Hard times for general practice

by Ursula Brennan

The Northern Ireland LMC conference took place recently in Belfast. First time chair Ursula Brennan reflects on the debate

Location: Northern Ireland
Published: Friday 1 December 2023
36369 ursulla brennan

General practice in Northern Ireland has genuinely never been in a more difficult place. This was my first experience of chairing conference.  It was an opportune time to hear the challenges facing our colleagues.


The professional and personal stress and distress across our General Practice Family, with the immense demand for our professional care, creates an environment of crisis and risk. GPs are currently trying to navigate our way through an NHS system creaking under unambiguous stress for both patient and professional. 

The day before the conference the nineteenth practice in Northern Ireland announced it was handing back their contract.

Talking about this, the contract holder was visibly distressed and emotional.  They emotionally delivered the conference a stark warning that while practices may feel safe, they really are only one resignation, maternity leave or long-term illness away from a crisis.

Political Paralysis

The frustration, helplessness and anger at the state of our health service comes against a backdrop of severe financial and resource challenges in health. Our civil service faces all these challenges with a complete lack of political leadership from either Stormont or the Northern Ireland Office. We are operating in a system on the verge of paralysis which is detrimental to our practices and more importantly our patients.

Northern Ireland lags behind the other nations in many critical areas; we are still the only devolved nation where GPs have to pay our own indemnity meaning attracting new GPs is exceptionally difficult. Conference challenged the Department’s stance whereby we are being asked to prove the ‘tangible economic benefit’ to addressing this for GPs in Northern Ireland.

NHS 111

Conference debated a motion around NHS 111 system. NIGPC was urged to resist attempts, if NHS 111 system is introduced, to allow appointments to be bookable directly by outside organisations.

Elective Care

Recent funding cuts for elective services in Northern Ireland were also discussed with the recent decision to end funding for the GP elective care vasectomy service drawing particular criticism. Conference directed NIGPC to open negotiations with the Department of Health and the SPPG to seek restoration of the funding for elective care and, to ask if an equality impact assessment was carried out in relation to the decision to decommission women’s health and vasectomy services and ask where within the Northern Ireland NHS providing these services after April 2024.


Conference also agreed to strengthen the role and governance of LMCs and ensure LMC officers and representatives are protected from liability. The motion agreed there needs to be proper job descriptions outlining the role and remit of LMC officers; LMC constitutions in all LMCs in Northern Ireland, liability insurance arrangements for LMCs, clear financial guidance for officers and committee members attending meetings from external organisations and NIGPC is to scope and cost honoraria arrangements for committee members as well as LMC officers.


Finally, and maybe most importantly, conference passed a motion that instructs NIGPC to demand immediate engagement with the Department of Health regarding a new GMS contract for 2024 to ensure the continued existence of general practice.

While some of the debate was challenging, what was clear to me was the unwavering commitment GPs have to their patients and the wider GP community. All the motions debated whether they passed or not show the commitment of all of the Northern Ireland GP representatives, trainees, Salaried, sessional and partner to try and change and enhance general practice despite the poor financial situation in Northern Ireland and lack of a government.