Rural GP crisis impacting on women’s access to vital health supports

Women in rural Ireland are being locked out of key health supports because of ongoing difficulties accessing GP services.

While the debate over whether rural communities have been left behind continues, women outside urban areas face a clear disadvantage, with shortages of GPs creating a major barrier.

That means many cannot access programmes such as the HRT scheme, which provides free hormone replacement therapy medication for women experiencing menopause symptoms, and the Free Contraception Scheme for people aged 17 to 35.

The Irish Medical Organisation (IMO) has repeatedly raised concerns about the shortage of GPs in rural areas.

Castlerea doctor Madeleine Ní Dhálaigh, vice chair of the IMO’s GP committee, said the problem has been building for years.

“Our population has gone up, and there has been a lag with regard to planning to get more GPs on the ground to accommodate that population,” said Dr Ní Dhálaigh.

She said the reversal of earlier cuts had helped general practice, with extra funding directed towards chronic disease management and contraceptive care for women.

Dr Ní Dhálaigh said population growth and the continued emigration of young doctors had added to the pressure, although GP training numbers are now rising.

“There has been an increase in training posts now in general practice, so that it's gone from 250 with a few years ago to a rapid increase now to 400 new GP trainees being taken in for training each year, so we're beginning to see vowels??? coming out now,” said Madeleine on the future GPs.

She said further government support could help boost GP numbers in rural communities.

“Look at supporting doctors who number one want to open up new practice with grants for equipment or for property and for recruitment of personnel, but also supports with regard to existing practices, increasing the footprint and taking on new partners,” she said.

Asked what people should do if they are struggling to get a place in a GP practice, Dr Ní Dhálaigh said patients should “spread the net”.

“We know there are practices that are closed to new patients, but there are many practices who are still taking on new patients and are expanding their services. But it's a very difficult spot at the moment.

“If things are improving, they're improving slowly but surely, with the investment into training, and hopefully the HSE will look at improving grants and tax exemptions for GPs, expanding or starting up, but I would advise patients to keeping throwing out the net wide.” Doireann Crosson of the National Women’s Council of Ireland said access to healthcare has emerged as a major issue for women, alongside ongoing concerns around public childcare.

“Certainly, one of the things that's coming out in terms of rural women's perspectives, and a lot of our research would be access to GPs,” said Ms Crosson. “That's increasingly becoming an issue that we're hearing. We published research just towards the end of last year, which looked at kind of evaluating some of the women's health services that have come on in the past couple of years, so things like free contraception, the availability of HRT, menopause clinics, all these really fantastic, really brilliant women's health services, but what we're finding is that you obviously need a GP first to access those.” The NWC works with local community and rural grassroots groups to identify the issues affecting women in rural areas.

“We work across these different issues, and so feminist communities for climate justice, women's health, tackling women's economic inequalities, violence against women, care, childcare, women's participation, and leadership,” Ms Crosson continued. “We work with our memberships to develop like research policy position campaigns on issues like that.” Under its new strategic plan, the NWC says it wants to drive greater equality for women. It has previously influenced policy and decision-making on work, pay, social protection, pensions, taxation and public spending to advance gender equality and reduce poverty among women and girls.

According to the report, Ireland’s two-tier health system is widely seen as deepening inequality. Participants who could afford private health insurance described faster and more responsive care, while others reported delays, refusals by GPs to take them on, and restrictive prescribing practices.

Many women described serious barriers to healthcare, not because services did not exist, but because they could not afford, reach or navigate them. Financial pressure was a recurring theme, with participants across all groups saying they had gone without treatment, prescriptions or regular care because of cost.

“Women living rurally and disabled women struggled to reach services or found that facilities lacked the equipment, accessibility, or staffing needed to meet their needs, “stated the report The report found that while women’s healthcare in Ireland has seen significant progress, those improvements have not reached all women equally.

Many continue to face overlapping barriers, including limited service availability, unaffordable care, discrimination and inaccessible systems.

Local Fianna Fáil TD Martin Daly has also repeatedly warned about the challenges facing rural GPs and their patients.

“Many areas in the country are under significant pressure to obtain GP services, most especially deprived urban areas, rural areas, and also growing urban areas,” he said. “We have a real problem recruiting and retaining GPs in rural areas.” He said the high cost of setting up new practices remains one of the biggest obstacles for would-be GPs.

“We do need to take a look at how we help GPs to establish in the areas we want them, so not only are women's health services affected, all sorts of access to services are affected, and people are finding it increasingly difficult to sign on with the GP, and even when they are signed on with the GP, there are now significant wait lists for a routine appointment,” he said.