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Irish Examiner
16-07-2025
- Health
- Irish Examiner
Do we need a new model for GP care?
General practice is in trouble. A Cork-based director of Irish College of General Practitioners, Dr Diarmuid Quinlan said earlier this month that between 60 and 80 Cork and Kerry GPs are due to retire within five years. Perhaps a new model of care is needed. A recent report on GP supply and demand in Ireland from the Economic and Social Research Institute (ESRI) found that GP retirements in several counties will put services at risk where there is no viable replacement for them. While the number of training places have improved substantially, increasing from 155 a decade ago to the current figure of 350, this has happened at a time of rapid population growth along with increased life expectancy leading to increasing numbers of people aged 65 and over. Dr Diarmuid Quinlan. 'In 2019, we had 700,000 people aged 65 and over, by the end of 2024 that was 830,000 and we expect it to exceed 1m by 2030,' Dr Quinlan said. Older people, often with multiple medical conditions, play higher demand on GP expertise and GP care. The ESRI research, funded by the Department of Health, predicts that the demand for GP visits is expected to increase by much as 30% in the next 15 years, with an extra 1,200 doctors needed to keep pace. The report highlighted that 'lack of nationally representative and accessible data on general practice presents a major challenge for effective capacity planning. 'It remains unclear whether current measures will be sufficient to meet future demand.' Lead author and associate research professor at the ESRI, Dr Sheelagh Connolly said there is already some evidence that general practice is struggling to meet existing demand. 'The recent increase in training places for GPs — from 258 in 2022, to 285 in 2023 and 350 in 2024 — should help but would need to be closely monitored over time to ensure supply keeps pace.' But GP numbers are not the only problem. Housing costs, costs of commercial premises, working in isolated rural areas; a mismatch between availability of GPs in low-income areas where they are needed most; burnout; lack of appreciation of GPs as specialists within the medical fraternity — these are all issues that have been identified and will need to be given focused attention if the numbers are going to match medical need in the coming decades. UK general practitioner and freelance healthcare advisor Helen P Davies attempted to address some of these issues in a recent article in the British Medical Journal. After 40 years as an NHS doctor and 34 years as a partner in General Practice, at the point of retirement, Dr Davies suggested that general practice is under existential pressure. With that in mind, the article, written with chief medical officer and consultant cardiologist Kiran Patel is about 'reimagining the value of general practice.' 'It's provocative," Dr Davies said, 'but I believe now is the time for brave conversations if General Practice is to survive and remain at the core of the NHS.' Brave conversations are exactly what General Practice in Ireland also needs. Davies and Patel suggest that critical to success is the organisation of general practice to support neighbourhoods and integrated care teams. Burnout and low morale The article highlights widespread burnout and low morale among GPs with many choosing part-time work, an erosion of identity and divisions emerging between salaried and partner GPs. These problems are not confined to the UK. A survey by the Medical Protection Society in 2024 found that almost two thirds (64%) of doctors in Ireland say they are frequently burnt out and exhausted while almost one-in-five (19%) described their mental wellbeing as 'of concern.' Just over half (53%) said they felt disillusioned or disengaged at work while 60% said the Government does not do enough to discuss mental wellbeing issues at work. A recent article in the Irish Medical Times also highlighted the lack of visible public and professional appreciation for GPs that is undoubtedly contributing to the undermining of the specialty. 'The mismatch between the narrative of the GP as a family doctor providing continuity of care and the current realities of poor morale, recruitment, and employment challenges, and part-time work is fuelling negative public perception,' Dr Davies suggests. 'GPs are working harder than ever but the supply-demand mismatch is leading to compromised care.' The authors write that what is needed is a population-based service delivery. They suggest the single front door model of general practice is no longer effective and propose a model that moves away from the individual GP practice. They propose that a better alternative would be designing an integrated team approach by designing services around cohort needs and population health management principles while accepting that different groups in our communities need different types of services. Rural communities with large numbers of elderly people have different needs to young urban populations. Communities with large numbers of young families or low-income communities with specific and often unmet healthcare needs are often not matched by appropriate healthcare services at local level. 'The small business model of general practice is no longer appropriate for an integrated healthcare system.' The authors suggest that one option is a provider model that combines primary, community and acute care. GPs would be salaried with a redefined role more closely aligned to a multidisciplinary team and critically, the model would support the creation of a new role — a consultant in primary care. Another model would be the aggregation of practices into mega-practices that would allow for the partner model to continue but would allow much closer integration between acute health services and community health services. The authors highlight how this model is likely to be unpopular with both GPs and patients. 'We believe that we must value and relaunch the status of general practitioners recognising them as expert generalists,' the authors write. 'We advocate for recasting the role of GPs as 'consultants in primary care.' This would involve reviewing the training and salary structures to ensure parity with secondary care consultants.' While these proposals are challenging particularly in Ireland where the lifetime support of one GP practice is so valued, Harris and Patel suggest that the proposed solutions would aim to tackle health inequalities 'as well as tackling the inverse care law, through a needs-based approach to planning, ensuring equitable access to care across communities and strategic resource allocation.' GPs in Ireland as consultants in primary care, coordinating primary, community and acute healthcare in a local model that focused on a population-based approach that matches health services to local needs across the community. Would such a model be acceptable to GPs and patients in Ireland? It certainly provides food for thought as we face into the increasing needs of an ageing and diverse population in a decade of overwhelming uncertainty. Dr Catherine Conlon is a public health doctor in Cork Read More GP practices in West Cork close their lists to new patients due to shortage of doctors
