Why I left the NHS for Ireland
Dr Eamonn Jessup
With my practice contract returned to the Health Board in the watershed year of 2016, I decided to look at locum opportunities within Europe.
Our local health service provision had deteriorated to what I felt was an unsafe position, and the referendum decision on EU membership would only exacerbate this situation.
Ireland looked promising so, with minimum fuss and a few hundred euros lighter, I registered there.
The Irish Republic is an oddity as, being part of a common work area, a doctor from the UK should be able to work in Southern Ireland, regardless of Brexit.
House prices are reasonable, schooling is of a high standard, and after working in Ireland for some years, you can gain an Irish passport.
An excellent locum agency in Dublin gave me experience throughout Ireland, including working in out of hours Co-ops. Practices throughout have been friendly and welcoming.
The computer system is ‘Health One’, which is antiquated by UK standards, with prescriptions printed on a dot matrix printer.
CPD is related to educational meetings, with 50 hours of study needed yearly to remain registered.
Since October, I’ve worked for two practices in the South West of Ireland, and feel settled into Irish ways. Sufficient similarities exist so that anyone working as a UK GP could settle into Irish practice quickly.
General practice in Ireland is, in many ways, where things were in the UK before the 2004 contract. There’s no significant provision for anyone other than GPs to prescribe, for example, and no community midwives, so it’s been a pleasure bringing back the skills needed to care for pregnant women.
I'm glad the Tardis has taken me back to 2003
The GP is the first call for all deaths, no matter the situation, as police surgeons don’t exist in Ireland, and care home deaths need reporting to the coroner, whether expected or not.
Moreover, 30% of patients pay for their consultation, with €50 the usual rate, then extra charges for procedures performed.
The Irish Government are committed to increasing public health provision, which doctors perceive will place further pressure on the service. Currently all patients under six, over 70 or diagnosed with a major illness, along with those reliant on state benefits, get a medical card making care available to them at reduced cost.
Contraception isn’t free - many women pay as much as €300 for a LARC fitting, with half that cost being for the device itself.
Another key change I’ve noticed is that the private/public health divide is most acute when it comes to hospital care. For those with private cover, doctors can order any investigation within a short time period, often leading to over-investigation. It’s very different for those who rely on the public health system.
The hospital service is under pressure, but less so than in Wales, where I moved from. Media pressure on the Government to address the issues of hospital overcrowding is relentless, and the Government has committed to increasing bed numbers substantially. When I’ve ordered an ambulance, it’s arrived within minutes.
Morale remains high in the practices where I work, where fun is still an important part of the job - out-of-hours is run by GP co-operatives, with daytime GPs having ownership of the local service. Recruitment of GPs remains problematic, but not to the extent I witnessed in North Wales.
This isn’t to say the experience has come without negatives. Poor liaison between primary and secondary care often makes it very difficult to know what happened to someone during their in-patient stay. Scribbled handwritten scripts arrive from hospital needing decoding; many patients are on a large medication cocktail, including many drugs blacklisted years ago in the UK; and private medicine has fuelled an expectation of a drug for even the most trivial illness. Perhaps most of all, trying to change patient demand is challenging.
In conclusion, the current health service in Ireland isn’t under as much pressure as the UK’s. There’s much more face-to-face contact with patients, and healthy respect for the GP from patients, which has largely disappeared from the UK.
It won’t be for everyone but I, for one, am glad that the Tardis has taken me back to 2003.
Dr Eamonn Jessup is a locum GP currently working in Listowel, Ireland