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The waiting game

We must stop poaching of GPs from other understaffed health systems

Cork GP Dr Nick Flynn is dismayed at a new NHS England recruitment drive targeting GPs in Ireland 

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The Irish healthcare system and Irish general practice in particular is in trouble. In Ireland there are currently 350 vacant consultant posts – 10% of the total – and some doctors with consultant contracts are not on the specialist register. Meanwhile there are 150 GP vacancies advertised on one website alone. We have over 500,000 patients on hospital outpatient waiting lists and over 150,000 of these are waiting for over a year.

Irish GPs, like our population, are aging and an additional 700 GPs are due to retire over the next five years. We currently train 175 GPs per year in Ireland. Not all of these GPs will work in Irish general practice and not all will work full time. The aging population is also going to bring an increased demand for healthcare. So we have an increasing demand on the system with an impending decreased capacity. The perfect storm.

It is not only our GPs and population who are aging in Ireland. Our GP contract is also 34 years old. It is based on treatment of acute illness and does not allow for the advances in diagnosis and patient management that have evolved over the last 34 years. Imagine your TV 34 years ago and your TV today. Healthcare has evolved just as much, but Irish general practice is still contracted to service a system that existed 34 years ago.

This is not unique to Ireland. There is a worldwide skills shortage in healthcare and we are already losing GPs to Australia, Canada and the Middle East. Last week, I received an email advertising 25 posts in Essex, as part of the NHS drive to recruit 2,000 GPs from overseas over the next two years.

We need to increase capacity in our healthcare systems and use existing capacity more efficiently

An initial inquiry from me has been followed up with professional emails and telephone contacts advising me that the recruitment company will make the process of relocating to the UK as painless as possible. Benefits include a relocation package, paid induction, full visa status ahead of Brexit and help with accommodation and schooling.

Meanwhile in my own practice we have been actively trying to recruit European and South African doctors for the past two years. The NHS recruitment drive worries me. I’m worried that the NHS will successfully recruit our graduates and indeed our experienced GPs. I’m worried that, even with all its difficulties, the NHS brand will make it more difficult for Ireland to recruit from other countries as doctors from overseas may prefer to work within the NHS.

I am a GP trainer with the Irish College of General Practice and only two out of my last six registrars are working full time in Irish general practice. Three have emigrated and one is working part time. When we asked them why they have left Irish general practice they tell us a number of reasons:

1. The Irish healthcare system is dysfunctional and GPs cannot access basic tests for their patients – for example, no GP access to MRI or CT referral in many areas and long waits in other areas.

2. Outpatient waiting times are so long that GPs cannot access timely specialist opinions for their patients – for example, three-year waits for ophthalmology, orthopaedics and neurology.

3. GPs feel that the Irish government does not respect general practice and prefer to work within a system that values them.

4. Reductions in funding to Irish general practice (cuts they were made during the financial emergency) have made many practices unviable and certainly prevent young doctors from establishing new practices.

Welcome to the new reality – the international merry go round. Instead of these short-sighted solutions, we need to increase capacity in our healthcare systems, train more doctors ourselves and use existing capacity more efficiently.

In the meantime the poaching of valuable healthcare professionals from other, less fortunate countries, is set to continue.

Dr Nick Flynn is a GP in Cork, Ireland. You can follow him on Twitter @drnickgp

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Readers' comments (7)

  • Sounds like GP life in the UK!

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  • Unfortunately worldwide medicine has been devalued by patients and successive governments. This has led to relatively average income for what used to be a well paid job. This makes for poor outcomes for all the training that doctors need to go through before they start earning a good living. Unsurprisingly they will go where they are valued more and don't have to kill themselves to make that living that they expected .

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  • The UK better be careful it is becoming more and more uncompetitive in the free world wide market of health care workers.In a capitalist system a shortage means the providers will cost more.A 10+ year pay freeze is and will collapse the market.It will cost them a lot more to stabilize it/repair it once this happens.Whatever happened to free market Tories.

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  • Dr O'Riordan might be available...

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  • NHS recruitment in general is becoming more unethical. it is not just the poaching of Drs from Ireland to England that should be of concern but the general wholesale poaching of health care staff for resource poor countries. Many Drs are now being brought in from Africa, from countries who struggle to provide even the very basics of health care for their populations.what then happens to those populations ?

    If medicine had not been made so unpalatable we would not have the retention andrecruitment disaster we now face. we should not try to solve our problems by worsening those in countries with far less resources and who's people have a quieter voice .

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  • England in particular need to incentivise GPS properly which means better pay, less stressful working, medical indemnity cover, clinical support and peer support as well as sustainable working conditions
    The Nhs should offer to buy all GP surgery buildings and make all GPS salaried on the BMA contract with 8 weeks paid leave, protected and funded training time, sis stainable safe workload tetc
    Then some of the retired GPs would return to part time work- they mainly retired early because of stress, burnout and unsafe clinical working conditions.
    Look after the GPs and you will have you an extra
    5000 quite quickly

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  • I am afraid it is just about supply and demand. Any attempt to circumvent that is unfair and unjust.

    If Ireland, England, or any other country wants to keep it's top talent, it needs to make sure they are rewarded appropriately. If you treat people terribly, there should be an expectation that they will leave.

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