The Merits of Choosing General Practise in Ireland Today

General Practise has given me a wonderful, rewarding life, and it is never boring. You literally never know what is going to walk into your room, so if you are a problem solver, this is the career for you.

General Practise was my only specialist choice from before I commenced college. From the minute our visiting family GP took on my formidable grandmother and pulled back the curtains, admitting light to my darkened childhood "measles room", and announced that I should be allowed to read - I was totally in love with General Practise.

I qualified in 1980 and was fortunate enough to Intern at Bantry Hospital.

Those days it had an Obstetric and a Paediatric unit, as well as Medicine and Surgery, offering a great breadth of experience and expertise. The rota was one in two from midnight to midnight, challenging for a social life but somehow we managed.

From there I obtained a place in the Cork GP Training scheme under the inspirational Prof William Shannon who was instrumental in setting up GP training in UCC.

I got another very fortunate experience during my single placement year, in Skibbereen with Dr's M. O'Sullivan, John O'Keeffe and Michael Boland. The utter joy of a West Cork morning call in springtime is hard to surpass, even out to the offshore Islands on the odd occasion.

These were the pre-mobile phone days and on-call involved moving into a B&B where the long suffering lady of the house answered the phone at all hours of the night when I was out.

Directions to find places were a considerable challenge without Satnav, and invariably involved the well known Creameries scattered throughout the hinterland.

My GP life has spanned a revolution in Sexual Health and during my GP placement, Minister for Health Charles Haughey's Family Planning Act came into being whereby contraception in all forms, including condoms, could be prescribed for bona fide family planning purposes provided a Marriage Certificate was produced !!

Some cringe-worthy moments ensued; This was not the first attempt to make GP's the police of peoples morals, but it was the first time I became aware that General Practise was the dumping ground for matters no one else wanted to handle.

Skibbereen for me was the perfect Registrar experience, arming me with skills and experience under the tutelage of my extraordinary mentors.

Thus armed, I spent two and a half years in north eastern Kenya at the end of the 1984 famine under the auspices of APSO (Association of Personal Service Overseas) - the Irish equivalent VSO (Voluntary Service Overseas). I worked in Maua Hospital in Meru and met amazing friends and colleagues, some with whom I continue to have regular contact.

We had a major cholera outbreak while there and only used scarce generator fuel for making IV fluids. Distillation was not included in undergraduate training !!

On return to Ireland I spent some years in Dunmanway, again West Cork which I love, but left in hopes for a better rota than one in two, and also to escape a worrisome local stalker.

I have worked the last 30 odd years in Ballincollig. I have grown old with many of my patients and have had many instances of intergenerational care, the high point was five generations!!

I feel I'm everyone's great grandmother and am a believer in the continuity of care and of a personal physician, to the advantage of GP and patient alike. The acquired knowledge of how a family works, their strengths and weaknesses, make decision making easier. Being able to walk with your patients through the most difficult times is an enormous privilege. I'm often in awe at peoples courage and resilience.

The Practise grew and expanded over the years and an on-call every third or fourth night changed to Southdoc. This was a brilliant innovation at the time when there were adequate numbers of GP's to cover it, at least in urban areas, and when it was appropriately used for urgent care.

I have been fortunate in the last two years especially in the pandemic, to work with the most wonderful colleagues and in this I include the entire Practise team who together form a resilient unit bolstering us up and allowing us to continue when things were extremely tough.

General Practise has been more than a worthwhile experience for me and any drawbacks largely exclude the patients.

The Cons;

• The GP Contract: The Irish GMS Contract dates back to 1987 and has not been updated. Obviously a contract that is 34 years old bears no relationship to today's world.

• HSE Admin: Quite how to be polite about this organisation and it's interfacing with GP's is beyond me. However some meaningful communication needs to be developed between HSE administration and GP's to allow any further development. I am aware there are some excellent people in the organisation but how to reach them, is a mystery.

• Work-life balance: Holidays, sickness, child-care, and family life all need to be protected.

• Consultants: Hospital colleagues and associated professionals: Some have reduced us to scribes, phlebotomists, scapegoats and a dumping ground for all the things no one else wants to take responsibility for.

• Business Training: A GP Surgery is a small business and must be run like one. Idealism does not pay bills or salaries.

• Partnership: Get good legal advice. Doctors are no more honourable or honest when it comes to partnership agreements and the like, than any other sector of the population.

Almost all the difficulties of General Practise that I have listed, could be resolved with ongoing communication and goodwill on both sides.