Minister for Health Jennifer Carroll MacNeill welcomes the publication of the ‘General Practice in Ireland: An Analysis of Supply & Demand’

The Minister for Health Jennifer Carroll MacNeill has today published ‘General Practice in Ireland: An Analysis of Supply & Demand’ to improve the evidence base for the Strategic Review of General Practice. The Paper was produced by the Irish Government Economic and Evaluation Service (IGEES) at the Department of Health.

The paper presents key findings in relation to six policy questions:

1. How many general practices and general practice staff are there?
2. What does retirement and succession planning in general practice look like?
3. What is the productivity of general practice?
4. What are the characteristics and drivers of public contract uptake?
5. Are there capacity constraints within the system, and if so, what are the determinants?
6. What are the factors that should be considered in forecasting future GP workforce requirements?

The research finds that in 2022 the workforce of GPs and General Practice Nurses and Midwives (GPNM) provided a reasonable level of coverage nationally in response to demand and there was good uptake of public contracts. GPs carried out 19 million consultations annually, 29 per whole-time-equivalent per day. GP Nurses and Midwives carried out nine million consultations annually – 16 per whole-time-equivalent per day. However, some geographic areas had clear capacity constraints, often in areas of growing or ageing populations.

Identified capacity challenges can be addressed by 2030 through the increase in GP numbers that is already underway via increased training places and the International Medical Graduates Programme. By 2030, almost 4,000 graduates and international recruits are expected to enter the system while just over 1,000 GPS are expected to retire and resign. The number of GPs expected to retire is also in line with normal workforce distributions. This increase in capacity will meet constraints in the system currently and future constraints arising from demographics and changes in working practices.

The paper’s recommendations include expanding and streamlining the role for GPNMs, and the adoption of practice-based public contracts to improve public administration. GPNM already provide almost a third of general practice consultations and appear to be an important source of supply and stability in areas with growing and ageing populations. However, an expansion and standardisation of the GPNM’s role could be beneficial. The Strategic Review will identify measures to improve the current system as part of a primary care-focused health service and in line with the Sláintecare vision on access.

Minister for Health Jennifer Carroll MacNeill welcomed the publication saying:

General Practice in Ireland: An Analysis of Supply & Demand

This paper has been produced by members of the Irish Government Economic and Evaluation Service (IGEES) in the Department of Health, Strategic Research and Evaluation unit. The research and analysis of this paper has been guided by the evidence requirements of the Strategic Review of General Practice, to support evidence-based policymaking.

The paper presents key findings in relation to six policy questions:

(1) How many general practices and general practice staff are there?

There were 3,262 clinically active GPs providing standard services in Ireland in mid-2022. In terms of Whole Time Equivalent (WTE) and demographics, that is 1,879 persons per WTE GP. Regionally, capacity constraints are observed in two areas: areas with growing or ageing populations and areas with risks to succession planning for GPs approaching or at retirement age. GP Nurses and Midwives (GPNM) play a significant role in providing clinical care accounting for 33% of all general practice consultations. In some areas where there are lower GP numbers, single-GP practices, and an ageing population, GPNM workforce numbers are relatively high indicating that they provide an important source of capacity. However, the variance in scope of the GPNM role could inhibit workforce development and mobility, so there is significant opportunity to develop policy in this area arising from how Health Service Executive (HSE) contracts relate to the work of GPNM. There is no visibility on other general practice staff such as total national numbers of administrators.

(2) What does retirement and succession planning in general practice look like?

The age distribution in the GP workforce is normal relative to the national workforce and the age at which GPs enter the workforce. By 2030, around 2.2 GP national graduates will have entered practice relative to each GP who becomes inactive. HSE largely appears to be effective in identifying and supporting panels at risk. However, inadequate succession planning for retirement may be a risk to the stable supply of GP services in some areas, with single GP practices making up half of the risk group. Young General Medical Service (GMS) contract-holders seem to be selecting areas that neighbour those with capacity constraints – thus capacity is increasing but travel requirements on patients may also be increasing in some areas.

(3) What is the productivity of general practice?

13% of GPs work at least 48 hours each week, increasing the overall supply of general practice hours by 4 – 7% through overtime. Consultation load is the best measure to assess the true demand on GPs. On average, WTE GPs handle 29 consultations per day, which slightly increases to 30 when adjusted for the complexity of care.

Based on younger GPs’ intention to have shorter working hours, 1.1 recent graduates are needed to replace the working time of a retired GP. There is an opportunity to improve the productivity of the workforce through incentivising and supporting complementary work in non-practice hours such as research, mentoring and supervision, and upskilling/specialisation.

General practices are somewhat responsive to access needs in terms of public opening hours – multi-GP practices in particular often have longer opening hours.

(4) What are the characteristics and drivers of public contract uptake?

Public contract uptake is largely a function of the career stage that a GP is in: GPs have fewer contracts when they are entering and leaving their careers. Public contract uptake is lower in more advantaged areas (indicating perhaps both lower eligibility for public services and higher willingness to pay). In some areas the proportion of GPs with GMS contracts is low relative to the number of public patients.

Stakeholders report that while the GMS contract is with an individual, named GP many are administered as de facto practice contracts – that is, there could be multiple GPs in a practice providing public services to a panel. However, under the current administration it appears that only a single GP is providing the service. There may be some scope to consider practice-based contracts to reflect the reality of modern general practice, minimise practice administration, and to improve our understanding of actual capacity.

Across the country, but particularly in the west and northwest, GPs hold multiple public lists in multiple locations – likely arising from GPs providing cover in some cases or working across sites in more rural areas. In this case, true capacity is again difficult to ascertain.

(5) Are there capacity constraints within the system, and if so, what are its determinants?

Capacity constraints arise predominantly in areas with high levels of population growth and ageing. The general practice workforce is least responsive to demand shocks in two types of area: large urban areas where populations are generally growing rapidly and areas with a high proportion of young children. Rural areas with generally ageing populations are also at risk of capacity constraints, given single-GP practices with GPs approaching retirement are more common. In areas with high child populations, short-term increases in workforce capacity could be useful in offsetting short-term demand shocks. Overriding any personal preferences, many newer GPs enter markets with clear capacity constraints – this is likely a result of good cooperation and signalling between the HSE, Irish College of General Practitioners (ICGP) and GPs.

(6) What are the factors that should be considered in forecasting future GP workforce requirements?

Population growth and ageing increases service demand. Where populations are growing, in Dublin and its commuter towns in Cavan, Meath, Kildare, Louth, Westmeath and Wicklow, there are some capacity constraints. In areas with ageing populations, there are risks to continuity of supply. The broadening of general practices to routinely include more disciplines could bolster capacity - for example increasing the presence and role of GPNM and pharmacists. The ESRI are currently carrying out a capacity view of health services, this work will forecast future requirements across the system.