GP shortages: State 'treading water' as population increases 9%
James Cox
While there has been a 10 per cent increase in the number of GPs, the State is "treading water" when it comes to shortages as the population has increased by nine per cent, according to the medical director of the Irish College of GPs (ICGP).
In an interview with BreakingNews.ie, ICGP medical director Dr Diarmuid Quinlan said: "We have made a lot of progress. Where previously I would have referred to it as a crisis, I would probably use less urgent terms now, but we still have a significant shortage in the GP workforce."
There are currently 4,650 GPs in the State, up from 4,200 in 2019, but Dr Quinlan estimates a need for 6,500 or more GPs in Ireland due to current demand and population growth.
"What we need is more GPs. In 2022, we had 4,200 GPs; this year we have 4,650. It's up about 450, which is great, very welcome, so the GP workforce is up about 10 per cent. However, in that time, the population has risen by 9 per cent.
"So we are just about treading water. In comparison, the hospital doctor workforce in that time has increased by almost 40 per cent.
"What do we need? We need well north of 6,000/6,500 GPs."
He added: "We also need to double our GP nurse numbers; there are currently about 2,200, we need to double that because they do a huge amount of work in terms of preventative illness."
Dr Quinlan explained that population growth is a key factor in the need for additional GPs. With the population now standing at around 5.2 million, it is expected to hit 5.5 million by 2030.
"That might sound like a small jump, but that's 300,000 extra patients, which will require another 300 GPs," he said.
Ageing population
Dr Quinlan said Ireland's ageing population also brings demand for GP services.
"People aged 65 and over are the main consumers of our healthcare at a national level. In 2019, there were 720,000 people in this age group; by the end of 2024 that was up to 830,000. The HSE and the Department of Health expect that by 2030 we will have in excess of 1 million people over the age of 65.
"We now have the longest life expectancy of any country in the EU. This is a real testament to all the stakeholders in improving the healthcare of older people."
He added: "With that comes additional needs for healthcare. As we age, we all accumulate illnesses. People aged between 45 and 65, 30 per cent of them have two chronic diseases, mostly heart disease and lung disease like COPD.
"People aged 65 to 84, two-thirds of them have three or more diseases, heart, lung, and bone issues. In people aged 85 and over, 85 per cent have four or more chronic diseases. Heart, lung, bones, but also dementia and chronic kidney disease are common in this age group.
"People accumulate illnesses and then are on lots of medicines.
"In people aged over 65, five per cent of them are on 15 or more medicines, and two per cent of them are on 10 or more medicines, so that's a lot of medicine... a lot of work for doctors.
"What is also really important is that 10 per cent of all emergency admissions in hospitals are related to adverse drug events, and about half are avoidable. There is scope to improve outcomes for patients and also reduce emergency, unscheduled hospital attendance.
"The mean length of stay for patients hospitalised due to adverse drug events is 11 days."
Money spent on training GPs in Ireland is money well spent.
Dr Quinlan said the GP workforce is also ageing.
"Data shows we have around 600 GPs aged 65 or over.
"Three hundred of these were aged 65 to 69, and 300 GPs are still working aged 70+, so it's not unreasonable to assume in the lifetime of this government, by 2030, that cohort aged 65 and up will largely have retired.
"We don't just have an expanding population; we have a significant number of GPs retiring. Covid has not gone away, so we are still doing tens of thousands of Covid vaccines. We are still seeing people with acute Covd, assessing people with long Covid.
"There has also been a GMS [General Medical Services] expansion. We know that when medical cards were introduced for children under the age of six, the consultation rate for that age group increased by 30 per cent. This is not criticising the children or the parents at all, their consultation rate came up to the NHS and European norm for children in that age group. So that's wonderful, and clearly cost was a barrier.
"But there are implications of people consulting their GP more when you have a limited GP workforce."
Dr Quinlan said the ICGP is working closely with the HSE and the Department of Health to "substantially increase our GP training".
He pointed to the 2015 figure of 155 trainee GPs, while there were 350 trainees in 2024.
"We were meant to reach 350 by 2026, but we got there earlier with the support and encouragement of the Government, Department of Health and HSE, two years earlier, so that is very good.
"We do know that the vast majority of people who complete their GP training not only do they stay in Ireland, but the majority stay in the area where they did their training.
"A small number, probably 5-10 per cent, emigrate, often for personal reasons.
"Money spent on training GPs in Ireland is money well spent, so we need to support GP training."
In terms of addressing the GP shortage in rural areas, Dr Quinlan pointed to the International Medical Graduate (IMG) Rural GP Programme.
This is a collaborative initiative between the ICGP, the HSE, and GP indemnity organisations. It aims to address the severe shortage of GPs in rural Ireland by identifying, supporting, and integrating experienced non-EU doctors into rural practices.
"To date, we've had about 170 people on the programme. If you look at the uplift of GP numbers, this is an important part of the jigsaw.
"The first cohort have graudated and have taken up posts in rural areas.
"It's a bonus for rural communities to have these highly skilled GPs."
Dr Quinlan called for additional support for infrastructure, both in terms of buildings and computer systems, to boost the number of GP practices in rural areas and to help existing practices which are "bursting at the seams".
"We need to look at the rural population. There are fewer GPs per head of population, while the patients are generally older with more chronic diseases. Rural practices need particular supports and incentives to attract GPs to come, and this is a global phenomenon."
Dr Quinlan also said he would like to see medical students spending more time learning in GP practices and about the work they do in communities.
"UL has about 25 per cent of its curriculum in general practice, Ulster University has over 30 per cent.
"In week one, medical students are out in GP practices, being exposed to it and seeing what a wonderful career it is.
"In Ireland, some of the medical schools see the GP component of the curriculum being less than 10 per cent. The medical schools need to be resourced to have students in general practice to show them what a fabulous career it is."
There are patients who simply cannot get a GP, and that is why we are working so hard with the HSE and the Department of Health to expand the GP workforce.
While we are all familiar with stories about people not being able to get access to GP care, Dr Quinlan stressed that GPs are doing everything they can to address this while carrying out 29 million routine consultations per year.
"There are patients who simply cannot get a GP, and that is why we are working so hard with the HSE and the Department of Health to expand the GP workforce.
"We do know that most GP practices treat some urgent illnesses. GP and GP nurses between us see in excess of 29 million routine consultations a year and 1.5 million GP out-of-hours consultations.
"The data clearly shows that in excess of 500,000 people per week are seen by a GP or GP nurse. We regret that there are people who can't be seen, and we're working to address it. However, over 500,000 people are seen by their GP or GP nurse every week.
"We do well in excess of 80 per cent of the patient consultations in Ireland. We are the bedrock of the health service.
"We need to specifically look at the challenges facing doctors and rural communities.
"Commercial propertly in rural towns can be eye-wateringly expensive, so it's difficult for younger GPs to establish a practice or existing GPs to expand their practice."
