Covid-19 is not the only strain on general practice

The pressure Covid-19 is placing on general practice is the subject of two features in this issue of the Medical Independent.

In our main feature, Niamh Cahill charts how the pandemic has affected general practice since Covid-19 first hit our shores. GPs had to change their ways of working almost overnight and their efforts were a key part of the health service’s successful early response to the virus. The ICGP has pointed out that GP input on the testing protocols, the end-to-end process of testing and tracing, public communications, and the resolution of delays, have been intrinsic to the Covid-19 response.

But more than six months since the beginning of the pandemic, with the country once again in lockdown, the signs of strain are showing. Though there is no data available on the number of GPs who have contracted Covid-19, anecdotally there are reports of GPs and other staff having to self-isolate as a result of exposure to the virus, which has caused staffing difficulties, and in some cases practice closures.

The pressure to maintain existing services and chronic disease management, while also responding to Covid-19 cases is immense, especially as we enter the traditional cold and influenza season. Also, the recent contact tracing controversy is but one example of where GPs are needed to help relieve problems elsewhere in the health service.

GPs were informed by the IMO on 20 October that the HSE contact tracing system had become overwhelmed and were asked to process calls and refer for Covid-19 testing the close contacts of positive cases confirmed by the HSE between 16-18 October. As ever, GPs are doing what is asked of them, but to rely on general practice to pick up the pieces as a result of the failure to appoint key public health staff is not sustainable.

GPs were already under pressure before Covid-19. This point is referenced in an article by GP Dr Catherine O’Donohoe, also published in this issue, based on a survey she conducted highlighting the challenges faced by the profession. Dr O’Donohoe refers to how Irish general practice sustained cuts between 2008 and 2013 of over 35 per cent to State payments for contractual services under the Financial Emergency Measures in the Public Interest (FEMPI) Acts. The roll-out of the chronic disease contract,
which was intended to address the inequities that have developed over the past decade, has stalled as a result of the pandemic.

One of the main concerns of GPs is the difficulty in securing locum cover. Of those surveyed, only one-in-eight felt they would be able to secure locum cover for urgent reasons at short notice, such as bereavement or personal ill-health.

The risk of contracting Covid-19 has made this issue more urgent. The survey shows many GPs are feeling stressed and burned out as a result of the pandemic. Regarding the impact of Covid-19, some 38 per cent of respondents said it would expedite their retirement. The shadow of mass retirement is already one hanging over Irish general practice, with some 700 GPs who are over the age of 60 expected to retire in the next five years. In 2017, the IMO predicted a shortage of 2,055 GPs by 2025. The ICGP has expanded the number of training places for several years now from 150 in 2015 to 209 in 2020. In its pre-Budget submission, the College said it committed to increasing this to 250 within two years, but that there was a need for an intake of at least 300 GP trainees per annum “to cope with the large number of gaps, which have emerged in general practice”.

GPs are to be commended for the workload they have shouldered over the past number of months in unprecedented circumstances. They will require all the support they can be offered, not just over the difficult winter ahead, but in the years that follow.