Dr. Noreen Lineen-Curtis:

Regarding the percentage of GPs being kept in the system, I would like to keep 100% of our trainees in it. They are absolutely fabulous and I would like to see them all stay in the country but the current conditions are not conducive to that. Regarding a pathway, I feel that when GPs leave their training system, very often they are cast adrift a little bit. They have been managed through their GP training in a very structured fashion and all of a sudden they are out into the working world. There is not a very definitive pathway for them to follow unless they choose to go into a general medical services, GMS, post, which very few of them do, go abroad, or take a sessional post, which is what most of them end up doing. In the University of Limerick, they spend a lot of time in general practice and they have a higher rate of people ending up in rural general practice because they spend 18 weeks. I recently started teaching at the University of Limerick and I am looking after students in the north-west hub, who are all in remote rural practices as far as possible. It is a new development in the north west from the University of Limerick, UL. These students are getting an 18-week placement in rural practices, which is their longest clinical placement and because of that, they are statistically more likely to end up in rural practice.

The other universities maybe need to look at having their students spend more time in general practice than their usual two weeks, which is what most of them spend. That could be incorporated into the pathway, and then when they come out the other end qualified and eventually go into GP training, some way of gathering those newly-qualified GPs into a structured workforce needs to be looked at. Two birds could be killed with one stone here because GPs in situhave huge problems getting locums. If these newly-qualified GPs were offered salaried positions in a structured fashion where they could do a certain number of weeks for GPs A, B, C and D in an area, very often they will find a practice where they say, "I like that. I could work and live there and raise my family there". Now they are being asked to commit fully, 100% and 24-7, to a job, or do what they want, work part-time or leave the country. If they were harnessed into a more structured work format after they qualify as GPs, we might see a lot more of them choosing to stay. That is my belief anyway. We are losing far too many of our fabulous GPs to foreign countries.

On the chairs of general practice, a chair of rural general practice has just been established in UL. Professor Peter Hayes is the new chair of rural general practice down there. The other universities have a chair of general practice but it is not specific to rural areas. There is a very big difference between rural general practice and urban general practice. Yes we are all GPs but only people working in rural areas will really know what it means to be a rural GP. Establishing chairs in all universities for rural general practice would be an important step forward.