Is a shortage of GPs contributing to overcrowding at UHL?

University Hospital Limerick found itself at the centre of the national conversation around hospital overcrowding once again, after recording the highest number of emergency department attendances in the country at the start of August.

With more than 55,400 patients attending the emergency department so far this year and almost 1,350 presentations over a four-day period, HSE Mid West appealed to the public to consider alternative healthcare services where appropriate to help ease pressure on the region's only Model 4 hospital.

The "exceptionally high demand" raised fears over how UHL will cope this winter if it did not have enough capacity during the summer months.

There was no shortage of health stories making the news last week.

It emerged that almost 6,000 people with medical cards or GP visit cards have contacted the HSE's GP Assignment Office so far this year, seeking help in finding a GP willing to accept them as patients.

New figures also indicate that while Ireland's population increased by around 10% between 2020 and 2025, the total number of GPs increased by just 6.4%.

The figures have prompted concern among politicians and GP representative organisations that primary care is struggling to keep pace with population growth.

Sinn Féin health spokesperson David Cullinane said the figures showed GP services had "fallen further and further behind the needs of a growing population".

He argued that if people cannot access a GP, continuity of care suffers and more patients ultimately present to already overcrowded emergency departments.

The Irish Medical Organisation has voiced similar concerns.

Chair of the IMO's GP Committee, Dr Tadhg Crowley, said he believed more than 6,000 people were struggling to find a GP and warned that shortages were particularly acute in rural communities, commuter belts and some urban areas.

Ireland, he said, faces an ageing population alongside rising obesity levels and increasing rates of chronic disease, all of which require greater investment in general practice.

It raised the question in the midwest: Is difficulty accessing a GP driving more people through the doors of UHL?

The answer appears to be more complex than a simple yes or no.

General practice remains the cornerstone of healthcare in Ireland. Around 4,900 GPs are practising nationwide, and approximately 80% of the population visit their family doctor at least once every year, according to data published in March by the Irish College of General Practitioners.

Collectively, general practices provide around 21 million GP consultations, and a further 8 million practice nurse consultations annually.

However, access to those services is not evenly distributed. The figures show significant regional differences in GP availability.

Sligo has the highest GP coverage per capita, with a range of 121 to 125 GPs per 100,000.

Clare has 69 GPs for every 100,000 people, while Tipperary has 75, according to the ICGP figures. Limerick fares somewhat better with 92 GPs per 100,000 population, but all three counties depend on UHL for emergency and acute hospital care.

Against that backdrop, it might appear logical to conclude that limited access to GPs is placing additional pressure on the Dooradoyle hospital.

However, the HSE argues that the reality is considerably more complicated.

HSE Mid West Regional Clinical Lead for Strategy and Development Dr Terry Hennessy said the principal problem facing the midwest is not simply access to general practice but an overall shortage of healthcare capacity throughout the region.

"The real problem in the midwest is the actual capacity issues in terms of bed numbers and staffing," he said.

"We would be bottom of the table with regard to the number of beds and the number of staff available to the number of patients presenting to health services in the midwest."

Importantly, Dr Hennessy said those shortages extend well beyond UHL itself.

He pointed to capacity deficits in Model 1 hospitals and rehabilitation services, citing independent reports by both HIQA and the ESRI which have repeatedly highlighted the midwest's comparatively low healthcare capacity.

A new 96-bed unit was opened on the Dooradoyle campus last year, and Minister for Health Jennifer Carroll MacNeill announced the acquisition of a 44-acre site for a new hospital facility in Raheen.

HSE Mid West hopes the new hospital will be built in stages, allowing access to patients upon the construction of each unit.

However, construction will take time, and measures are required in the meantime.

Dr Hennessy has called on the Department of Health and the HSE to allow additional recruitment in the midwest, arguing that increasing staffing could immediately help reduce the risks associated with exceptionally high patient numbers.

He also disputed the suggestion that large numbers of patients attending the emergency department could simply have been treated elsewhere.

Data from admissions over the busy four-day period paints a more nuanced picture.

One-third of patients admitted to UHL arrived with a referral letter from their GP.

While around half of patients presented without a GP referral, 42% of those arrived by ambulance. A further 7% were referred by Shannondoc, while others came via private healthcare providers or nursing homes.

"The vast majority that came through the emergency department had come through very expert medical hands who felt that they needed to be at the emergency department," said Dr Hennessy.

The figures suggest that many patients attending UHL are seriously ill rather than bypassing community healthcare unnecessarily.

HSE Mid West continues to encourage people with non-life-threatening illnesses or injuries to consider alternatives where appropriate, including local pharmacies, injury units and GP-referred medical assessment units in Ennis, Nenagh and St John's Hospital.

The emergency department, it stresses, remains the right place for anyone experiencing a life-threatening emergency.

Meanwhile, HSE Mid West is also taking a multi-pronged approach to increase the number of GPs working across the region.

It said it continues to work with the ICGP to support ongoing provision of GP services, including the Rural Fellowship Programme - a collaboration with the ICGP and the University of Limerick.

HSE Mid West said there is increased GP training capacity with 56 trainees in the midwest since July, which is a 25% increase in GP trainees since July last year.

It said engagement is ongoing between the HSE and the ICGP to continue to attract GPs to the region.

Regional Executive Officer HSE Mid West Sandra Broderick said: "Our GPs are at the heart of our health service, supporting patients from childhood right into later life. When people can access primary care quickly, we prevent small issues becoming major ones, protecting patients, easing strain on hospitals, and building a healthier future for everyone."

Taken together, the evidence suggests GP shortages are contributing to wider pressures within the healthcare system, particularly in counties where access to family doctors is more limited.

However, the information also indicates that overcrowding at UHL cannot be explained by GP availability alone.

Instead, clinicians, GP organisations and independent reports all point towards a healthcare system under strain from multiple pressures: Population growth, increasing demand, workforce shortages, inadequate hospital bed capacity and overstretched community services.

Improving access to general practice may help reduce some unnecessary emergency department attendances and strengthen continuity of care.

But those working within the midwest health service argue that meaningful progress will also require sustained investment across the entire healthcare system if the region is to meet the demands.