Urgent action needed to stabilise general practice
Dr Frances O’Hagan, chair of the BMA’s Northern Ireland general practitioners committee, outlines her hopes and concerns around the provision of general practice services across Northern Ireland.
Q. How would you describe the current state of general practice in Northern Ireland?
A. Unfortunately I think we are in one of the most challenging periods general practice has ever experienced. Post-Covid, pressures have increased significantly. Some of the reasons for this are well documented, we have an increasing population that is getting older but living for longer with serious, chronic ill health. We have fewer GPs and are losing many due to retirement and burnout. We are struggling to fill training places, being a GP is not perceived to be an appealing career pathway any more due to the immense stress related to the job.
While our practice patient numbers are rising, the funding we receive is not increasing in line with this. We have seen practices forced into a position where they were no longer able to continue providing a service and have therefore handed their contracts back. In turn, this causes instability across geographical areas, and some of the solutions, for example, trusts taking over the running of a GP practice, are not optimal in terms of creating a sustainable long-term solution.
We are also facing a perception issue that compounds the problem. Many patients believe that GPs are no longer offering face to face appointments, but this is simply not true. Even during the height of the Covid pandemic, GPs continued to see patients face to face.
Every GP will see patients face-to-face, every day. There are about 200,000 patient contacts every week, with 20,000 face-to-face every day, but there is still a perception that ‘you cannot get an appointment’, which undermines public confidence in general practice.
A key shift has been the adoption of triage-based models of care. Without this change general practice would have been overwhelmed. Where it is appropriate, we will consult with patients over the phone, which many find more convenient. However, we recognise this approach does not work for everyone and that is why GPs continue to offer a mix of options, including agreed face-to-face appointments.
Another frequent source of frustration for patients is the difficulty in getting through to their surgery by phone. Media reports often highlight patients calling multiple times before getting an answer. This frustration is entirely understandable, but it reflects the overwhelming demand. Even with dozens of phone lines and staff available, there is only so much capacity in a day.
GPs and their teams are working tirelessly to meet as many patients’ needs as possible, but the system will only deteriorate further unless more is done to retain existing GPs and recruit new ones.
The damaging narrative that GPs are ‘closed’ is taking its toll on morale across the profession, affecting both GPs and their practice staff. This year we are committed to challenging this misconception and making it clear that GPs are open, working harder than ever and are dedicated to supporting their patients.
Q. What are the short-term fixes needed to stabilise general practice?
A. To stabilise general practice in the short term, urgent action is required on two critical issues: Indemnity costs and National Insurance contributions.
Firstly, it is clear we need an indemnity solution. While there have been some temporary fixes, we need a proper solution agreed and funded now. When a GP is looking at where they want to make their career, Northern Ireland is unappealing because of this additional cost.
There are many medical students and young doctors from Northern Ireland who do their training elsewhere in the UK. Unfortunately, they are not going to want to return here if it is more expensive to work in Northern Ireland. To address this we have been working with the Department of Health to try and find a solution and we hope to see more progress on that this year.
Critically, we also need a solution to the National Insurance employer contribution problem. By increasing NIC the Chancellor has significantly increased the costs of running every GP practice. This has caused widespread concern and worry across the profession, with some practices now facing the prospect of cost-cutting measures to remain viable.
We are collaborating with colleagues across the UK to lobby for urgent changes to this policy, as it risks pushing practices into an untenable position. A solution must be found before further damage is done to general practice.
Q. What are the longer term aims for you in this role?
A. Longer term there are two key priorities that need to be addressed; increasing funding and expanding access to multi-disciplinary teams (MDTs).
General practice currently receives just 5.4 per cent of the overall health budget, despite handling a significant share of patient care. The current state of the hospital system, with enormous waiting lists and delays, means GPs are left managing patients repeatedly as they await assessment and treatment.
This places an unsustainable burden on practices and highlights the need for a funding increase to address the imbalance. Adequate investment in general practice would not only improve patient care but also alleviate pressures across the wider health system.
The planned rollout of multi-disciplinary teams across Northern Ireland is a welcome development, but its success depends on proper engagement with GPs on the ground. At present, only 8 per cent of the population has access to MDTs, which must change to create a meaningful impact. Expanding MDT coverage would provide critical support to practices and patients alike, while also contributing to better long-term health outcomes.
We need a collaborative approach to ensure MDTs are implemented in a way that genuinely supports GPs and benefits patients. Achieving this will require careful planning, sufficient resources, and ongoing communication with those delivering care on the front line.
| Dr Frances O’Hagan was the deputy chair of the Northern Ireland General Practitioners Committee (NIGPC) from 2018 and she has also been the chair of the Southern Local Medical Committee (LMC), the first female GP to hold a LMC chair/secretary role. O’Hagan was the first female chair of the 17 GP federations in Northern Ireland. She qualified as a doctor from Queen’s University Belfast in 1989 and has been a GP partner in The Friary Surgery in County Armagh since 1997. She is now the senior partner in the practice. She is a wife, mother and a grandmother. |
T: 028 9026 9666
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