Policy Report

Politics, policy and action: lessons from rural GP advocacy in Ireland


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Shagun Tuli
1,2 MGHD, Resident * ORCID logo

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Peter Hayes
1 MMMed , General Practitioner and Senior Lecturer in General Practice

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Patrick O’Donoghue

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Fergus Glynn

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Robert Scully
5 MD, Deputy Director

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Andrew W Murphy
6,7 MD, Professor of General Practice ORCID logo

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Alan Bruce Chater
8 MBBS, Mayne Professor of Rural and Remote Medicine, Chair Rural WONCA ORCID logo

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Liam Glynn
1,9 FRCGP, Professor of General Practice and General Practitioner ORCID logo


1 School of Medicine, University of Limerick, Limerick, Ireland

2 Department of Obstetrics and Gynaecology, Hurely Medical Center/Michigan State University, USA

3 Dunleer Medical Practice, Dunleer, Co. Louth, Ireland

4 Ennis Medical Centre, Ennis, Co. Clare, Ireland

5 School of Medicine, Medical and Biological Sciences Building, University of St Andrews, St Andrews, KY69TF Fife, Scotland

6 Department of General Practice, National University of Ireland, Galway, Ireland

7 Health Research Board, Primary Care Clinical Trials Network, Ireland

8 Rural and Remote Medicine Clinical Unit, The University of Queensland, Herston, Queensland, Australia

9 Health Research Institute, University of Limerick, Limerick, Ireland

ACCEPTED: 23 June 2024

early abstract:

Context: Ireland has one of the most rural populations in Europe. Rurality presents challenges when accessing health services but should not be perceived as 'problematic' in need of a structural fix. Structural urbanism where healthcare is viewed as a commodity for individuals rather than an infrastructure for populations, innately favours larger urban populations and has detrimental outcomes for rural health. In this paper we present a brief account of advocacy led by rural general practitioners, their communities, and the political and policy implications of their efforts.
Politics, Policy, and Action: In the period 2010-2016, Irish rural general practices were struggling for viability. Two key financial supports the 'Distance coding' and the 'Rural Practice Allowance' were withdrawn. This directly contributed to the founding of the 'No Doctor No Village' public campaign following which the rural practice allowance took shape as the Rural Support Practice Framework and was expanded to cover a larger number of rural practices. The more recent World Rural Health Conference in June 2022 at the University of Limerick invited over 600 expert delegates who contributed to the authorship of the 'Limerick Declaration' a blueprint for advancing rural health in Ireland and internationally. This created a new momentum in advocacy for Irish Rural General Practice which has drawn financial investments, sparked research interest building capacity for a pipeline to train rural general practitioners.
Lessons learned: Local voices have driven monumental change in the Irish healthcare context as for the communities themselves, the policy and politics of rural health are mere tools to maintaining or restoring their way of life. The biggest lesson to be learnt is that unrelenting community commitment, when supported by the capacity to advocate, can influence politics and policy to generate sustainable outcomes and thriving communities.
Keywords: community advocacy, rural advocacy, rural general practice, rural policy.