, and I’m absolutely shattered
— Tom Murray, a pharmacist in Ramelton, Co Donegal
Pharmacists too have been affected by three winter viruses surging together, says Tom Murray, a pharmacist in Ramelton, Donegal, and Irish Pharmacy Union’s (IPU) honorary treasurer.
“This year has been significantly busier. The public has a reduced natural immunity and we’ve spent the last few years wearing masks. Three very common viruses and reduced immunity, it’s creating pressure at every stage.”
“My working week at the moment, I walk in at 9am and I put my head down and I start dispensing and I don’t put my head up again until 6pm, when I stop dispensing, and I’m absolutely shattered. That’s the reality for a lot of pharmacists now.”
He adds: “You have lots and lots of patients who have been waiting in the GP surgery or the out-of-hours practice or A&E and then they come to the pharmacy, and they have to wait again because of the shortage. It does cause pressure.”
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“Patients are presenting to the pharmacy that have been prescribed Calvepen [an antibiotic], but it’s in very short supply. I then have to ring other pharmacies to see if they have them, or ring the GP, which makes the GP unnecessarily busy, to say ‘I haven’t got Calvepen but I have oxacillin’, which the GP then agrees to, but it takes a lot of time, and most importantly, it leads to delayed care for the patient.”
The Irish College of General Practitioners (ICGP) is now training 70 per cent more GPs per year than it did six years ago. However, according to the medical director of the organisation, Dr Diarmuid Quinlan. “We have an ageing workforce and an expanding population. Twenty-five per cent of our GPs are over 60 years of age.”
“More and more patients are unable to register with a GP practice, because many practice lists are at full capacity, and already there are significant waiting times for routine appointments,” says Quinlan.
A spokesman for the IMO says “GP numbers are relatively static while the population is increasing as is the complexity of care required”.
“While pressures are now year round, we do need to plan much better for predictable levels of care required in the winter and put in place sufficient resources to manage the expected winter surge.”
A spokesman for the Department of Health said the Government was aware of general practice workforce issues, and it has been implementing measures to improve GP recruitment and retention such as increased capitation fees for GPs and supports for practices in rural and urban areas of deprivation.
He said: “The number of entrants to GP training has been increased significantly in recent years, from 193 in 2019 to 258 in 2022, and another large increase is planned for this year. Working with the ICGP, it is aimed to have 350 training places available for new entrants per year by 2026.
“The State is working with GPs to implement and improve the utilisation of e-health measures, the benefits of which include a more integrated service delivery and a reduction of the administrative burden on GP practices.”
A spokesman for the Irish Pharmacy Union said: “If properly resourced and allowed to do so, the community pharmacy sector can contribute significantly to the delivery of the Sláintecare vision of one universal health service for all, providing the right care, in the right place at the right time, in turn relieving pressure on the healthcare system.”
