Rural GP services could become a thing of the past as a result of new national policy and the ending of grants for doctors with practices in rural locations, Cllr Pat Crowley (FG) has warned.
The risks are twofold, says Cllr Crowley, himself a GP who lives in Kells and has a practice in Kilmoganny.
The first relates to legislation that is currently going through the Oireachtas to “regularise” professional services according to European norms. The idea is that anyone on the Irish College of General Practitioners register will be able to open a practice anywhere in Ireland and accept both private patients and those with medical cards.
While it will have the benefit of boosting competition and giving new doctors a better chance of working as GPs, Dr Crowley said, “on a practical level it will probably mean that doctors entering general practice will tend to go into practice in the larger centres of population, particularly towns and cities.”
“Since the early 1800s, doctors were appointed to positions in rural areas and need to have some incentive to settle there to administer GP services to local rural populations,” he said.
This relates to the second risk he cited for rural GP services, the ending of a grant for doctors who operate rural GP surgeries.
“It has come to light recently that the HSE (Health Service Executive) is withdrawing rural practice grants from practices that become vacant in rural areas, and if this becomes the norm or widespread, the sustainability of rural practices on an on-going viable basis is called into question,” Dr Crowley said. “Without the rural practice grants scheme, many of the rural practices would become nonviable overnight. Not even in the British times in Ireland in the 19th and 20th centuries was this done, but yet we seem to be sleepwalking into a situation where in 2011 and 2012 we will be doing just that.”
He gave the example of a post that was advertised in Newbawn, County Wexford. In that case the grant was withdrawn when the local GP retired, and the doctor who was hired to replace him “discovered that the financial implications were so bad that he had to walk away from the practice as he considered it nonviable.”
Closer to home, Dr Crowley himself operates in a practice that has traditionally had a rural practice grant attached to it, “and in the future I and many other doctors when we come to retirement age are looking at these practices becoming extinct.”
“Left to their own devices” – i.e. in the absence of these rural grants – “GPs, particularly young GPs, are not likely to apply for these jobs or move into these areas to practice medicine,” Dr Crowley said. And “with the development of primary care centres and primary care teams all located in towns, this will mean there is a big question mark over the survival of the traditional rural practice. This is neither desirable not practical, particularly from the patients’ point of view, and the authorities – whether in government or HSE – should make it their business to see that the rural practice grant scheme is maintained into the future to preserve rural practice.”