There has been no let-up over the past year in the pressures general practice is facing; this is the message from the GP leader in Northern Ireland, Dr Alan Stout, at the Local Medical Committee conference today [Saturday 18 November 2023].
At the conference, attended by GP representatives from across Northern Ireland, Dr Stout, who is now in his final year as NIGPC chair, said that general practice in Northern Ireland was now in the most difficult position it has ever faced with more practice contract hand-backs, financial pressures, staffing pressures and rising patient need.
“Let me be absolutely clear, the crisis is not the fault of the hard working, committed GP’s and it is not the fault of our LMC or other GP representatives. We have and we continue to lobby, to advise and to warn of the problems we face and the problems that are coming rapidly at us, but we see so little to help us or to even give us some hope.
“It is impossible at this point not to reflect on the past six years and how we got to such a difficult position.
“When I started as chair, it coincided with two big events. The Bengoa report had just been published and it filled us with optimism and hope. We could see a way forward, we could see a hope and we could see a clear path into the future of healthcare delivery in Northern Ireland.
“Rafa Bengoa himself said however, that the plan was never going to be the difficult bit, it was implementing it that would always be the biggest challenge. How right he was.
“Not only have all the predictions in the plan relating to us being on a burning platform come true, but the actions proposed are still all the correct ones, they have just not been actioned.
“Front and centre of these was building a strong, well-staffed foundation in Primary Care; this would be vital to everything we tried to do in the future, be it elective care, urgent care, out of hospital care, early discharge, preventative medicine, population health, the list goes on and on. Instead we have seen the collapse and the struggles we are all too familiar with. We can never be surprised when we see the crises.
“The second big event of course is the ongoing political instability in Northern Ireland. I will not delve into the politics of all of this, but suffice to say that for health to work, for it to evolve and for us to transform we absolutely need local government, a health minister and local and multiyear budgets. Without local, public accountability we see doctors and staff being held accountable time and again for things that are totally out of their control, and this is simply unacceptable.
“In my time as chair I have unbelievably only had one health minister, Robin Swann, and this coincided with a global health crisis that none of us ever want to revisit. It demonstrated very clearly how local politics can and should work, how decisions can be made and how the system can flex, react and can change very, very quickly. We will never, ever underestimate just how difficult that time was, and we are still feeling the effects of it, and to be left with no political lead and local accountability now as we try so hard to rebuild and to recover is utterly disgraceful.
“This of course leads me on to the current position, and I do not need to rehearse the multitude of difficulties with workforce, workload and with funding. We all know the key things that need addressed and my goodness we have tried. We have created our plan to save General Practice, we have our options paper which remains dynamic, and we have recently released our safety paper in a desperate attempt to keep our colleagues and our patients safe in the current environment.
“Unfortunately, we have seen no movement on any of these key actions and this has resulted in a very clear mandate at our last NIGPC meeting, with a unanimous vote to urgently start work on a new contract. This is not without risk, it may be negotiated but we have to be prepared that it may not be, and it has to provide safety, to value what is currently being delivered but be massively simpler than the current contract which just simply isn’t working for our GP’s and our practices.
“If the Department are committed to general practice, as they say they are, then they need to recognise that the power to stem the tide of practice hand-backs is in their hands. Messaging is critical, the prospect of help is vital, and additional simple things like updating and publishing the SFE, increasing payments for vaccinations and enhanced services along with inflation, as well as actually funding GPs for the number of patients they have would make a huge difference. We not only see the problems, but we see all of the solutions too.”
Notes to editors
The BMA is a professional association and trade union representing and negotiating on behalf of all doctors in the UK. A leading voice advocating for outstanding health care and a healthy population. An association providing members with excellent individual services and support throughout their lives.
Dr Stout will make his speech at 10.15am
The LMC conference is taking place in Belfast on 18 November 2023. A full list of the outcome of motions will be available at the end of conference.
A copy of the agenda can be found here: https://www.bma.org.uk/what-we-do/local-medical-committees