Debate contribution: Primary Care: Extreme Pressures

Debate contribution by Mr Colin McGrath on 14 May 2024.

MLA

Mr Colin McGrath

Party at the time

Social Democratic and Labour Party

Date

14 May 2024

Type

Debate contribution

Business

Private Members' Business

Heading

Primary Care: Extreme Pressures

Assembly identifier

Official Report component 4490253

Read the official Assembly record

Text

Thank you very much, Mr Deputy Speaker.

"The stark options facing the HSC system are either to resist change and see services deteriorate to the point of collapse over time, or to embrace transformation and work to create a modern, sustainable service that is properly equipped to help people stay as healthy as possible and to provide them with the right type of care when they need it."

Those words formed part of Professor Bengoa's report eight years ago, and, prophetically, I believe that they have come to pass. We are seeing the collapse of multiple services and increasing waiting lists across the health sector. It is a deeply worrying time. The extreme pressures that we face are evidenced most clearly in primary care. The motion is an important opportunity for us to discuss these issues. The amendment that the SDLP is proposing is a minor one that we believe complements and strengthens the DUP motion. The focus of our amendment is to shine a spotlight on the importance of the multidisciplinary teams. The provision of MDTs was an outworking of the Bengoa report in 2016 and was first piloted in Down and Derry in 2018. Primary care in the North has undergone significant operational change in a short time. On top of the operational change, we have witnessed an incredibly turbulent time for those working in primary care, which only intensified with the emergence of COVID-19. As a result, over time, we have seen a fresh focus, though perhaps not enough of a focus, on prevention and health promotion, and a reorientation of the health system away from treatment solely in hospitals towards the delivery of care in the right place for the patient. That can often be in the community or, as we are seeing even more now, at home. Multidisciplinary teams have emerged out of that focus. This new way of delivering primary care brings together GPs, pharmacists, district nurses, health visitors, allied health professionals, social workers, advanced nurse practitioners, physician associates and others. There is no doubt that, where multidisciplinary teams have been implemented fully, successful health outcomes have followed. I see it in the Down area in practices where MDTs have been fully implemented. I have been lucky to visit some of the MDT practices in my community to see the benefits not just for the patients who go to them but for the staff who work in those units. MDTs establish a truly holistic way of delivering primary care. With the development of modern technology, the ideal is that members of the public will find it easier to book an appointment with their local practice and get the right care at the right time. That is the ideal, but the present reality is different. Partial implementation of MDTs across the North has resulted in unintended consequences by creating new health inequalities. Of the 17 GP federations across Northern Ireland, only one — the Down federation — has had a full complement of MDTs since the inception of this new way of delivering care. That is not because it is my local area, I promise, but we have supported the moves to deliver MDTs. I have been proud to host in the Down area the pilot for across the North. It is distinctly worrying that 10 of the 17 GP federation areas in the North have no MDTs at all. That creates the unintended consequences that I mentioned: the creation of health inequalities.

I thank the Member for her intervention. It strengthens the argument about how we need to see that roll-out across all areas so that everybody can access the full range of services on an equal basis. The people of Fermanagh are just as entitled to that as the people of Down. It leaves us in a situation in which our health is affected by where we are born, where we live and work, and our age. When there is an imbalance in the distribution of resources and services, we see that imbalance in health outcomes. As a result, those living in areas of greater deprivation are often at risk of suffering from poor health outcomes. General practice is ideally placed to help to counter that and address the imbalance. Be under no illusion: contrary to what some said yesterday, the SDLP is not criticising for the sake of it. This is not about apportioning blame. Rather, we must recognise the reality of where we find ourselves and seek the right solution. That is the purpose of the amendment. I say that because nobody could be in any doubt as to the Health Minister's commitment to the important issue of reducing the pressures on primary care and to the roll-out of multidisciplinary teams specifically. I know that his commitment has been unwavering, and I am not just bigging him up so that he compliments me in his remarks.

I know that the Minister offers that support to MDTs. We must, however, be cognisant of those working in our healthcare sector, because, for them, the reality is that they are suffering from burnout or are not far from it. With more contracts being handed back by GPs, and health trusts then having to take over control, it is clear that that a paradigm shift is required, both operationally and culturally, in our delivery of primary care. Multidisciplinary teams are ideally placed to deliver that change. Operationally, the process of triage by reception staff is important for placing the patient with the most appropriate mental health, physical or social care needs within the MDT profession at the right time. We know that, culturally, some members of the public are still reluctant to speak to GP reception staff and want only to speak to their GP. That is understandable, but it places another operational layer on our GPs, who are already struggling. We are living in a post-pandemic world, and that presents new opportunities and new challenges. Today, more than ever, we need to unlock the potential of the health service to meet the needs of patients. Today, more than ever, we need to support our general practitioners to ensure that not only do we retain staff but we make the career path attractive for future generations, which the proposer of the motion referenced. The Royal College of General Practitioners Northern Ireland recently published 'A Workforce Fit for the Future', In that document, we hear doctors express the factors that are most important to them, the top six of which are work-life balance; income; workload; practice stability; the ability to pursue a GP role with special interests; and a practice with MDTs. It is important to note that the implementation of MDTs can lead to enhanced practice stability, so much so that, in practices that have a full complement of MDTs, only one contract has been handed back. When that happened, the trust was able to put in place the necessary structures to reduce patient disruption. Access to MDTs was also factored into GPs' decisions to remain working. The evidence could not be clearer: MDTs are essential for the present and future of our health service, and they must be fully rolled out. I appeal to the Minister to provide an assessment of the impact that the Finance Minister's proposed Budget settlement will have on our ability to roll out multidisciplinary teams. We know that their roll-out is needed for the future stability of primary care here and that we must get the right finance delivered to the Department of Health in order to be able to deliver the transformation that will strengthen our health service and make sure that it is indeed fit for the future.

1,281 words. Text as published by the Northern Ireland Assembly.

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