Dr. Ray Walley:

The average age of a general practitioner in Ireland four years ago was 52 years. At the time the average age of a general practitioner in Australia was also 52 years, which was looked upon as being old. Markets like Australia then began to aggressively incentivise people to move there. There is a difficulty in all countries in which English is spoken because they have an ageing medical workforce. What can now be done in the health care sector is more complex. People are also living longer. There are statistics which show that a person aged over 70 years has so many comorbidities he or she requires more inputs by a doctor and so on. All of the countries in which English is spoken are incentivising medical personnel to move and remain there. I am a trainer under one of the general practitioner training schemes. The modern day graduate is no different from the majority of those who are still working here, but what he or she wants is a work-life balance. When a GP experiences a 40% reduction in turnover, the only person from whom he or she can get more is himself or herself. As a result, he or she ends up arriving at work before the staff and leaving after them. He or she will also take on fewer locums and assistants and do more of the work himself or herself. Many practices have closed. I know of one in which the GP employed an assistant who he had hoped would replace him when he moved on, but that practice has closed and the assistant has moved to Canada. Only about 15% of practices in the country are operated single-handedly. We moved to a double partnership and then to operations comprising three or four doctors. We need to move to having practices that will have the least referral rates to hospitals. The most expensive is an average practice with two to three GPs because they know their patients. The problem is we do not use evidence based medicine. Ireland is no different from Britain which, following the Second World War in which a swathe of people were killed, had to bring people in from the colonies. It had to incentivise people to move into areas of deprivation and rural areas. It had to design contracts in a certain way. However it is done it will be expensive, but we have to do rather than talk about it.