I'm a GP in rural Ireland AMA

[drdolots]

Not sure if anyone will be interested but it's a Sunday afternoon so why not.
I'm a GP in a small practice in very rural Ireland.I work with one other doctor,one nurse and one receptionist.I can imagine it's a pretty stark contrast to how things are run on the NHS so I guess -ask me anything ?(but maybe not specific medical advice because I hear MNHQ don't like that understandably,I will keep it general )
Oh and I have NC'd just Incase

How many patients on your list?

Are your patients able to get appointments quickly and easily?

In total we have just under 2000 patients,however due to the healthcare system in Ireland we may not see some of them for 20 years.We mainly see children and the elderly

Do you do home visits sometimes?

It is easy enough to get an appointment if it is urgent we will squeeze them in same day otherwise maybe two or three days however I think this is due with people having to pay.In some poorer areas with higher medical card populations it can be more difficult it could take a few days to a week.

Can you explain the healthcare system in Ireland? Why would you never see any adults who are not elderly? Where do they go?

What do you charge for a consultation?

Is your home-vist fee much higher?

Do you have a lower fee if a patient returns with same issue?

I do home visits very frequently,we have a large elderly population which means I usually do at least one home visit a day but this is reserved for the elderly and people who cannot physically get to the surgery.We also participate in an OOH GP service which you are on call for a few nights a month and with that comes more home visits but we have a driver so it's not a big inconvenience

I’m imaging a Dr Martin type surgery (was it called that, the series with Martin Clunes, I think set in Cornwall?). Is it easy for your patients to get an appointment? Our doctors surgery used to have several ‘satellite’ surgeries and the doctors used to travel to these to see patients nearer to there homes. These have now all been culled and patients have to travel to the main surgery. I’m guessing this is part of ‘cost cutting’. Do you think the standard of care is better in a big surgery (this is how it has been put to the patients in our town) or is it preferable for doctors to know their patients a bit better (obviously if you are the only doctor, you will know patients history and family relationships Better).

@Apolloanddaphne the healthcare system in Ireland is a two tier system.
If you earn under a certain threshold varies by number of dependents etc you may qualify for a medical card which means you can visit a GP free of charge,get prescription medicines at 2 euro per item to a max of 20 euro per couple or 15 euro for the over 70s.If you do not qualify for a medical card you may get a GP visit card which means you pay for medicines but can visit GP for free.if not then you pay 50-60 euro for a gp consultations (sometimes 40 at a follow up but only if it's an ongoing issue ) people with no medical cards pay a maximum of 124 euro a month for medicines but there is no cap on GP visits.Public waiting lists are long for consultant care,I would say without a medical card you really do need insurance and even with that consultants are still 200 euro a visit to see.

How often is your out of hours rotation?
What do you think of the new proposed contract for GPs?

@RedForShort the majority of people requiring home visits would have medical cards and therefore be free but otherwise no the charge is the same but a home visit is based off medical need.
Not really I'd someone comes back a few times in a single month then they may be charged less but still about 40 euro.
I also forgot to add sometimes medical cards are issued on medical need irrespective of income but this only in the place exceptional cases.I have a patient with a brain injury who needs a ventilator and he's having to pay over a thousand euro a month to rent it and his medical card application has been denied

@Maryann1975 I have answered the appointment questionto be honest I'm not sure it makes much of a difference in terms of older people I think they are more comfortable in a familiar environment so from that point of view maybe smaller surgery but IME the care in both is equal .A bad doctor is a bad doctor no matter where he is .Sometimes knowing too much about a patient is a negative.

What part of Ireland are you in. My parents live in Connemara are aging and getting a great service fro their GP. On behalf of family living away and worrying as they age thanks

Do you get paid for under six's?

@HandsReachingOut I do one or two nights /days a month but it varies depending on areas and how many practices are involved
I'm all for it we need change I'm sure they're will be teething issues but I do hope it will make better for both us and our patients

What's the furthest you travel to see a patient?

Also how long are appointments at the surgery?

@MegCleary what a lovely post I'm in the south of the country in Munster

@kenandbarbie yes we get payed for under six's like we get payed for medical card patients we get a fee from the HSE for providing care for them

@FrancesFlute the furthest I've had to travel is probably an hour but it was exceptional circumstances where there was no other GP available and an ambulance would have taken two hours

@FrancesFlute our appointments are scheduled for 20 minutes however there is no time limit on patients some take half an hour occasionally they take an hour but that's just life.Things don't run like clock work you couldn't just make an appointment on your lunch break as we are often an hour or two behind and people just have to wait.Its unfortunate but there is no time limit or limit to problems we can address which is how I think it should be

If a woman comes to you wanting to terminate a pregnancy, will you support her, and how?

@womaninthedark as you are probably aware abortion services in Ireland only came into practice in January 2019 and to say we have had some teething problems would be an understatement.So there is a very clear guidance on GP provision of abortion services in Ireland .We provide medical abortions up to 9 weeks and refer for surgical abortions up to 12 weeks.I will always support a women and her decision,I often get women referred to me from other GPs as a limited number of GP s provide this service .the usual procedure is woman come in we discuss options and if they are eligible for medical abortions they come back in three days (which is set out by law and abortions have to be certified by myself ).Two weeks after the abortion we have a follow up consultation which is optional but I always encourage people to attend and focus more on the psychological aspect of termination and I can refer them for counseling if necessary.

Thank you for your answer.
What happens to women who need a termination, for whatever reason, after twelve weeks?
Are any of your patients (using you as an example of a rural practice) still having to travel?