Mayo GPs want Government to tackle ‘crisis’

Áine Ryan

SEVENTY seven County Mayo GPs have written to the Minister for Health, Leo Varadkar, requesting him to ‘urgently address the ongoing crisis in rural general practice in Ireland’ and to implement key proposals immediately.
The letter, which was also sent to Taoiseach Enda Kenny, and all Mayo TDs, refers to a series of expert reports which, the letter contends, ‘make for concerning reading and outline clearly how practices in rural and deprived areas, in particular, are struggling’ while ‘the manpower crisis is deepening’.  
The letter refers to ‘four important reports’ published since September this year. They include, “The Future of General Practise: ICGP Member Survey 2015” and “Irish General Practise – Working with Deprivation”.
The writers state that while negotiations continue on the introduction of ‘a new GMS (General Medical Services) contract’, they urge Minister Varadkar to implement four important measures immediately. They are an ‘immediate reversal of the distance coding cut which has been in place since 2010; guaranteed retention of the current 15 Rural Practice Allowances (RPA) in Mayo; improved nursing and secretarial supports for all practices to cope with the ever increasing workload; and the abolition of the ‘Red Eye’ shift (12am to 8am), which effectively ties a single-handed practitioner in a 24-7-365 obligation from the current GMS contract’.
Dr Noreen Lineen-Curtis explained to The Mayo News that ‘distance coding’ – which allowed a slightly higher capitation grant for each listed client to cover the longer journeys made by rural GPs during home visits – was cut in 2010 without any negotiation.   
“This did not affect town or city GPs the way it affected rural GPs. The loss to the income of a rural GP was very significant. We are basically doing all the same work (or more) for significantly less income, and we know that the cut needs to be urgently reversed. The level of upset induced by it was due to the inequity of it. This was not an equal cut for all. This targeted rural and remote practices specifically and hit them very hard,” she said.
 
Unsustainable rural practices
SHE also explained how the RPA (Rural Practice Allowance) had provided ‘an extra subsidy towards staff employed by the practice’ and, moreover, that ‘[many] rural and remote practices’ which have small GMS lists are unsustainable without this subsidy.  
“The RPAs were traditionally attached to a named GP and passed on from one to another. In recent years, the HSE has been refusing to continue the RPA when one GP retired and another took over. This makes many rural practices unviable and is one of the reasons that these positions are not being filled,” Dr Lineen-Curtis said.   
She cited the fact that Dr Liam Glynn, of Ballyvaughan, Co Clare, recently successfully challenged this decision in the High Court. However, the guidelines have been further tightened, she said, arguing that an RPA should be attached to an area or village [and] not to an individual GP.’ She also said that this is further compounded by the fact that County Mayo’s population is quite elderly and dispersed widely and its GPS are aged above the national average.  
The GPS note that there are over 20 million GP visits each year and that over 90 percent of these patients ‘are managed in primary care with high satisfaction rates’. However, with many rural localities facing the loss of their local GP, it will be the patients who ultimately suffer.         
Signatory, Dr Noreen Lineen-Curtis, confirmed to The Mayo News yesterday (Monday) that so far there had been no response to the letter, which was just sent last Friday, December 11.

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