Crisis in rural GP care as East Mayo could become black spot

The small village of Mulranny has been without a permanent GP since the retirement of Dr Jerry Cowley in January 2024. Since then, his patients—many of them elderly—have relied on locum cover.

“This isn’t a surprise. We’ve seen this coming for a long time,” said the retired rural GP, Dr Cowley, reflecting a sentiment echoed across other rural counties. “It’s the elderly and rural communities that will suffer most.”

READ MORE: Priests sought for Reek Sunday Pilgrimage on Croagh Patrick

The vacuum left by Dr Cowley is not just a local inconvenience—it’s emblematic of national systemic problem. The erosion of key supports like the “distance codes” under FEMPI (Financial Emergency Measures in the Public Interest), which once reimbursed rural doctors for house calls based on mileage and patient age, is now being felt These payments had enabled GPs to travel long distances to treat frail patients at home, often preventing unnecessary A&E visits through early interventions such as intravenous antibiotics.

“They tried to put Humpty Dumpty back together again, but not properly. They couldn't bump together again like before, they left out the ‘distance codes’”, the former GP laments.

This crisis is unfolding against a backdrop of escalating demand and dwindling supply. According to the Economic and Social Research Institute (ESRI), GP consultations are projected to rise from 19.4 million in 2023 to between 23.9 and 25.2 million by 2040—a 23–30% increase. By then, Ireland will need between 943 and 1,211 additional GPs, beyond the 2023 headcount of 3,928.

Alarmingly, over 700 GPs are expected to retire in the next five years, with East Mayo flagged as one of the areas most at risk due to a high proportion of ageing, single-practice GPs.

READ MORE: Mayo councillors clash with officials over Achill greenway

“Rural doctors were doing a lot more work. They were not sending so many patients to the hospital. They were treating them for pneumonia. They were doing all this other stuff themselves, and doing minor procedures, like taking away lumps and bumps and doing minor surgery and so on. And they were highly skilled, and they would see people you know, at any hour, the day or night,” explained Dr Cowley.

A 2023 survey by the Irish College of General Practitioners revealed that three-quarters of GP practices have closed their patient lists. Younger doctors are less willing or able to work the long hours that defined the previous generation, and practices report increasing difficulty securing locum cover or affording participation in international graduate schemes.

Patient complexity is also rising. Just 10 years ago, it was rare to see patients on 10 or more medications; now, 5% of those over 65 are on at least 15.

The 2019 GP Agreement and newer contracts like the Chronic Disease Management (CDM) and Under-6 schemes have improved coverage in areas such as Mayo, Donegal, and North Tipperary. Uptake of the CDM contract, which targets older populations, has reached up to 100% in some areas.

READ MORE: Hundreds climb Croagh Patrick in honour of Aughamore’s James McNeive

However, these contracts alone cannot overcome the geography, ageing workforce, and lack of new entrants willing to take on rural roles.

Regions like East Mayo, Wexford, Inishowen, and East Clare face a triple threat: high service demand, high retirement risk, and poor recruitment.

Meanwhile, rural GPs continue to struggle under unsustainable working conditions. The Rural Practice Allowance, intended as a lifeline for isolated doctors, is now considered insufficient, according to former Independent TD Jerry Cowley.

If current trends continue, large swathes of rural Ireland may be left without regular access to primary care. That, in turn, will drive more patients into overcrowded emergency departments—ironically increasing the hospital burden that health reforms aimed to reduce.

The Sláintecare strategy envisioned a re-orientation of healthcare toward community and primary care settings. But without urgent, targeted investment, that vision may collapse.