Debate contribution: Primary Care: Extreme Pressures

Debate contribution by Mr Robin Swann on 14 May 2024.

MLA

Mr Robin Swann

Party at the time

Ulster Unionist Party

Date

14 May 2024

Type

Debate contribution (made as a minister)

Business

Private Members' Business

Heading

Primary Care: Extreme Pressures

Assembly identifier

Official Report component 4490317

Read the official Assembly record

Text

I welcome the debate today and the opportunity to recognise and pay tribute once again to the vital role played by primary care as part of our health and social care system. We have heard from many Members about matters such as community provision, community pharmacy and waiting lists, and that is recognition that no part of our health and social care system stands alone in regard to how we want to support all our patients or where pressures are felt. Many Members who spoke today acknowledged the enormous contribution made by GPs, their practice teams and, indeed, the other health and social care professionals who, together, make up the primary care workforce. I therefore understand the ongoing challenges that patients and GPs, along with their teams, face, not least the impact of increasing demand and the resultant burgeoning workloads. The fact that 26 general practice contracts were handed back between 2022-23 and the end of April this year has been mentioned a number of times. That is a testament to the pressures that GPs and their teams have to deal with daily, but it is right to recognise that officials in my Department have worked hard to ensure that, where contracts have been handed back, no practice has closed and patients have continued to access GP services in their area. That achievement is a testament to the work of my departmental officials. Mrs Erskine mentioned the closure of Roslea. I checked that, and I think that it happened in 2017, somewhat before my tenure, but I will get back to the Member when I have checked who held the Ministry around that time.

Absolutely. I will come back to the Health Committee Chair's point later in my contribution. It was interesting that Mr Carroll referred to the healthcare model in Cuba. I looked around the Chamber to see how many Members were, like me, here in 2012 and remember that Health Committee members — Jim Wells and Sue Ramsey, I think it was — visited Cuba then to see how that healthcare model worked and whether they could bring back recommendations. I am not sure how far that has progressed since then.

That may be uncalled for. On a serious point, we cannot continue with a situation where, in some instances, GPs face such sustained pressure that they feel that the only course of action left to them is to hand back their contract. I am firmly of the view that it is not enough for primary care or general practice simply to survive. That is why I said that it was important to stabilise it before we move on to what is my ambition as Health Minister, which is for it to thrive. I want to build the resilience and capacity of the service so that it is sustainable for the long term and is better supported to deliver improved outcomes for patients. As Mr Chambers mentioned, some of the points in today's motion have been superseded by discussions and engagements that have long been under way. For instance, only last week, I was pleased to announce that agreement had been reached on the 2024-25 general medical services contract. In the past, that was never the subject of debate or a ministerial statement, but I will take forward the concerns that have been raised, and maybe future Health Ministers will make that the subject of a statement. I appreciate the constructive and positive approach to those negotiations that was taken by the leadership of the Northern Ireland General Practitioners Committee to get us to that position. Whilst the budget provided to me by the Executive does not allow me to make a substantial increase in the overall value of the contract, I am pleased that the agreement makes significant progress against one of the key aims identified by GPs, which is the inclusion of provision for dedicated funding for indemnity costs.

Importantly, the new contract arrangements will provide GPs with greater certainty about their income throughout this year, as well as reducing administrative burdens and associated costs to practices.

The 2024-25 contract replaces the quality and outcomes framework (QOF) with a clinical care domain, which itself is part of a wider Northern Ireland contract assurance framework, and the funding that was previously associated with QOF, as well as a number of specified enhanced services, will now be incorporated, for the first time, into the core GMS contract. It is important to stress that, in bringing QOF and enhanced services into the core contract and under the new contract assurance framework, GPs will still be required to deliver these services to their patients as is clinically appropriate. I know that GPs have previously raised concerns about indemnity. I am pleased, therefore, that this year's contract, for the first time, provides dedicated funding of £5 million to practices to support the costs of indemnity. That is an interim measure, as has been identified, pending the identification of a long-term model for future provision. That was a promise that I made to general practitioners before I left office the last time, and it is a promise that I have kept. My Department is committed to identifying solutions to address this issue, and work is continuing on options appraisals through the business case process, which will result in the identification of a proposed way forward for GP indemnity here. However, I am under no illusion that the new 2024-25 contract will resolve all the challenges faced by general practice: given the limits on the funding available to me, to put it quite simply, it will not do that and I do not believe that it can. The motion refers to the Northern Ireland Audit Office's recently published report on access to general practice, and I have welcomed the publication of that report because it holds up a mirror to the current state of general practice. Its findings reflect my and my Department's assessment of the challenges facing our service. However, I want to be clear on this: the issues impacting on general practice are complex and require a sustained, long-term response. There is simply no short-term fix, and it will take time as well as resources, but we are committed and determined to deliver for primary care, for its workforce and for patients. Central to that is exploring how we can make primary care and general practice more resilient; improve demand management and access to GP-led services; and strengthen the GP workforce. On demand management and access to GP services, we have already started to do that. A set of principles has been developed that will support more coordinated and streamlined management of the interface between primary and secondary care, clarifying the appropriate responsibility for patient management right across those two sectors. I am asked regularly, including by Members of this place, when general practice will be back to normal or back to how it used to be. As Minister, I need to be honest and say that we have a growing and ageing population that is living with more complex chronic conditions, and, over time, that is leading to increased demands on our GP services. In a standard week, as has been mentioned, our general medical services clinical teams carry out over 200,000 consultations, of which half are currently done face to face. I fully understand that there will be times when people are frustrated that they cannot get through to their GP practice without numerous redials, and, again, that is why my Department has been actively looking at practical ways in which we can best respond to and deal with increasing demand. Our GP access working group is working to continuously improve the management of patient demand and to optimise workflow within practices.

