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GPs should earn 80% of consultants’ pay

24 Feb 2017

The ICGP warns that urgent action on recruitment and retention is needed to tackle the growing shortage of GPs, especially in rural and deprived areas, reports Gary Culliton

International evidence on primary care services suggests that to have a strong primary care system, GPs should earn at least 80 per cent of the salaries of their hospital consultant colleagues, an Oireachtas Committee has heard.

A recent TCD study found that 76 per cent of all GPs were full-time and worked eight clinical sessions a week, with another three devoted to paperwork. Yet there was evidence that these GPs worked 60 to 70 hours a week and then provided an out-of-hours service, according to Dr Karena Hanley, ICGP National Director of GP Training.

Of those who trained in general practice, 92 per cent remained in the specialty. However, the numbers of vacant GMS lists have been accelerating, the Oireachtas Health Committee was told earlier this month during a session devoted to GP workforce, capacity and resourcing issues. The vacant lists numbered approximately 14 in 2014, 21 in 2015 and now totally 24.

“Ireland will continue to see an exodus of GPs unless clear actions are taken now, and there will be a shortage of approximately 1,000 GPs in the next 10 years,” warned Dr Hanley.

‘Sadness and ill feeling’
While she said general practice was still an attractive career, with dropout rates during training low, GP trainees now feared that Irish general practice was not a viable career choice, with posts in Canada, Australia and New Zealand better resourced and those countries actively recruiting in Ireland, Dr Hanley told the Committee. “As well as the economic loss, it is a cause of sadness and ill feeling.”

She explained to members how there was a lack of flexible working options in the current GMS contract. In terms of gender, two-thirds of women doctors worked full-time, but they tended to work part-time in their 30s, which was a time of intense child rearing. A proportion of male doctors also worked part-time, but some doctors who were employed by a practice did not hold a contract with the State, and often did not receive any maternity or sick pay.

Some older GPs intended to continue practising beyond their contracted retirement age, and that needed to be welcomed, planned and supported, with flexibility in the contract, she added.

The National Doctors Training and Planning (NDTP) unit has indicated that 100 more GPs would need to be trained every year to meet demand. The ICGP supported that goal, and could deliver it, if resourced, stressed Dr Hanley. “We are currently training 172 GPs per year. In the past six austere years, the ICGP delivered a 43 per cent increase in training places with barely any increase in resources. The dilution of GP training must be avoided as dilution will result in less resilient GPs with fewer skill sets, and this will not help retention.”

She lamented that Ireland was “giving away our GPs”, who were not returning in any significant numbers. “Some 92 per cent of graduates from GP training remain practising as GPs, although, alas, at the moment not all of them in Ireland. Retention of GPs trained in a rural area was very good, however. For example, in the past 30 years, of the 100 doctors trained in Co Donegal, 50 had stayed practising as GPs in the county.”

Rural training
“Co Cork has an even higher retention figure. Train the GPs in rural areas and they will stay there,” she stressed.

Access to diagnostics would also help, in Dr Hanley’s view, although she accepted that some improvement in access to ultrasound was achieved in some areas of the country last year.

The ICGP vision for rural practice backed education and training initiatives, financial incentives and locum supports as well as funding for a rotating assistantship. “I cannot overemphasise the efficiency and productivity of a well functioning, good general practice team,” said Dr Hanley.

In terms of direct employment by the State, she pointed out that practice nurses and staff being employed by the HSE “fragmented care”. “Someone who is self-employed in his or her own business can increase productivity by 20 per cent compared to state employment or a large, anonymous organisation.

One will not have unity of the practice message and one will not have unity of the practice objective and vision.

“There is a loyalty and a continuity of care,” the Donegal GP added. “If one fragments that and loses that dedication to the general practice vision and objective within that practice, one will have lower productivity and worse outcomes than one has in the tight ship that a good general practice is.”

A total of 66 per cent of emerging GPs saw themselves being independent contractors in five years. “There may be a place for salaried GPs, but the independent contractor model must be bolstered as the mainstream model. We already have salaried GPs in some of the island areas,” noted Dr Hanley.

The post GPs should earn 80% of consultants’ pay appeared first on Irish Medical Times.

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