General practitioners working in rural areas with an ageing demographic need greater support to address the worsening levels of GP coverage, according to the Irish College for GPs.
Drawing on CSO data and recently published Irish Medical Council figures, the organisation says population growth is still outstripping the increase in GP numbers with the problem being most acutely felt in rural areas due the greater proportion of people aged over 65 and the tendency of new GPs to work in larger towns and cities.
A number of measures, backed by the Department of Health and the Health Service Executive, including increased recruitment of doctors from abroad to work in rural areas and a generally expanded training programme, have been instigated in recent years. These are designed to address growing shortages related to the increasing and ageing population as well as other factors related to demand including the expansion of free GP care.
The IMC figures suggest the total number of doctors working in general practice last year was 4,456, up from 4,431 12 months previously, an increase of just 0.6 per cent.
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The ICGP points to an increase in the general population of just over 3 per cent, citing CSO preliminary 2022 census data and estimates for 2023. Other estimates put the scale of increase at between 2.6 per cent and 3.5 per cent.
The resulting GP to population ratios vary considerably across the country with 102 per 100,000 in Waterford and Galway but just 54 per 100,000 in Meath and 57 in Monaghan.
In Dublin, which is estimated to have experienced a 3.5 per cent increase in population, the number of working GPs is reported to have dropped from 1,334 to 1,316, a decrease of 1.3 per cent.
There are currently 1,191 GPs in training, the organisation says, up by a fifth on last year, with 350 having commenced their training last month. The benefits are still several years away from being felt, however, and in the meantime the shortages are said to be contributing to the numbers of doctors retiring from or closing practices, particularly small rural ones.
“It takes time for these things to wash through,” says Dr Mike O’Callaghan, clinical research lead with the ICGP. “In the meantime, there is a need for a greater focus on supporting practices in areas where there are particular shortages, those in rural areas, single-handed GPs.
“There needs to be more support for practices to ensure they don’t fold and to encourage new GPs not to follow the general migration trend into urban areas.”
Dr O’Callaghan says the ageing population issue is relevant across the country with the number of over-65s having increased from 570,000 in 2013 to 806,000 in 2023. Those numbers are projected to continue rising substantially in the coming decades.
Within that, he suggests, however, counties in the Border region and parts of the west and southwest tend to be disproportionately older and a greater number of young people leave for larger urban areas.
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“There is a massive growth in the number of older people and the reality is they have greater medical needs,” he says.
The GP shortages are also, he suggests, being acutely felt in some Leinster counties including Kildare and Kilkenny.
ICGP chief executive Fintan Foy said the organisation hoped the data “will help guide policymakers to ensure general practice is fully resourced to meet the needs of our growing and ageing population”, but echoed Dr O’Callaghan’s support for targeted action.
“We need a real focus on rural and urban deprived general practice, and the support of the HSE in helping GPs who wish to set up new practices in areas of expanding population,” he said.
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