‘We have nowhere to put people’ - Kilkenny among worst in country for GPs per capita

County Kilkenny has one of the lowest rates of GP per capita in the country according to a new report, with struggles in securing infrastructure upgrades in rural areas being cited as a key challenge in making up the shortfall.

The Medical Council’s workforce report for 2025 shows that Kilkenny is fifth from bottom in terms of GPs per person, with 76 working in the county, ahead of only Roscommon, Monaghan, Meath and Kildare.

When compared to the most recent census data of 2022, there is approximately one GP per 1,370 people in Kilkenny, much higher than neighbouring Carlow which had 102 GPs, one per 607 people in the county.

Though the total number of GPs in the country is at its highest recorded point, centralisation and lack of resources being allocated to rural centres is making it more difficult to maintain quality of services according to practitioners themselves.

Dr Stephen Brennan is a GP at Ballyhale Health Centre where his father previously held the same position since 1987. In that time services like speech and language therapy, dieticians and physiotherapy have gradually been removed from the area.

Additionally, the centre has been pushing for physical infrastructure upgrades and although they are included in the HSE Capital Plan, this is yet to translate to any actual change leading to difficulties as the centre hasn’t been able to keep up with evolving demographics.

“What we’re finding is that capacity is constrained based on infrastructure,” Dr Brennan said. “We’ve had the same four walls for the best part of 35 years and the population has changed.”

“We’re training more people than ever, which is what we need but actually what we’re finding is that we have nowhere to put people.”

“We don’t have the physical space to take someone on, and because of that, capacity and services actually start to constrain rather than grow to meet the community’s needs,” he added.

The centralisation of services in larger urban zones and dependence on cars to travel in rural areas has made connecting patients to care in the multiple towns in Dr Brennan’s catchment region harder and harder, negatively impacting patient outcomes.

“We serve maybe five or six villages and most of them don’t interconnect,” Dr Brennan outlined. “You’re relying on family members to try and get you from one place or another when you used to have the services actually out in the community and coming to all the various practices.”

“We’re not saying that people aren’t getting to appointments in Dublin or Kilkenny. It’s hard to get them from one village less than 10km down the road to the next biggest town and that’s not ideal care for them.”

The Programme for Government outlines steps to enhance and diversify professional care options including home care, community care and living supports in order to allow people to live independently as much as possible and reduce strain on the nursing home system.

However, when healthcare recruitment and infrastructure are lagging behind in rural areas across Kilkenny and the country as a whole, this becomes difficult to achieve as waits for specialists increase instead of reduce.

“Within the community posts, there isn’t the drive in recruitment out in rural areas compared to the acute sector like hospitals,” Dr Brennan explained.

“We’re saying that we want to keep people in the community and look after them at home which is what we should be doing, but what we’re seeing on the ground is that people are waiting over a year to see physiotherapists and occupational therapists.”

“It’s not because people aren’t working hard. Everyone is working to the absolute capacity, but the jobs aren’t there. People aren’t in posts to fulfill that,” he continued.

The Medical Council’s data also showed that over 20% of GPs nationally are aged 55 or above and approaching retirement age. The reduction of infrastructure compounds these losses in service as when GPs retire in rural areas, their practices are often not replaced to past levels.

“The service doesn’t contract when people are retiring, it tends to just disappear,” Dr Brennan said. “If a GP retires, unless there’s a clear succession plan in place, the practice tends to vanish and that’s a community without a service.”

“We’re training more people than ever but that doesn’t translate to appointments directly. That doesn’t translate to how quickly people can be seen or where they can be seen.”

“That just translates to more GPs but if you don’t have an infrastructure for them, it will be the same situation in that one area may need another GP, but if there’s nowhere to sit and see people, it’s just not going to happen.”

Though challenges in Ballyhale and elsewhere in the county are longstanding, Dr Brennan is confident that the current level of medical training and recruitment will improve the situation so long as the required facilities are given the proper funding.

“I’m optimistic the teams will be good. There’s high-quality people being trained, and there’s high-quality teams in development but we need that support coming up.”

“If we’re serious about keeping people at home, keeping people in their communities and keeping health care local, then we do need this investment piece.”

Article funded by the Local Democracy Reporting Scheme