With up to 50 per cent of GPs expected to retire in the coming years, parts of rural Ireland may be left without their local and trusted GP. Irish Farmers Monthly speaks to 29-year-old Dr Maitiú O Tuathail, from Co. Galway, recently appointed president of the National Association of General Practitioners, about the challenges facing general practice in Ireland today and finding solutions to ensure there are sufficient numbers of young GPs to keep general practice alive and well across Ireland.
Just two years ago, Dr O Tuathail joined the National Association of General Practitioners (NAGP) Council as its GP trainee representative. Speaking at the recent NAGP AGM, Dr O Tuathail said that journey commenced out of ‘sheer frustration’.
“Within several days of starting work as a general practice registrar in Ashbourne, Co. Meath, I quickly learnt that it would take me a month to get a chest x-ray report, that I was denied access to basic scans, and that many bloods in our local hospital were ‘consultant-only’.
“We had little functioning support from allied healthcare professionals. I started off by writing harshly worded letters to the hospital CEO, but within days, my trainer at the time, Dr Stephen Murphy, quoted Muhammad Ali, when he said to me: “The man who has no imagination has no wings.” This was his way of saying, stop moaning and do something about it. With just a few months left before his GP qualification is complete in July, Dr O Tuathail is ready to do something!
IFM: Congratulations on your recent appointment. How do you feel about taking on this role?
MOT: I am hugely humbled and honoured to have been selected as president of the NAGP. It hasn’t fully sunk in yet, but I am incredibly thankful to the NAGP for having given me this opportunity. I feel a huge sense of responsibility now to represent our members and general practice as best I can.
IFM: Why did you want to take on this role?
MOT: I am from rural Ireland, and the plan – long-term – is to return home, to Leitirmóir in Galway and be the rural GP there. I have always wanted that. But the conversations I have had with the GPs at home paint a picture of a specialty on its knees, bursting at the seams with the workload and with little to no support from the HSE. I genuinely want to change that, so general practice, again, becomes the best specialty in Ireland, and I believe that is achievable.
IFM: You are the youngest ever NAGP president. Is this a progressive move and why?
MOT: I really think it is. I think 2018 will be a landmark year for general practice in Ireland. I think, whether general practice lives or dies, will be based on actions that my generation will take, whether we stay or go. I think the NAGP Council gets that. I think this year, we – as a specialty – need to get the boxing gloves on and I’m happy to do a few rounds in the ring if that’s what it takes to achieve change. Minister for Health, Simon Harris, is only a year older than me and one of the first things I’d like to do, once in the role, is sit down with him, and have a frank conversation about where we are at, in terms of general practice.
IFM: What are the main challenges that exist in general practice?
MOT: Where do I start? I meet and hear stories from GPs up and down the country and it’s the same narrative throughout. Many have their backs to the wall. We recently asked the NAGP membership where they felt our priorities should be in 2018 and the overwhelming result was the reversal of Financial Emergency Measures in the Public Interest (FEMPI). FEMPI resulted in a 38 per cent reduction in funding for GPs and that has really hit hard. So, this has to be priority one, as many of the other problems really stem from the financial difficulties that GPs are having.
The lack of locums is also a huge issue. Our local GPs at home just don’t take holidays or days off. I spoke with a GP in rural Galway recently who hadn’t taken a day off in 18 months. And he is more than twice my age. It’s bananas! I think we really need to start looking at a system where GPs get the annual and study leave they’re entitled to – and that would require a nationally supported locum system to be put in place. This is something my generation wants. We simply will not work without a break for a year. It’s unsafe for patients and it’s unsafe for doctors. This is something I’ll prioritise this year for the new generation of GPs. For me, and for trainees, the third big issue is access to diagnostics. GPs are incredibly skilled specialists but many of us feel that we cannot work to our full potential because we have zero access to diagnostics. I was gobsmacked on my first day in general practice when I realised it would take six months to get a physiotherapy appointment and that I had no access to the most basic blood tests! I remember going to another GP at the time, who pointed out that an intern with no experience in a hospital can order all these and more but a specialist GP with 30 years’ experience cannot! It’s embarrassing for me as a GP and it’s something I think we need sorted before there is any talk of chronic care provision. Fix the basics first.
IFM: How do you plan to reverse the low morale that exists in general practice?
MOT: We need two simple things, that most other workers take for granted: access to the resources we need to do the job to the level we are experienced and expected to do; and the ability to take a break when we need it. I think if we had these basics, both the mental and physical health of our GPs would greatly improve.
IFM: What is positive about being a GP in Ireland today?
MOT: I think being a GP is the most rewarding job in the world. Continuity of care is what makes it special. No one else has that. In any job. I remember early on, during my first year as a registrar, I overheard a conversation at the reception desk where one of the patients asked for an appointment to see ‘his doctor’, Dr Matt. The patient was in his sixties, and I was unavailable but he was happy to wait the two days to see me. I felt an incredible sense of pride in that. I’d never felt that before. But, that doctor-patient relationship is something special, and an incredible privilege to have. My mother keeps reminding me how unique our job is, anytime I give out about it. She keeps telling me that children are the most precious things in the world to their mothers, and she always tells the story of when we were sick as kids she would attend our local GP, Eddie, and just hand us over to him. That level of trust in a GP is something special, she would say. She is right. Sometimes, when I have a tough day, I just try to think of moments like that.
IFM: Are you excited about your own career?
MOT: Absolutely. I can’t wait to do things my own way and adopt my own style of general practice. At the moment, I am leaning towards group practice. I love the idea of having a team, such as a registrar and intern. I think if we are going to have a GP-led healthcare service, we have to realise that we will need more personnel in general practice. So, I would hope that, in the future, we would have more junior doctors in general practice. I think this is vital to give doctors a flavour of what general practice is like. I was in Liverpool at a leadership conference in October and they have an initiative whereby GPs go to a hospital to shadow a hospital doctor for a day and vice versa. I think this is a genius idea, so that we can all gain an appreciation of what our jobs are like. I’m looking into organising something like this.
I would also like to teach in some form, as I really enjoy it and it’s a great way to keep you on your toes. Having a GP registrar and regular medical students would be the dream. I’m not pushed about hours or hard work as long as I can take breaks when I need them. I love learning and, to date, have done about two diplomas a year, so I’d like to be able to dedicate time to this when I need to.