Capitalising on interest in general practice

In this edition, Niamh Cahill reports that applications for GP training have continued to increase.

Since 2020, the Irish College of GPs has facilitated a 68 per cent growth in trainees. This is in response to mounting GP shortages, expanding population needs, the shift to more community-based care, extension of GP visit cards, and significant looming GP retirements.

The launch in 2023 of the international medical graduate rural GP programme is another part of the response (an update on this programme is also included in this edition, see news, p3). This programme, which was initiated by the College and the HSE, aims to identify, support and integrate a cohort of international doctors into the rural GP workforce. It incorporates two years of self-directed learning and supervised practice and supports doctors to undertake the MICGP exam, leading to specialist registration in general practice.

But these positive developments do not detract from wider home truths. Firstly, there is a fundamental problem at source. An insufficient number of Irish medical school graduates are choosing to specialise in general practice, with lack of exposure at undergraduate level an important contributing factor.

According to the Irish College of GPs’ 2025 pre-Budget submission, medical students in Ireland have “very limited” exposure to clinical general practice (an exception being the University of Limerick graduate-entry medicine programme). 

The College has called for greater investment in undergraduate education to ensure sufficient exposure, and notably, the planned graduate-entry medicine programme at University of Galway (commencing in 2026) will include a focus on rural and remote medicine.

Of course, if posts are unattractive, then refining the curricula will have limited effect. The College has advocated “innovative ways” to attract GPs to rural areas, including consolidation of smaller practices, satellite practices, provision of built infrastructure, and more rural practice supports and incentives.

According to the College, the issue of built infrastructure is increasingly perceived as an “unwanted, unnecessary, and unwarranted liability” by potential GPs.  “Society does not require other healthcare workers to provide the work premises. The ‘bricks and mortar’ is now a barrier to recruitment, retention, mobility, and retirement. This is especially the case in affluent urban areas where property and rents are unaffordable for young GPs.”

The College says the HSE can support GPs to establish their practice by providing purpose-built GP premises, thereby avoiding substantial capital expenditure on ‘bricks and mortar’.

“This ‘built infrastructure’ approach will support young establishing GPs, support relocation of overseas GPs to Ireland, and the amalgamation of smaller GP practices. This may include a variety of options, including interest-free loans, HSE-provided and HSE-leased premises.”

Other measures advocated in the College document included the further development of GP-led multidisciplinary teams, increasing the number of practice nurses, ensuring greater access to mental health services, and “a radical overhaul” of numbers entering undergraduate and graduate medicine in light of chronic shortages across healthcare.

Publication of the Department of Health’s strategic review of general practice is still awaited. As matters stand, GP numbers are not keeping pace with rising population needs. Many patients are waiting longer to see a GP or are experiencing difficulties finding one. Enhancing the overall attractiveness of GP posts, and adapting to changing work preferences, are matters of some urgency.