Debate contribution: GP Services in Fermanagh

Debate contribution by Mr Mike Nesbitt on 10 September 2024.

MLA

Mr Mike Nesbitt

Party at the time

Ulster Unionist Party

Date

10 September 2024

Type

Debate contribution (made as a minister)

Business

Adjournment

Heading

GP Services in Fermanagh

Assembly identifier

Official Report component 4517876

Read the official Assembly record

Text

Thank you very much, Mr Deputy Speaker. I thank Áine Murphy for securing the Adjournment debate, and I thank the Members who have contributed. This is an opportunity to recognise and pay tribute to the fantastic work that is carried out by our primary care services. It is obvious that I am on my own in the Chamber, in a party political sense. Baron Elliott of Ballinamallard would have loved to have taken part in the debate, as he represents the area, but he was called away, and our health spokesperson, Alan Chambers, has been inconvenienced this afternoon. So, it should not be taken as a lack of interest from my party on the issue. I will come to Members comments presently. Over the past three and a half months, I have had the opportunity to meet many staff working across primary care, including a number of representatives from the South West GP Federation. We are very fortunate to have such a dedicated workforce. I am very aware of the challenges that face general practice. Those are particularly felt in rural communities, because there is a feeling there of being left out of public services and investment more generally. I appreciate that some people in Fermanagh have concerns about whether they will continue to be able to access high-quality primary care in their area. Those concerns are, of course, not unique to Fermanagh, but they carry a particular weight in rural areas. I reassure you that my Department has worked and will continue to work very closely with GP representatives on how best to respond to those challenges. As some of you will be aware, I want to make it my mission to tackle health inequalities in Northern Ireland. I have announced plans for a pilot scheme under the banner "Live Better" that is aimed at taking services right into the heart of the community and making a positive difference to people's life. I am very aware of the recent issues that were raised in the media about escalating tensions at the GP premises in Lisnaskea. Let me make this clear: that behaviour is absolutely unacceptable, and I condemn it utterly. I fully support our primary care staff and value the dedication that they show daily to those who need them. You asked about the new health and care centre in Lisnaskea. That facility will support the delivery of integrated primary and community care services for the population of Lisnaskea and the surrounding area of east Fermanagh. I hope that I will not frustrate you too much when I say that the announcement is imminent.

Boom. I am sorry. There is no issue that I am aware of that will delay it. It will happen. It is tied in with a couple of other announcements. They need to be tied down — the i's need to be dotted and the t's crossed — and then I will be ready to go. Imminent means imminent.

Of course I will give way to the very frustrated Member.

I will get back to you.

There have been too many broken promises to make a promise in the Chamber. I want to get the time frames absolutely nailed down. I promise that, when I say "imminent", I do not mean weeks and months. I acknowledge and appreciate the need to further stabilise and bolster capacity for services in primary care more generally. I fully understand the ongoing challenges that patients and GPs along with their teams face, not least the increasing demand and resultant increasing workloads. Colm Gildernew's point about the workforce was extremely well made. When we think about health and social care, we think about buildings, equipment and medicines, but they do not matter, or they do not count, because they cannot deliver without the workforce and the people. Officials in my Department have worked hard to ensure that, where contracts have been handed back, no practice has closed — I commend them for that — and patients have continued to access GP services in their area. Stability of services across Northern Ireland will require new ways of thinking about how our services are organised. In Fermanagh, the Western Trust is playing a leading role in promoting stability through holding the contracts for GP practices that have got into difficulty. There are three such practices in Fermanagh, and my Department is supporting the Western Trust to move towards a more sustainable model for service provision in those practices through the appointment of salaried GPs. That will help to strengthen the service in those practices and reduce reliance on locums, which is a very expensive way of doing business. We cannot continue with a situation where, in some instances, GPs face such sustained levels of pressure that they feel that the only course of action left open is to hand back their contact. I want to build resilience and capacity in that service. However, I am under no illusion that the new 2024-25 contract will resolve all the challenges that face GPs. The issues that are impacting general practice are complex and will require a sustained and long-term response.

In a standard week, our general medical services clinical teams carry out over 200,000 consultations, over half of which are face-to-face. I think that that maybe explains part of the pressure on access to services. I also share this with Members: according to our Business Services Organisation, we currently have 1,448 GPs, excluding locums. That is an increase over the past 10 years of just about a quarter: 22·7%. Per 100,000 registered population, we are just behind Scotland in the headcount of GPs. Scotland has 77·1 GPs per 100,000 registered population; we have 70·9 GPs, which compares really favourably, particularly with England, which has the lowest ratio at 56·4. That suggests that we should not have the problems that we are having to endure at the moment, so I am determined to work at that. Jemma Dolan made the point that 95% of first contact is at a primary level. That is true, but it is also true that primary gets 5·4% of the total budget. I would like to see that go up really significantly. That is why I am promoting what Professor Bengoa called the "shift left". In an ideal world, if you need access to healthcare, you get it in your home, and if you cannot get it in your home, you get it as close to your home as possible in a GP surgery, a community centre or whatever. The second-worst outcome is having to go to an acute hospital. The worst outcome is having to go to an acute hospital and stay overnight. The problem with the budget is that, if you are in an acute hospital, that is where the big problems and the expensive processes to fix are. To shift the budget left will require health inequalities and health literacy to be tackled, and people to be more conscious about staying healthy and not getting sick. Deborah Erskine talked about promoting the beautiful constituency of Fermanagh and South Tyrone. Áine Murphy asked whether I would meet her to talk about problems in south Fermanagh. I most certainly will, but maybe we should do it in the beautiful constituency of Strangford. Maybe we should go down to Harrisons on Strangford lough and have a little meeting there. Other restaurants are available. What else can I say in response? I want to talk about multidisciplinary teams. Professor Bengoa reported eight years ago. Some people think that that report went on to a shelf. It did not; we have started actioning it and shifting left. We have daycare procedures in places such as Lagan Valley. We have elective overnight centres, such as the South West Acute Hospital, and I hope that we will develop the Causeway Hospital in the fullness of time. Things are happening. The professor is coming back — he is scheduled to be here on 9 October — to reboot that report. That is when I am going to say, "We need to finish this deal". Multidisciplinary teams clearly work. They are probably the biggest success story of recent years in transforming our health service. Seven of the 17 GP federations have MDTs. Fermanagh and South Tyrone is down to be one of the three in the next tranche, but I gently say this to the Members opposite and Mrs Erskine: you voted for the Budget. We did not vote for the Budget in this party, and one of the reasons was that we were not going to be able to roll out the MDTs as we would wish. Let us speak again after the debate about south Fermanagh.

1,452 words. Text as published by the Northern Ireland Assembly.

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