Brian Stanley: Warns of GP Shortage and Pressure on A&E
Brian Stanley raised the nationwide difficulty patients face getting a GP, especially those without a medical card, and warned of a chronic shortage of GPs. He urged a major ramp-up of salaried GPs, more training places and active HSE recruitment; the Taoiseach and the minister subsequently outlined support and recent capacity increases.
Brian Stanley cited an ERSI estimate that between 943 and 1,211 additional GPs are needed just to meet current demand. He said Ireland has far fewer GPs per head of population than many EU states, noting the State has roughly 60% of the GPs per head compared to Germany and other EU countries. The IMO recommends one GP per fewer than 900 people and the WHO recommends one per 1,000.
He highlighted severe local shortages, naming County Leish as an example where the average ratio is one GP per 1,600 people. Only 35 of 67 GPs in that county take medical cards, and patients without medical cards often cannot afford GP visits and resort to hospital emergency departments.
Brian Stanley warned that at least 700 GPs are due to retire between 2023 and 2026 and that too few new GPs are remaining in the State after qualification. He said costs of establishing a practice, long hours and limited support drive some newly qualified GPs to emigrate, and argued many new GPs would stay if there were more salaried positions with 35-40 hour weeks.
The minister responding acknowledged access challenges but set out recent capacity increases: more third-level places, an increase of 350 entrant GP training places since 2024, 662 additional student places in health-related higher education this year, and an expanded network of primary care centres (179 centres, 50 opened since 2020). The minister also noted 95% of GPs are signed up to the chronic disease management programme, with over 645,000 GP patient reviews in 2024 and 92% of chronic disease patients routinely managed in primary care.
Brian Stanley pressed for immediate measures: a major ramp-up of salaried GPs in general practice, substantially increased training places and active HSE recruitment into permanent positions to improve retention. He said the shortage reflects a lack of forward planning over two decades and called for urgent implementation of these solutions.
Key claims and figures
Brian Stanley cited an ERSI estimate that between 943 and 1,211 additional GPs are needed just to meet current demand. He said Ireland has far fewer GPs per head of population than many EU states, noting the State has roughly 60% of the GPs per head compared to Germany and other EU countries. The IMO recommends one GP per fewer than 900 people and the WHO recommends one per 1,000.
Local impacts and County Leish data
He highlighted severe local shortages, naming County Leish as an example where the average ratio is one GP per 1,600 people. Only 35 of 67 GPs in that county take medical cards, and patients without medical cards often cannot afford GP visits and resort to hospital emergency departments.
Workforce turnover and training pressures
Brian Stanley warned that at least 700 GPs are due to retire between 2023 and 2026 and that too few new GPs are remaining in the State after qualification. He said costs of establishing a practice, long hours and limited support drive some newly qualified GPs to emigrate, and argued many new GPs would stay if there were more salaried positions with 35-40 hour weeks.
Government response and statistics
The minister responding acknowledged access challenges but set out recent capacity increases: more third-level places, an increase of 350 entrant GP training places since 2024, 662 additional student places in health-related higher education this year, and an expanded network of primary care centres (179 centres, 50 opened since 2020). The minister also noted 95% of GPs are signed up to the chronic disease management programme, with over 645,000 GP patient reviews in 2024 and 92% of chronic disease patients routinely managed in primary care.
Proposed solutions and next steps
Brian Stanley pressed for immediate measures: a major ramp-up of salaried GPs in general practice, substantially increased training places and active HSE recruitment into permanent positions to improve retention. He said the shortage reflects a lack of forward planning over two decades and called for urgent implementation of these solutions.