Irish Times
09-07-2025
- Climate
- Irish Times
Heat wave advice: How to look after your pet, garden and family in the hot weather
Ireland's summer is finally expected to kick into gear this weekend, with temperatures forecast by Met Éireann to reach highs of 21 to 28 degrees between Thursday and Sunday. Uisce Éireann has also announced that national water supplies are in drought status, with warnings in place for three areas of the country. 'Irish people get really excited when the weather gets good, but this means we are prone to overdo it,' says Dr Suzanne Kelly, deputy medical director of the Irish College of General Practitioners . Rather than leave the hosepipe running all weekend, follow these recommendations to take care of your pets, children and garden through the mini heatwave. READ MORE For pet owners: Walk your dog in the morning Peter Bishton, deputy chief executive of Veterinary Ireland, says pet owners should ensure their animals have enough fresh water, adequate ventilation and cool shade at all times. Exercising your pet under the hot sun or leaving them in a hot car could be very uncomfortable for them and even fatal. Dogs that are short nosed, naturally very active, have a thick coat and are older or younger are particularly at risk of overheating. Animal welfare experts recommend walking your dog in the early morning or evenings, when temperatures are cooler, and to watch out for signs of heatstroke. Dogs cool off in the river in Murr, southwestern Germany, in June as temperatures exceeded 32 degrees. Photograph: Thomas Kienzle/Getty Dogs and cats can get sunburned too. Pet sunblock – not human creams which can contain some chemicals toxic to animals – might be a good idea for white-haired pets that enjoy sunbathing. When cooling off in rivers, lakes and ponds, dogs are at risk of algae poisoning and secondary drowning from taking in water through the mouth. Bishton says that while it is rare 'the risk of drowning increases during the summer months, through a higher rate of exhaustion, or from cooling down too rapidly'. For the garden: Water plants twice a day – if allowed Luckily, the sunny spell this weekend is unlikely to harm most Irish household plants, says James Fennell, owner and manager of the kitchen gardens of Burtown House in Co Kildare. But to keep plants hydrated, Fennell advises gardeners to water plants twice a day in the morning and evening, and never in the middle of the day. However, gardeners should avoid using hosepipes over the weekend and stick to watering cans instead, says Uisce Éireann, as the water network is experiencing increased pressure on supplies. Residents in Mullingar, Milford, and Kells-Oldcastle are asked to pay special attention to water-conservation. For those with larger gardens with glasshouses or polytunnels, 'open them in the morning and leave them open all night because they become super hot,' Fennell says. Watering cans, rather than hoses, are best way to conserve supplies while giving plants a drink. File image. Photograph: Strelciuc Dumitru/Getty He and his team will be harvesting their produce more regularly as the warm weather encourages fast-paced growing. And now is the time to do large-scale weeding: 'The warm weather is a great time to hoe small weeds because they will die very quickly in the sunshine, meaning you can do it very quickly.' Fennell says his team will start planting root vegetables also: 'The soil will be so warm after the weekend that we will be germinating seeds straight into the soil – planting beetroots, carrots and root vegetables, but we'll need to keep a sprinkler on it constantly to make sure they get enough water.' If your plants do look particularly weary or dehydrated, place shallow trays filled with fresh water beneath the containers, group pots together for shelter and to slow down water loss. There is no need to water lawns that have turned brown in the sunshine as they will rebound quickly when more rain comes. For the family: Keep sipping water, but don't skimp on sunscreen Sunburn is the number-one risk facing Irish people this weekend, Dr Kelly says. 'We see Irish adults sunburned after good weather all the time. When there's a breeze, we won't be aware of the damage being done to our skin. 'Good suncreams are available at a reasonable price in most supermarkets – but we don't use enough of it or apply it frequently enough.' Dr Kelly advises for young children in particular to have a good layer of suncream in the morning before they go outside, wear full-body swim suits and have hats to cover ears and neck. Overheating is likely in young children and elderly who don't have good thermal regulation. Dr Kelly says they see more heart attacks in hot weather. Older people with risk factors and a medical history need to stay indoors during the hottest part of the day, keep hydrated and cover up. A woman drinks water to cool down as temperatures reach 40 degrees in Rome on July 1. Photograph: Antonio Masiello/Getty Those who head to the beach or parks and drink alcohol at the weekend also need to be careful as it doubles your risk of dehydration and sunburn from forgetting to reapply cream and falling asleep in the sun. To get the recommended 1.8 to two litres of water per day, Dr Kelly recommends having a large reusable bottle of water on you at all times and to keep sipping away at it. While pollen can spike when the sun is not shining, those with hay fever might experience more symptoms due to farmers cutting silage. Dr Kelly recommends over-the counter antihistamines or steroids for those more severely affected. For the farm: Schedule rest times to avoid fatigue Farmers face particular challenges during prolonged periods of hot weather, with crops and livestock potentially affected. However, 'on any farm, the person farming is the most important asset', Niall Madigan, head of communications at the Irish Farmers Association , says. 'The tillage harvest is under way and the motivation is to get through as much work as possible when the weather is so good. Our advice would be to schedule rest times and avoid fatigue setting in. 'The risks associated with working on a farm can increase if those on the farm are suffering from fatigue. We would ask farmers to keep farm safety to the forefront during their working day. 'Higher temperatures reinforce the importance of being sun smart. By the nature of their work, farmers are more exposed than most workers. Have a supply of sunblock with you and keep yourself covered.'