That group is also exploring how technologies can further develop improvements in accessing services for practices and patients alike. I will give way to the Member.

I will not deal with a case about a specific patient on the Floor, but if the Member wants to write to me with specific details, we can follow up on that. It is important to recognise that primary care is changing and that it offers a range of services that previously have been outside its scope and have been provided in secondary care. As an example of that, in April, I announced that regional vasectomy services in Northern Ireland will be fully transferred from secondary care to primary care to be provided by GPs, with the required funding moving from trust budgets into primary care. Innovative initiatives to extend the range of services that are provided in primary care are also happening at a local level. Earlier this month, I visited Moy health centre to see a new GP-led service in the Armagh and Dungannon GP Federation to improve lung health. That early respiratory diagnostic hub will provide advanced lung-function testing, meaning quicker diagnosis, which will reduce respiratory admissions and help deliver better management of respiratory diseases. Those are just a couple of examples of how primary care is evolving, providing a broader range of services closer to people's home and improving the patient experience, as Ms Dillon referenced. In order to help primary care to deliver and grow, it is critical that we train, develop, support and retain the GP workforce. In my previous term as Minister, I increased the number of GP training places to 121 by direction. As referenced, that was an increase of 86% since 2015-16. The number of places will be retained at that level even with the challenging budget position that I have. My Department has worked with GP representatives and other stakeholders in the Northern Ireland Medical and Dental Training Agency (NIMDTA) and our universities to increase the exposure of undergraduates to general practice as part of the curriculum to not only, hopefully, encourage more GP trainees but ensure that there are sufficient GP training practices to meet the demand for and support of GPs in training. The GP fellowship scheme is also supporting recently qualified GPs to transition from the training environment to independent practice, with opportunities for personal and professional development. My Department very much values the fellowship scheme and the chance that it provides for recently qualified GPs to have access to an attractive portfolio of opportunities. Looking to the future, my Department is considering how the scheme might be further developed, subject to available funding, to extend the range and scope of fellowship placement opportunities and to provide for educational bursaries to be available for all fellows. Other steps that my Department is taking to support the GP workforce include the introduction of the attract, recruit, retain scheme in order to support the recruitment of GPs in areas where it is hard to recruit. That scheme is already in place. Since its establishment in January 2023, 46 GP practices have applied and received approval in principle for funding under that scheme, and some 25 practices that have applied have received final approval and payment for a recruited GP. We have continued to boost capacity in the wider primary care workforce by investing £25 million per year in the primary care MDT programme, £90 million annually in the general practice pharmacy programme and £3·1 million to recruit advanced nurse practitioners. Members have discussed, and I know, how valuable MDTs are in areas where they have been established and the difference that MDT roles have made. That model remains key to stabilising vital primary care services in our communities, providing a continuum of high-quality services right through from prevention to treatment, management and care of patients with more complex needs. I am committed to the further implementation of the MDT model across Northern Ireland. My Department has long since developed the plan for the implementation of MDTs. Unfortunately, as with other initiatives, the pace and roll-out of MDTs has been seriously and repeatedly constrained by the ability of the necessary recurrent funding to support it. I will point out that, in the transformation pot that the Finance Minister identified, funding for MDTs will be one of the bids that I will make from that, so I look forward to support from across the House in whatever way possible for that bid. The bottom line is that I cannot deliver what I do not have the money to fund. The 2024-25 Budget, which the Executive recently approved, was deeply disappointing. As a direct consequence, Health will face significant budgetary pressures this year. I have no doubt that, despite the best efforts of my Department and the wider health and social care system, we will deal with the fallout and consequences of that financial shortfall not only in primary care but across health and social care. Sadly and, unfortunately, the fallout from that will impact directly on the lives of people across Northern Ireland. Therefore, I continue to press my case to get the funding that we need for health and social care. That is what I believe our population deserves and what our workforce deserves.

I urge all Members to stand alongside me on this, and, more importantly, to stand alongside health and social care in Northern Ireland because, to reduce waiting lists and to deliver transformation, our health service —

— needs the quality services that our people deserve, and it needs commitment from across the Assembly Chamber.

2,227 words. Text as published by the Northern Ireland Assembly.

Assessment

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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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