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Transcript
The issue I'm raising with you is the problem that people have around the state in accessing a GP or getting a GP to take them on. It's even more difficult for patients, for people who don't have a medical card. It's a huge problem. There's a shortage of local doctors which leads to problems for some GPs trying to take holiday as relief. The emergency departments of hospitals are clogged up with people who should be seen in a community care setting or primary care. Some go to the emergency departments either because they can't get a GP appointment or they don't have a medical card and they can't afford the GP visit. Figures from the ERSI report recently outlined that we need between 943 and 1,211 to cope with demand. That is just to stand still, not to improve the ratio in terms of the head of population to GPs. But we know from several sources that the number of GPs per head of population is way too low and it's completely out of sync with our European neighbours and developed countries. The Irish College of General Practitioners has stated that we have a huge deficit and I'm directly quoting them. That's what they say. They've identified several counties to have a chronic shortage including County Leish. The IMO concur with this and they've highlighted this fact as well. The state is only 60% of the GPs per head of population compared to Germany and compared to other EU states. Some EU states are even more favourable than that. The IMO reckon that we need one GP per less than 900 people are required to provide adequate community care. The World Health Organisation says one per thousand population. In County Leish, ratio is on average one GP per 1,600 population. Only 35 GPs in the County take medical cards out of 67. At least 700 GPs are to retire in the years between 2023 and 2026. New GPs, Taoiseach, there's not enough of them in training and in many cases when they're qualified to face with the choice of trying to establish a general practice or emigrating. Some emigrate because of the cost of trying to establish a practice, pay for premises, hire equipment, hire staff, etc. and the long hours. We have a chronic shortage due to the lack of forward planning by all governments over the last 20 years. So solutions are needed now. We need a major ramp up of directly implied Taoiseach, salaried GPs working in general practice. The Taoiseach said here last week that he's in favour of this as well. Many of those trained GPs would be more likely to remain if they could work in a 35 or 40 hour week job. Particularly a lot of women who are coming into it and more women are coming in and that's welcome because unfortunately they tend to have more home responsibilities and caring responsibilities because as a society we have more work to do in that area. The number of training places needs to be increased substantially. When young GPs qualify, the HSE need to be actively recruiting them and offer them in permanent positions. Thank you, Tshak. Please. First of all, I thank the Deputy for raising this issue in terms of primary care and GP provision. Undoubtedly, in rural Ireland in particular and in some urban areas, there has over recent years been challenges in terms of accessing a GP and in terms of getting a GP. On the other hand, there's also been very significant developments and growth particularly in terms of the number of places at third level has increased very significantly over the last two to three years. Work that Minister Donnelly did with the Taunashta when he was Minister for Higher Education resulted in additional places in our colleges. It will take some time for those places to come through. We also secure additional places more generally in terms of postgraduate education and that is important. But also in terms of primary care centres, I think we have an extra 149 additional childcare centres now are primary care centres in the country, which is I think very significant. 179 primary care centres, 50 new ones opened since 2020. In terms of chronic disease, 95% of GPs are now signed up to the chronic disease management programme and over 645,000 patient reviews by GPs in 2024. 92% of patients with chronic disease are now fully managed routinely in primary care and not attending hospital for managing their condition. The number of new, as I said earlier, entrant GP training places has increased significantly, as I said in recent years, up 350 now since 2024. College and training places are continuing to grow. An additional 662 student places have been provided in higher education sector and health-related courses overall this academic year. And that includes nursing and midwifery. So the growth is there within the third level colleges, but also the quality and nature of the work of GPs is changing. So that work in chronic disease is essential actually, in terms of outcomes. And also in terms of the community enhanced care programme, a lot of GPs speak very highly of its impact. And that's why overall, our figures as a country in terms of life expectancy is improving because of the stronger role of primary and community-based care and the management of chronic disease, and also in terms of public health measures and also better quality of work within acute hospital services. Our life expectancy is above 82 now. Our mortality rate fell by 11 per cent over the decade 2014 to 2022. The mortality rate for all circulatory system diseases fell by 20 per cent in that period, with heart disease and stroke falling by 28 per cent and 37 per cent respectively. So there's another perspective to our health narrative which rarely gets articulated. Deputy Stanley. I would acknowledge that there's more training places, but as you correctly pointed out, that will take time for them to work through. The one thing we need to do better on is the retention of those who are coming out of courses, and I've outlined to you about directly implied GPs, which the tonnage said is in favour of. Under Sláinte care, it was a key part of Sláinte care. Remember that? It was agreed here in the Oireachtas back all of nearly eight years ago now. And the importance of primary and community care is absolutely central to implementing Sláinte care, and it's the cornerstone of a public health system, and we must try and do better on that if we're going to improve things. There needs to be a big shift and a big move, you know, to move health care from hospitals to primary care settings. Our hospital wards are overcrowded. Our ED departments are bulging. So the best we can hope for with the figures that are coming through at the moment is to stand still. And I'm asking you, Tisha, that standing still is not good enough. We have to do better. Life expectancy is getting longer. We will have a lot more older people, a lot more over 80s, and we need to work better at this and try and get more directly implied GPs to supplement ordinary general practice ones in the state. Thank you. The new program in Galway will be specifically focused on rural GP medicine. A huge investment is going into primary care and going into this area. Practices and receipt of the rural supports received the maximum rate of practice staff subsidies, significantly reducing possible staff costs for smaller practices. They also received the maximum rate of locum supports for leave taking. A new locum support initiative commenced in May providing GPs and receipt of rural practice supports with access to a streamlined locum sourcing service. The annual intake to the GTP training scheme has been increased by approximately 80 per cent from 2019 to 2024, with 350 new entrant training places made available from 2024. As I said, 346 new entrants commenced training last year. That was a 21 per cent increase in the previous year's intake of 286. We will continue to build on that. There is also recruitment of GPs from abroad commenced in 2023 under a joint HSEICGP international medical graduate role GP programme. 118 of those are currently in practice, and an additional 18 have completed the two-year course. Time is up. Thank you, Taoiseach.