GP survey: Family doctors have less access to X-ray tests for their patients than they had 13 years ago, a major study of the structure of general practice in the Republic has shown. And the percentage of female GPs has doubled over the same period, while total family doctors numbers have increased by 28 per cent.
The study, due to be published at the annual meeting of the Irish College of General Practitioners (ICGP) in Galway this weekend, found that access to skeletal X-rays (such as images of the hand, knee and spine) for patients attending general practice has dropped from 84 per cent to 70 per cent of doctors in the years between 1992 and 2005.
There was also a reduction in the number of family doctors who were able to organise a chest X-ray on behalf of their patients over the past 13 years.
The findings have implications for the accident and emergency crisis in hospitals. Without direct access to X-ray, in most cases GPs would have no option but to refer the patient directly to the nearest A&E department, thus contributing to overcrowding.
Both the Minister for Health, Mary Harney, and the chief executive of the Health Service Executive (HSE), Prof Brendan Drumm, have said they are committed to expanding the range of diagnostic services that can be directly accessed by primary care doctors and their patients.
Commenting on the findings, the lead author of the study, Prof Tom O'Dowd of the Department of Public Health and Primary Care in Trinity College Dublin, said: "If a GP wants to get a person with an injured ankle X-rayed, it means he has to send the patient to A&E rather than the X-ray department. It highlights how disconnected various parts of the health service are.
"Prof Drumm has promised to appoint radiologists with direct responsibility for community radiology. This survey emphasises that need. Another way forward is for the HSE to buy radiology access from the private sector."
On a positive note, the GPs, who were surveyed by Prof O'Dowd, Dr Fergus O'Kelly and Mr Mark O'Kelly, reported an increased availability of ultrasound tests in 2005 compared with 1992. Direct access to an electrocardiogram (ECG) also increased.
In terms of new services provided in general practice, travel vaccinations, minor surgery and joint injections are now widely available. Some 43 per cent of doctors provide specialist clinics for patients with diabetes, asthma and cardiovascular problems. Acupuncture is available from just 4 per cent of GPs.
Compared with similar surveys carried out in 1982 and 1992, the number of female GPs has increased to 30 per cent of the GP workforce. Family doctor numbers have climbed from 1,937 doctors in 1992 to 2,477 in 2005, a 28 per cent increase.
With more GPs and a greater age spread of doctors, Prof O'Dowd said he felt the manpower situation in general practice was not as bad as people had feared. "With an increasing number of vocational trainees and a surprising number of doctors wanting to stay on past retirement, this means that the more pressing workforce problems can be avoided in the short to medium term."
However, chairman of the ICGP, Dr Eamonn Shanahan, pointed out yesterday that in the region of 800 GPs, the majority of whom are male, will retire in the next 15 years. Emphasising the gender shift to a predominantly female GP workforce and a projected population increase of 1,000 people a week in the Republic, he said: "There is a need to increase the number of trainees entering general practice - some 150-160 trainees a year is about the right number."