10th May 2002
The Medical Manpower Crisis Must be Addressed Immediately
The System must develop more flexibility and attractiveness to retain Graduates, whether in the Hospital or in the Primary Care setting. There is an urgent need to look at the development of more flexible (eg part-time and sessional) contracts in both sectors, which reflect the different aspirations of the modern day doctor, whilst providing a quality service.
Given the length of time from enrolment in University to specialist qualification there is an imperative to address this issue now.
An Integrated Approach to Medical Manpower
There is a need for an integrated approach to medical manpower in our health system. Hospital workload is determined largely by referral from Primary Care and General Practice. A properly resourced and staffed General Practice and Primary Care system, can assist in a reduction in hospital workload and demand, and provide cost effective care to a large number of patients who currently attend hospital inappropriately.
We need to ensure that we train an appropriate ratio of General Practitioners and Consultants to meet the needs of the system and to ensure the correct balance between Primary and Secondary Care. Hospital manpower and General Practice manpower requirements are intertwined, and consequently should not be addressed in isolation from each other.
If we continue to address Hospital manpower issues in isolation from General Practice, and increase Consultant numbers, without a parallel increase in General Practitioners, we may by default create a Hospital and Consultant led Health Care System, which would involve serious cost implications to the State.
The terms of reference of the National Task Force on Medical Staffing need to be adjusted to reflect the balance between manpower for Primary and Secondary Care. Otherwise it is necessary for the immediate establishment of a parallel General Practice manpower task force to compliment the workings of the National Task Force on Medical Staffing.
There is a problem with both production and retention of General Practitioners
The number of students who listed medicine as their first preference in the CAO last year was in excess of 1200, however, each year only 330 Irish citizens are funded and allowed by the government to take up medical school places through the CAO. It is essential that the number of places available to Irish citizens in 2002 be increased by at least 50%.
Irish doctors graduating from our medical schools each year do not meet our current replacement needs, due to career change, part-time working etc. New General Practitioners report disillusionment with working conditions, workload, long hours and the frustration of professional aspirations. Career demands frequently conflict with family life and female General Practitioners, who comprise the majority of new GP Trainees, increasingly opt to work part-time, which further aggravates the manpower crisis.
Established General Practitioners are experiencing difficulties in securing locum cover for holiday and maternity leave.
The End of Self-Structured Training in General Practice
Self-structured training is no longer recognized for entry to the General Practice specialist register. The end of self-structured training, the surplus of applicants and the restricted number of places in Irish training schemes, means that it is far more likely that we will lose a considerable number of medical graduates to the UK for their training, and possibly also for their careers. There were 190 applications for GP Training places this year, with only 75 training places available, this means a potential loss to UK training of 115 per year.
The number of GP Trainees required per annum is about 150. With two years of GP Training taking place in Hospital posts, there is a need for 300 NCHD Hospital posts designated and suitable for GP Training.
Ireland has the lowest number of General Practitioners per head of population in the EU
When related to population, we have only one third of the number of permanent doctors compared to countries such as the USA, Canada and France, half that of the EU average and two thirds of the United Kingdom.
Health Boards are having difficulty in filling vacant GMS posts, both in urban and in rural areas, with no applicants at all in some cases.
The government's new ten-year strategy significantly underestimates the need for additional General Practitioners at 500, over the next ten years. The additional number of permanent doctors required over the next ten years will be more than 2,000. This figure would not even achieve the current EU average when related to population.