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'If you're the only GP providing abortion services in an area, you are open to protests'

Clare TD Dr Michael Harty, who is also the chair of the Oireachtas Health Committee, spoke to TheJournal.ie about the challenges for GPs in implementing abortion services.

CLARE TD DR Michael Harty, who is chair of the Oireachtas Health Committee, has said that the threat of anti-abortion protests could be putting GPs off from offering the service, and that the “ambitious” date of 1 January to introduce abortion services has led to “sporadic availability” across the country.

Harty, who has a practice in Kilmihil in Co Clare for over 3 decades, was elected in the last general election on a “No Doctor, No Village” campaign that aimed to increase GPs incomes after it was cut during years of austerity.

In an interview with TheJournal.ie, when asked whether GPs are signing up to provide abortion services, he agreed that concerns about protesters was a factor.

“In rural areas, if you’re the only person supplying a service in an area, you are open to protests. Certainly the GPs who are providing it just for their own patients, it could be an issue that they would be afraid that they would be targeted,” he said.

Minister for Health Simon Harris is currently working on legislation to provide for “exclusion zones” outside medical centres that provide abortions.

The law would prohibit communicating with a person within the safe access zone in a way that “causes distress”, and to “prohibit capturing and/or distributing images of any person in a safe access zone”.

2457 Simon Harris_90563965 Source: Sam Boal

Before the Eighth Amendment referendum last year, a group gathered outside the Rotunda maternity hospital in Dublin holding graphic posters that were described by Harris as “despicable”. Protests were also held outside a GP’s practice in Co Galway and outside Our Lady of Lourdes Hospital in Drogheda shortly after the introduction of abortion services on 1 January.

Last month, a GP clinic in Co Longford was spray painted with anti-abortion graffiti overnight.

It is understood that the Attorney General is being consulted on the new laws, and new proposals to introduce safe access zones are to be introduced early in the year.

“To date there have been sporadic protests,” Harty says “but it would be a factor in a GP’s decision to making their practice known to be supplying services for a wider community other than their own patients”.

There is a register of GP practices that offer abortion services to the public, but this is not the complete list; other GP practices might also provide the service, but only to their existing patients. 

In a statement to TheJournal.ie, the HSE said that in consultation with GPs, it had decided to make participating GP details available by calling the MyOptions helpline, rather than publishing a list of GPs.

“Daily changes to the GP listing, and some GPs offering abortion services to their existing patients only, were factors in this decision,” it said.

4016 Referendum count_90545944 Source: Leah Farrell

Last month, 35 pro-choice groups around the country signed an open letter that stated rural service provision for abortions was “sparse”. No GPs had signed up to services in some counties, it claimed, expressing disappointment at the service provision.

Although the HSE said that it couldn’t give a county-by-county breakdown of what GPs had signed up to offer abortion services due to privacy concerns, it said that it “is satisfied that there is a good geographic spread of GPs taking part, enough to meet the needs of people who may need to access the service”.

274 GPs have signed the contract and each day more GPs are signing up, as the service evolves.

“There are a number of reasons why GPs are slow to sign up,” Harty says.

Because it’s new, GPs are not quite sure what supports they’ll have in relation to referral pathways into the maternity hospitals.
They’re not sure of their access to ultrasound to confirm the dating of the pregnancy, and they’re not sure of the confidence in supplying the service because it’s something new.

The Irish College of General Practitioners said that over 200 GPs have completed its training course on providing abortion services, while other GPs are still waiting to complete it.

“So I think over the next couple of months, the number of GPs signing up to provide abortion services will gradually increase,” Harty said.

When asked whether the date that Simon Harris set for the implementation of abortion services was unrealistic, Harty said that the 1 January date “was a political timeline rather than a clinical timeline”.

“Politically it was promised, so from that point of view it was imperative that the minister deliver it from 1 January,” he said.

From a clinical point of view, the medical profession, the hospitals and GPs would have preferred if there was a longer run-in period. Having said that, no matter what the target date was, there would have been some kick-back on that target date.

He added that the 1 January was “very ambitious,” and has led to “a sporadic availability of abortion services” – not only the community general practices, but also through the maternity services.

Harty says his understanding is, of the 19 maternity hospitals in Ireland, just 10 were ready to offer abortion services on 1 January, “and some of them still aren’t ready to go”. He said that it wasn’t a straightforward “yes or no, we’ll supply the service” in hospitals:

You have to organise rotas to accommodate those who are conscientiously objecting in the hospital service. For example, in theatres where there would be surgical terminations you have to make sure you have a rota of staff who were willing to participate in supplying the service.

He said that depending on how many staff conscientiously object, that “can and does present problems for maternity hospitals”. 

CEO of the National Association of General Practitioners, Chris Goodey, said that the organisation was “of the position that abortion services were being rushed through”.

“That has certainly caused problems… There isn’t an equal spread of services,” he said.

He also said that not being able to get timely access to ultrasound or the support for blood tests “has caused problems” for GPs in making a decision to offer abortion services.

Women are still travelling abroad because the service hasn’t been rolled out properly.

He said that it was important to rectify this “to provide a safe [abortion] service for the women of Ireland”. 

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