#nodoctornovillage

Introduction

In its strategy documents, “Quality and Fairness: a Health System For You” and “Primary Care – A New Direction”, the Department of Health and Children clearly acknowledges the “central role of primary care in the future development of modern health services”. However, primary care only receives 2.5% of the overall Irish health budget, this compares to the UK where through a coordinated campaign by the RCGP it has been recently increased from 8.9% to 10%.

General Practice is the engine room of primary care, particularly in rural areas where access to other services is often compromised. Despite this, the current government has presided over the most significant reduction in funding to General Practice (GP) in the history of the State. This is in contrast to nearly every other developed country which, following overwhelming international evidence, is investing in General Practice as a way of improving patient outcomes and decreasing healthcare costs. In fact in the well-known Rhode Island experiment in the US, investment in primary care yielded a 15 fold saving in terms of healthcare costs across the state.

 

The Demise of Rural General Practice and Rural Communities

The “No Doctor No Village” campaign is a nationwide campaign led by rural patients and GPs. It aims to save & protect the GP service of rural communities which has become increasingly vulnerable and has led to many isolated rural communities losing their permanent GP service. Of course this is also part of a much wider neglect of rural Ireland generally where second class services in road, broadband, public transport to name but a few have become the norm. Eventually we are all going to be patients and what we all deserve is to be able to see our own GP in our own community who through knowing us and our contexts is in the best position to provide us with high quality, cost-effective care. Recent research from the BMJ appears to confirm Prof. James Mc Cormick’s words published in the Lancet over forty years ago that “knowing the person who has the disease is as important as knowing the disease that has the person”.

The communities of Feakle and Kildysart in Co Clare, Glenamoy in Co Mayo and Bansha in Tipperary are but some examples of over 30 across rural Ireland that no longer have a permanent full-time GP service. These communities which  predominantly serve very vulnerable older and often isolated citizens have lost their access to what is a basic human right as enshrined in the Charters of the WHO and the UN; that of access to primary healthcare.

 

The “No Doctor No Village” campaign

This crisis was very much in evidence at the most recent Rural, Island and Dispensing Doctors annual conference in Mulranny Co Mayo in October, 2015. As a GP serving a rural and remote community in Co Clare, I found it particularly poignant to see a whole generation of rural GPs who are close to retirement totally disillusioned. They had spent their careers providing a critical service in their communities yet their practices had become unviable with little prospect of young GPs willing to continue the service in such remote, rural and often vulnerable communities.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

The evidence for this is multifold but is perhaps best illustrated by the complete absence of candidates for vacant rural GP posts in Ireland and the ever increasing number of locum, part-time or shared service arrangements being put in place to provide rural GP services. Silence on this issue was no longer an option and from this invidious position the “No Doctor No Village” campaign was born with a personal commitment I made at that meeting to bring this matter directly to Dáil Eireann.

 

In the weeks that followed I was able to bring together a group of rural GPs from Wexford to Donegal, to present our case to the Fine Gael Oireachtas Health Committee chaired by Dr Liam Twomey, TD. Despite 25 members of the parliamentary party attending the meeting and assurances we would be heard, the weeks following the meeting were filled with silence. As word of our efforts filtered out, our communities began to mobilise around us, as did other GP colleagues. We organised a series of public meetings in December and January across rural Ireland attended by our TDs and other public representatives, our GP colleagues and several thousand members of our communites. Ultimately, however, no progress was made and despite all this effort rural communites like Bansha in Tipperary and Kildysart in Co Clare remained without a GP service. Our only remaining democratic option was the ballot box and this is what ultimately led to Dr Michael Harty and Dr Gerry Cowley standing for election under the “No Doctor No Village” banner in the General Election 2016.

 

Going from rural GP to election agent for Dr Michael Harty overnight was not something I had anticipated but with a tremendous team of passionate and motivated colleagues and patients around us, we were all energised for what was a big jump into the political deep end. Very quickly, our “No Doctor No Village” banner struck a cord with people across rural Ireland and we called on people to join our “Rural Revolution” which they did in their thousands. In 2016, as we commemorate the evolution of this State, the current deterioration in rural GP services is intolerable for the often voiceless and vulnerable older people affected. In the “No Doctor No Village” campaign they found their voice. In an ironic and effective turnabout, the patients came to save the doctor! The demands of the campaign are simple;

•  Re-instatement of the Distance Coding

•  Re-instatement and strengthening of the Rural Practice Allowance

 

These are only the first steps necessary in re-aligning our health service towards primary care.

Dr Robert Scully, an Irish GP working in the Scottish Highlands spoke out recently in support of the campaign. He captured brilliantly but quite poignantly the difficulty and “embarrassment” he has in explaining how experienced senior GP’s in a “developed” country such as Ireland have been forced into emigration or temporary locum work in the UK in order to keep the GP service open in their own rural communities in Ireland. As he says “high quality primary care is at the cornerstone of any efficient and equitable health service. The sad reality is that rural Ireland has been progressively dismantled over the past 10 years with respect to various services, and the undermining of rural healthcare provision could be the final straw for rural Ireland. The ‘No Doctor No Village’ campaign is not about supporting rural doctors - it is about supporting rural Ireland.”

 

Successes to date:

The first public commitment to the re-instatement of the Rural Practice Allowance (RPA) and the Distance Coding was given by Government TDs on December 3rd at the “No Doctor No Village” campaign meeting in Corofin, Co Clare. This was followed four days later by Minister Leo Varadkar making the same commitments on RTE news. The comments from Minister Varadkar that “100 additional GPs will qualify for the RPA under new proposals …by easing the qualifying criteria to cover doctors over three miles from a town of 2,000 or more” were welcome. As of May 6th, 2016, the RPA proposal has now been implemented, another notable victory for the campaign.

 

In addition, our election campaign proved what can be done and is a testament to our democracy that resulted in the historic election of a “No Doctor No Village” candidate, Dr Michael Harty to the 32nd Dail. Not only that but the Programme or Government has been strongly influenced by the “No Doctor No Village” campaign through the work of Dr Harty and his negotiating team.  This contains a commitment to a 10 year plan for health and a re-orientation of the health service towards primary care.

 

Conclusion

One of the mantras of the “No Doctor No Village” campaign were the immortal words of Edmund Burke - “No one could make a greater mistake than he who did nothing because he could do only a little”.

 

It was truly inspiring to see so many people come together to do a “little” and how this could change the course of history. Even though as GPs we spend our lives behind our desks advocating for our patients, we often forget that this advocacy is enshrined in our Medical Council guidelines which state that “Doctors should act independently in the service of their patients and have a responsibility to advocate with the relevant authorities for appropriate healthcare resources and facilities.” Sometimes it is worth getting out from behind the desk in this advocacy role, and you never know you might make a little bit of history in the process.

 

Please join (and invite all your friends too!) the campaign on Facebook https://www.facebook.com/groups/943896619029369/ and on Twitter #nodoctornovillage

and view our videos below which capture the heart of the campaign:

https://www.youtube.com/watch?v=bblD3U7UeLo

https://www.youtube.com/watch?v=_rBusNPiIaw

 

To the people of rural Ireland who came from across the country to canvass in the wet and the cold and contributed to the campaign in many other ways....we salute you and we thank you for your incredible support.

 

(uploaded 13.06.16)