Debate contribution: Primary Care: Extreme Pressures

Debate contribution by Mr Alan Robinson on 14 May 2024.

MLA

Mr Alan Robinson

Party at the time

Democratic Unionist Party

Date

14 May 2024

Type

Debate contribution

Business

Private Members' Business

Heading

Primary Care: Extreme Pressures

Assembly identifier

Official Report component 4490229

Read the official Assembly record

Text

I beg to move

Thank you, Mr Speaker. How many Members can say that they have never fielded a call to their office from patients struggling to get through to a GP surgery? I would safely say that not one of us can. I could tell you of multiple complaints to my office. I have struggled to access GP services, my staff have struggled and my family has struggled. It is a common complaint, and it is not getting any better.

Forgive me, Mr Deputy Speaker, for starting off my contribution on what some may see as a negative, but it is an issue that dominates my office and one that my constituents will expect and demand that I highlight on the Floor of the House. It is vital to state from the outset that we need to fix it on behalf of patients and GPs. I will follow up my somewhat negative comment by thanking those who work in that vital sector for their tireless efforts. We must always acknowledge their commitment to the well-being of the people of the Province. Primary care is often the first point of contact in our health service, and it plays a key role in maintaining the health and resilience of our population. Professionals such as GPs, nurses, health visitors, physiotherapists, social workers and mental health practitioners form the backbone of our healthcare system. They are the spine of the health and social care team. To put that into some context, 2,041,000 patients were registered with GP practices in Northern Ireland as of 31 March 2023, with around 200,000 general practice consultations undertaken each week in 2022-23. However, recent findings from the NI Audit Office reveal concerning trends. Almost one in three local GP practices has sought crisis support in the past four years. That alarming statistic underscores the urgent need for action. We cannot afford to overlook the challenges faced by our primary care workforce. The report said that 1,448 GPs were registered on the Northern Ireland primary care medical performers list as of 31 March 2023 but that more than a tenth of GPs on that list left during 2022-23, with 318 GP practices in the Province as of 31 March 2023. However, of those, 39 were assessed as being at risk in the same period. On top of that, 13 contracts were handed back during 2022-23. The report detailed how general practice accounts for 5·4% of all health and social care spend in the Province, with £375 million spent on GP practices in 2022-23. Whilst multidisciplinary teams (MDTs) are seen as a key element of transforming primary care and helping the wider healthcare system, only 8% of registered patients had access to the full range of MDTs as of March 2023. Progress on MDTs simply has not met the ambitions. MDTs are key to reversing the fortunes in general practice and wider healthcare. Working as part of a much larger team is attractive to many doctors. It means, in simple examples, such as arranging annual leave or covering for a colleague who is off sick, that there is a much broader group to carry the burden, rather than just one or two colleagues. The Department of Health has cited financial pressures as the key issue in not improving primary care. However, the Comptroller and Auditor General was clear in his March report that, even with a lack of sufficient funding, the Department needs to explore alternative and credible options for the implementation of the MDT model over the coming years. I trust that the Minister will answer the following questions today: has he taken this recommendation on board, and will he expedite the review of the MDT project and bring a revised business case? Other findings in the report were that pressures on general practice are driven by a growing and ageing population and that a significant number of GP practices are under severe pressure. It also found that data on activity in general practice is limited and that it is unclear whether activity is above pre-COVID levels. Published workforce data does not provide a picture of the working patterns of GPs. Nobody is questioning the commitment and integrity of our GPs or allied health professionals and the staff who support them. There are, however, legitimate unanswered questions facing the Department of Health on the current levels of accountability for activity in GP surgeries. Is the Minister confident that throughput has returned to pre-COVID levels? Has face-to-face contact increased in recent months? How many appointments are made available each day, and how does that vary from practice to practice? Are there plans for targets to be set in contracts for GP services? There is scant detail on these areas, and there is an apparent dearth of any robust or strategic approach to capturing such data for the purposes of informing future general medical services (GMS) contracts for service delivery. A workforce strategy is a cornerstone of any successful healthcare system. Regrettably, the Province lacks a specific strategy tailored to general practice. Without a clear road map, we risk stagnation and missed opportunities for improvement. Recruitment, training, retention and reward mechanisms are crucial components of workforce development. The Department of Health needs to do more to incentivise newly trained GPs and, indeed, to incentivise to stay those with experience who are considering walking away from the profession. This means ensuring that they have the space and opportunity to pursue professional aspirations. It means fair remuneration for the work that they do, and it requires a workforce strategy that practically acknowledges the need for flexibility when it comes to longer-term fostering and guaranteed leave. The recent Royal College of General Practitioners Northern Ireland (RCGPNI) strategy to tackle GP workforce retention and 'A Workforce Fit for the Future' had similar concerning findings. The average number of registered patients per practice has increased by around 17% from 5,500 to 6,439 since 2014. This increasing demand suggests the need for a further expansion in GP training places into the future. Whilst training more GPs is important, so is ensuring that those who qualify remain here and forge a career in primary care across Northern Ireland. The drain of expertise to other jurisdictions needs to be stemmed. An increasing number of early-career GPs who have trained in the Province are not taking up posts here, and, according to the recent RCGPNI survey, 29% of GPs stated that they would be fairly or very unlikely to be working in general practice in the Province in five years' time.

Some 60% said that they had found it fairly or very difficult to recruit GPs to their practice in the past year.

The report went further and said that fellowships were not available for young GPs working in substantive posts unlike in other parts of the UK, where weekly opportunities exist to further develop clinical aspirations. Many of the GPs surveyed reported practice infrastructure that was not fit for purpose, which led to poor working conditions, and the lack of a functioning secondary care service was highlighted as exacerbating GP workloads and patient demand. Also, there was a perception among many GPs that little help was available for practices until they reached the verge of collapse. Notably, only one of the practice contract hand-backs was in an area where an MDT model was in place. It is welcome that £5 million has been made available to help cover the cost of insuring GPs against claims, hopefully aligning with arrangements in other parts of the UK. That will, in the short term, provide much-needed support and security for our front-line healthcare providers, and we can only hope that it will help to persuade graduates to work in the Province rather than being lost to across the border. It is certainly a welcome start, and it is one that we hope will provide a longer-term solution. Added to the many other problems, the primary care estate is not in good shape. Technology needs to be embraced and better utilised, whilst being mindful of the quality impacts on certain protected groups. The morning rush to obtain an appointment by phoning the practice is utterly unacceptable for a modern service, and new ways need to be provided. That could include the ability to seek assistance and obtain an appointment online via mobile phone. Surely, there is no reason why primary care and other areas of public services, such as MOT booking, should be in any way less equipped for the modern world than business and retail. It is clear from the two reports that primary care in Northern Ireland has reached crisis point. We have fewer GP practices than 10 years ago, GP contracts are being handed back and a large cohort of trained GPs are choosing not to work in primary care or are working very limited hours because of the stress involved and a lack of support. All of that points to a model of general practice that is on its knees, and without concerted action —

— the situation will inevitably worsen as our ageing population grows.

1,517 words. Text as published by the Northern Ireland Assembly.

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Assessed 21 October 2026 at 10:23 UTC by jev-1.13.0 (requested as typesafe/jev) under rubric 2026.10-r9, methodology 1.9.

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