Debate contribution: Primary Care: Extreme Pressures

Debate contribution by Mrs Deborah Erskine on 14 May 2024.

MLA

Mrs Deborah Erskine

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 4490285

Read the official Assembly record

Text

Hardly a week goes by in which someone does not get in touch with me or my constituency office to talk about GP services. The common refrain is that it is difficult to get through on the phone to get an appointment. That is perhaps symptomatic of the pressure and problems behind the scenes, which are the cause and what we need to deal with. It is important that we pay tribute to the vast contribution made by our GP and primary care staff across Northern Ireland. I pay tribute to my GP practice and thank it for all the work that it does alongside the excellent community pharmacy provision in my area. My practice, Brookeborough and Tempo Primary Care Services, was one of 13 practices that had to hand back its contract in 2022-23. The Western Trust stepped in to provide a service for the some 8,000 patients on the books. We have already seen practices in my constituency close their doors. Rosslea surgery, for example, closed a number of years ago. How is that sustainable? In Northern Ireland, as of March 2023, there were 317 active GP practices — a reduction of 33, equating to 9%, since 2014. Yet, the average number of registered patients per practice has increased by around 17% since 2014. It is clear that primary care in Northern Ireland has reached crisis point. We now have fewer GP practices than we did 10 years ago. The practices that are operating are not evenly distributed across the Province. GP contracts are being handed back with increasing frequency. The roll-out of multidisciplinary teams has stalled. Many patients are frustrated with the phone triage service and have been unable to secure timely access to care. Contracts for GP services still do not contain performance targets. A large cohort of trained GPs are choosing not to work in primary care, because of the stress involved and a lack of support. The list goes on. Those problems will not be addressed overnight. However, the importance of delivering real change cannot be overstated. Previous evidence shows that over 90% of NHS contracts are with GPs, yet they account for only 5·4% of the health and social care spend in Northern Ireland. Training more GPs is a key pillar of the DUP's five-point plan, but so too 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. Recruitment and retention are two sides of the same coin. The Department of Health needs to do more to incentivise newly trained GPs, and, indeed, those with experience who are considering walking away from the profession, to stay. That is particularly true when you look at rural areas and the need to incentivise young trainees and GPs to stay in the likes of Fermanagh and South Tyrone. I welcome the Department of Health's announcement of an agreement on the general medical services contract with GPs for 2024-25. However, I heard more detail on that through the media, as I travelled to Stormont, than I did from the Minister, either through a written ministerial statement or in the Chamber.

Yes.

I thank the Member for his intervention. I agree. This is a huge issue that all our constituency offices deal with. It is regrettable that it was not brought to the Chamber in order for us to look at it fully. Progress towards addressing the long-standing lack of indemnity provision for GPs is welcome. However, the uplift in funding between practices is linked to annual contractual arrangements, and there is still a need to pursue and agree a long-term solution. Furthermore, we understand the desire for GP practices to have certainty on cash flow. Equally, that needs to be balanced with ensuring that GPs are accountable for their performance against clinical indicators for the various illnesses and conditions that they manage. Cutting ties with the equality and outcomes framework in the current GMS contract has raised concern in that regard, particularly given that the new Northern Ireland assurance framework does not seem to have been finalised ahead of agreement being reached between the BMA and the Department on this year's settlement. Can the public be confident that all practices are operating services at the same standard when those outcomes are not being recorded? For too long, "Budget issues" and "Pressures" have been the cry and the reason behind not moving to a sustainable solution. "Stabilisation should come first", is what I have heard, but waiting around for stabilisation is clearly not working, and failure to act will see the complete collapse of our primary care, with a domino effect across the health service. Therefore, I thank my colleagues for tabling the motion. We will support it and the amendment.

803 words. Text as published by the Northern Ireland Assembly.

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