A major challenge in remote rural areas is how services will be provided to unsupported people who are often poor and elderly, according to Dr. Martin Daly. Martin is a GP in Ballygar on the east Galway/Roscommon border and a member of the Irish Medical Organisation’s GP committee.
Working alongside his wife, Myriam Mangan, Dr. Daly runs a training practice and serves three centres: the HSE premises in Ballygar; one session a week in Ballyforan, Co. Roscommon; and another weekly session at Ahascragh, Ballinasloe, Co. Galway. The practice looks after just under 2,000 medical card patients, some of whom have lost GPs in their own localities.
Challenges for his patients, Dr. Daly said, include access to public transport in getting to his surgeries or hospital. With many of them from small family farms, supported by jobs in construction and public services, the effects of the recession saw many young people from the area emigrate, he said.
“We have a practice pool of very young and very old. The middle ground of 18 to 45 year-olds is a very small part of our population. This has knock-on social effects.
Many older people in remote rural areas are dependent on their families to access social and community services. If their young people have emigrated, it leaves them isolated and dependent on their postman, GP, Gardai and voluntary groups.
Rural GPs differ from their urban counterparts in that a lot of secondary and tertiary care falls back onto their plates, according to Dr. Daly. This, he said, leads to increased demand for house calls and palliative care among people suffering from chronic debilitating illnesses and creates an additional burden on GP services.
While Dr. Daly said he enjoys the interaction and variety of his work, he maintained that there is a real feeling among rural GPs that the state doesn’t recognise that work. “It often chooses to rely on the goodwill of GPs and often places unrealistic expectations on them including attending meetings and conferences as well as providing a comprehensive range of GP services.”
While the GP out-of-hours system has helped to ease the expectation and pressure on GPs, the working hours model will not appeal to the next generation, he said. “I work a 60-70 hour week and my wife works 40 hours. This will represent a massive challenge to the state to provide adequate services to people in rural areas.
“The GP is only one part of the whole fabric of rural life which includes the school, the post office and retail services in the community. If we lose these services, communities will become less attractive to young families and become unviable,” said Dr. Daly.
“It would appear to us that we might be the last GPs in Ballygar because of the shift towards urbanisation by society in general and the state.
Many young doctors see their future in urban areas which have greater access to education and social and cultural facilities. They see the life of a rural GP as being very demanding. The fear is that we may not be able to attract someone to replace us, and at 56 years-of-age, I’m starting to think about retirement.
“The disproportionate cuts implemented under Financial Emergency Measures in the Public Interest [FEMPI] have been borne by rural GPs, such as the supports and recognition of the fact that rural GPs do more house calls. Their removal by the Government has had a major impact,” said Dr. Daly.