GP retention symposium
Dr Brid Shanahan, Clinical Lead for Deep End Ireland contributed to a panel discussion at the RCSI/ICGP GP retention symposium in the convention centre on the 24th of September 2024. The following is a summary of the statement given by Deep End Ireland regarding the key issues relating to recruitment and retention of GPs in areas of deprivation.
Patients living in areas of deprivation tend to experience significantly higher morbidity and mortality rates when compared to those in more affluent regions. There is often a concerning tendency to ascribe these elevated rates in deprived area simply to issues like drug use or suicide; however, this perspective overlooks the complexities involved. In reality, our patients frequently develop illnesses such as cancer and chronic disease in their 50s and 60s — conditions that would typically not pose serious threats to other individuals until they reach their 70s or even 80s. This results in an increased workload for Deep End GPs compared to our peers. This is especially inequitable considering that the increased capitation rate begins at age 70, and many of our patients do not live to see that age.
In addition to this, there is a considerable amount of complexity and numerous logistical issues that arise in these situations. For example, interpreters are required for a significantly greater number of consultations in areas of deprivation, and these consultations typically take at least twice as long as those where both the GP and the patient both speak English. This is primarily because everything must be communicated twice to ensure understanding, which adds to the already stretched resources and does not come with any additional support or funding for our practices. Furthermore, there are higher rates of homelessness in these underserved areas, which complicates the situation even further. Managing the care of homeless individuals presents significant logistical challenges for multiple reasons, including their frequent changes of address and phone numbers, the difficulties these patients can face in attending scheduled appointments, and the lack of stable housing, which can exacerbate their ongoing health issues and make it even more challenging to manage their illnesses effectively.
The CDM programme benefits GMS practices greatly, but while it is true that CDM can contribute to a more equal distribution of resources, it is essential to understand that they primarily provide equality, not equity. If you are not already familiar with the distinction, equality refers to everyone receiving the same resources and opportunities, while equity involves allocating additional resources specifically to those who are most in need. As for the deprivation grant, it stands at a maximum of €12,500 per year, and it is critical to note that this funding must be directed towards an additional service rather that shoring up an existing one.
We need more GPs working in the existing practices in areas of deprivation, but we also need more GPs to set up practices in these areas. The current GMS contract is a major disincentive to doing this. The capitation model assumes that all practices have comparable levels of need, which does not hold true for Deep End practices. We are tasked with delivering the same standard of care to a much more complex patient population, yet we do so with fewer resources.
Working in the Deep End, although very fulfilling, can be emotionally draining. Many of us aim to provide trauma informed care which can mean doing things like providing same day appointments for many patients who otherwise would not return. This results in many extra appointments every day. Ideally, we would have enough resources to provide patients living with additional challenges with longer appointment times instead of squeezing them in to fully booked clinics. We need to be able to support GPs and their practice teams to prevent staff burn out.
We need to actively incentivise GPs to establish their practice in areas of deprivation. Implementing a system similar to the DEIS school initiative, which would provide additional payments and support for practices operating in the Deep End, would significantly aid in attracting healthcare professionals to these underserved areas. This approach not only encourages GPs to work where they are most needed but also contributes to improving health outcomes for vulnerable populations.
Addressing health inequity by providing additional resources via a system similar to the DEIS school model would help attract more GPs to work in areas of deprivation thus increasing doctor patient ratios in those areas, allowing longer appointment times when necessary, improving working conditions and job satisfaction for Deep End GPs and ultimately improving health outcomes for patients living in areas of deprivation. This would ensure the viability of general practice in areas of deprivation across the country for years to come.