Thirty-five annual conferences later and in the spirit of Alma Alta, the Rural Island and Dispensing Doctors of Ireland (RIDDI) assert the right of Irish rural dwellers to enjoy optimal physical and mental health, in addition to economic and social wellbeing. In this regard and recognising that Irish rural medical practitioners are an essential part of the extensive Irish rural infrastructure we call on government to guarantee that Irish rural practice is sustainable into the future by ensuring as a first step that sufficient medical practitioners are retained and supported in rural areas. By using novel schemes including succession plans, Government must ensure that all vacant and locum- run rural and remote area GP panels are filled as a matter of urgency.
Due to serious issues with the recruitment and retention of rural practitioners in the most isolated rural areas and on the offshore islands, we urge that these isolated solo practices should instead operate with a second GP appointed to them and be fully resourced by the HSE.
Imaginative GP Associate schemes are urgently required to address the looming workforce crisis due to the imminent retirement of hundreds of ageing rural medical practitioners. A “thinking outside the box” approach by Government to sustain smaller rural and semi- rural practices is overdue. Models looking at extra staff including shared practice managers, practice nurses and other practice support staff such as physician associates, student, and post graduate interns are options which require to be considered. To counteract the serious and growing problem of rural medical practitioner burnout, RIDDI suggests creating a resourced virtual campus.
We are committed to fully engaging with our patient advocacy groups in our quest for a better future for all rural dwellers. Improving local rural services as a powerful weapon for rural regeneration, to break the vicious circle of further rural depopulation, has been RIDDI’s catch-call for decades. Supporting older people locally, including in congregated settings when appropriate, is integral to the work and viability of rural medical practitioners. So is the dispensing of medicines in areas where it is not economically feasible for a pharmacist to operate. Both the aforementioned need to be fully supported and developed further for the sake of rural dwellers.
The recent COVID -19 experience has shown us the value of cooperation, including the sharing of expertise and financial resources between rural medical practitioners, long- stay care providers, the Health Service Executive (HSE), and Government, which has enabled local services to be supported and sustained throughout the pandemic.
The return during COVID by many younger people to rural areas who can see the clear life- enriching advantages of lower cost living and working in rural Ireland has engendered new hope with greater potential for rural regeneration, but has resulted in an increased workload for already hard pressed rural medical practitioners. While reiterating that Irish rural medical practitioners are an essential part of the rural infrastructure, we call on our Government and the HSE to revisit and build on this newfound spirit of cooperation and support engendered during COVID and so ensure rural medical practitioners are facilitated to take due time off by providing a locum bureau, and ensure the viability of local congregated settings providers, whether they be HSE -funded or private, by ensuring they are adequately and equally resourced.
We will continue to forge links with third level institutions in a spirit of true equal partnership rather than on a “country cousins” approach, and in accordance with our constitution.
Young students in health sciences should all be given a chance to experience the amenity of rural communities and training in those communities.
We are certain that rural practitioners are willing and able to contribute further and significantly to the rural research base.We need meaningful and relevant evidence- based rural practice research with the agenda being set by local communities and their practitioners on the ground, which can advance our cause going forward on behalf of our rural population.
The rural medical practitioner is the first “port of call” in every rural “storm” with often no colleague or Emergency Department close to hand. The acute critical care role of remote rural medical practitioners needs to be recognised and supported adequately with essential training and equipment.
We call for the restoration of the distance codes system, the abolition of which has amounted to a massive disincentive to rural practice as a career choice for young medical practitioners. We are confident that adopting the aforementioned will not only stop the exodus of medical practitioners from rural Ireland, but will actually reverse it.
A Chair of Rural General Practice should be resourced within a higher education institution nationally.
Our partners in this conference the Irish College of General Practitioners (ICGP) already provide Clinical Leads for diabetes, global health, mental health etc. We would welcome an ICGP Clinical Lead in Rural Health, while acknowledging the major support offered already by the ICGP to Irish GPs through their extensive CME network in particular. We need to prioritise Vocational training and placement of GP Registrars in rural practice.
RIDDI as a stakeholder in rural Ireland will continue to work in equal partnership with the Irish College of General Practitioners (ICGP), the Irish Medical Organisation (IMO), Patient Advocacy Groups, and all other organisations which seek to improve the health of all rural dwellers, especially the most marginalised, including our ethnic travelling community and refugees. We need to be mindful of our duty of care to our planet, and everything we do should be in an environmentally sustainable manner. Above all we need to be central to the decision making on the future of rural and semi-rural Irish General practice and have a meaningful representation at any table where decisions are being made which affect us; these need to be rural- proofed as agreed by the OECD. The voices of rural communities must be heard and listened to in a spirit of partnership and equality. “Nothing about us without us.”
We demand that our Government Department of Rural and Community Development and the Health Service Executive partner with us in our quest for rural practice sustainability.
Ní neart go cur le chéile. There’s strength in unity.
To quote Fintan O’Toole at WONCA World Rural Health Conference Limerick 2022
“There is no clearer way of telling people they are unequal than denying them access to healthcare”
As Dr Anna Stavdal, President of WONCA, said today – ‘Family Doctors- Always There To Care’- but, in Rural Ireland- there is a real risk they may not be!
END
Dr Jerry Cowley
Chairman
On behalf of RIDDI on 20/06/2022