Imagine you live in a rural town in Northern Ireland and you've just been told that a quarter of your already overstretched GP practices in the area are going to close. How would you feel about that? Shocked? Dismayed and Worried? This is the present situation people in County Fermanagh in Northern Ireland are facing as i write this article. GP practices are closing in unprecedented numbers across the whole of the UK and is hitting Northern Ireland hard, with more set to close their doors under the worst government we've have known in generations. General practice in Northern Ireland is in grave trouble unless action is taken and funding is made available. Fermanagh is one of the worst hit areas in NI being so rural, and described by a leading British Medical Association doctor, who stated, “GP services are on life support”
Roughly three years ago the (BMA NI) carried out surveys and collected data on services being used by patients and the number of full time GPs, locums, nurses and receptionist's at each practice. Approx 349 practices in Northern Ireland were sent the survey. The analysis data looked incredibly worrying, so concerned they were that a new report was commissioned highlighting the findings and warned of an approaching crisis. At this point, rather than describing the GP service in NI as ‘on life support’ it could probably best be considered as ‘hospitalised'. The powers that be all received a copy of the report, but what did those ministers responsible do about the report? Well I’ll tell you; Nada, nothing, and a few other similar expletives that i will not write here for the sake of shared connections and kid's sneaking peeks over their mum's and dad's shoulders. We truly are faced with a shocking state of affairs.
They never lifted a finger to help is the short answer! Northern Ireland has the lowest number of GPs per head of the population within the United Kingdom at 6.10 per 10,000; Wales has 6.70; England has 6.80 and Scotland stands at 8.20. We know there are 1,274 GPs registered with an average list size per GP of 1,663 in October 2015. ''BMA estimate that this equates to 950 full time GPs, allowing for part-time working, maternity leave and other responsibilities.'' 53% of GPs in Northern Ireland described their current workload as generally manageable but too heavy at times, 40% described their workload as unmanageable, leaving only 7% describing their workload as generally manageable. In the same survey, GPs stated that their workload does at times have a negative impact on the quality of care received by their patients (75%) and they believe they should be able to offer longer consultations for certain groups such as patients with long-term conditions (72%). Let that sink in for a moment and understand the stress GPs are under knowing the impact it has on their patients and community at large.
The report showed that from 2003/04 to 2013/14 there has been an overall increase in:
– consultations by 63% per person
– prescribing rates by 28%
– repeat prescribing rates by 41%
– laboratory tests per patient by 216%
– administrative workload processed by general practice by 115%
– consultation rates of nurses in general practice by 66%
– consultation rates for health visitors by 34%
– patient contact by 66%
The issue is this; Over the last few years due to various reasons, GPs have been placed under increased pressure trying to look after not just a growing population but also from a demanding population too. Without increased investment to cope with changes. GPs were resigning or taking early retirement; Some moved away to more manageable practices, like Dr Ronan Harte (MICGP) moving on to Omagh in 2015, but replacements were not and are not even close to keeping up with demand. Northern Ireland has a 20% less than average shortage of GPs traditionally than other parts of the UK. In February of 2015 it was stated, we needed at least another 46 full time GPs trained each year to keep up with practice demands. The average patient list size per doctor in Northern Ireland on October 2015 was 1,663 which is a much higher than average patient list size per doctor for practices anywhere in the UK. Now we have a situation where we don’t have enough GPs. Would it not be fair to add that if there are no surgeries open for people to use, government will save a fortune from none referrals, prescription's and surgery running costs? But not only that, they save money on GP salaries and from all those who worked in those surgeries, therefore would it not be unreasonable to suggest closures are a cost beneffiting exercise favouring government, not to mention would have an impact on local communities, both financially and otherwise!
There has been no more real or significant investment since, and despite a growing population, some GP services have been cut to the bone. We're facing a position of prolonged and persistent disinvestment in primary care which means that whilst any additional investment is welcome, it's a matter of too little too late. Hospital clinics and wards are closing down due to more cuts so current GPs are being forced to take up the slack. The BMA (NI) produced another report which looked horrifying and even more damning than the first and highlighted how dangerously close surgeries were to shutting down for good. The minister's response was to increase the number of places for training doctors at Queens University medical school, which is great and should seem like action is taken, but you must consider it can take up to 10 years to fully train a GP. So what happens in the next ten years? That’s the same question the BMA (NI) asked in a letter to the then Secretary of State for Health, Jeremy Hunt in October of 2015. What else has been done to remedy this terrible situation since then, despite consistent warnings from the BMA? Nothing, nada,…you get the idea. Nothing much of any worth or of use to the people of Northern Ireland or to the UK in general.
Why isn’t it being resolved? Health in Northern Ireland is a devolved power. In other words, the ministers in Stormont oversee that, but the problem is we don’t have a health minister in Northern Ireland or any minister for that matter, because Stormont has not been able to reform the Northern Ireland Executive and start the assembly again because the main parties, namely 'Sinn Fein' and the 'DUP' are deadlocked over power sharing issues and cannot come to agreement.
On top of all that, because the BMA are largely being ignored, they felt they were left with little choice but to unanimously agree to sign ‘undated’ resignation letters to the NHS. Now consider that two thirds of General Practices in NI are BMA members this means that 10% may close altogether and the rest will be private only practices. So two thirds of General Practices in NI will no longer be able to provide free NHS front line care if the situation is not remedied with great haste. You can only really imagine how this is going to affect people that are either below or on the poverty line or how much pressure it will put on many families thus putting more people into poverty having to pay for their GP services. You might imagine how much more pressure this will pile onto other frontline services such as A&E departments which are already at breaking point as it is.
Smaller practices with few partners are at serious risk of collapse in the immediate future and a large percentage are vulnerable. The reduced capacity of GPs leads to increased workload and a higher incidence of practitioner burn-out. We know that some practices had double the average vacancy rate with over half stating that they had difficulty in taking annual leave. The impact of unmanageable workloads, too few GPs and inadequate resources are putting practices on the brink of complete collapse. NIGPC have set out necessary steps that need to be taken to ensure the survival of general practices as we know it. This is far from breaking news. GPs in Northern Ireland have made all key decision makers aware of this impending crisis for over a decade. NIGPC has developed the GP federation model to attempt to ameliorate the situation and ensure the delivery of a responsive safe and sustainable general practice service. However, strategic long-term investment in primary care now needs to be made to counteract the demise of general practice, as set out below:
– A public commitment from the new minister to invest incremental recurrent funding in general practice at a minimum of 10% of the health budget and to rebalance health resources to where care is delivered. Transforming Your Carexiii, envisaged care being delivered closer to home with the expected shift in resources to accompany this.
– The provision of an immediate stabilisation fund for general practice to provide emergency support to vulnerable practices at risk of collapse or where safe patient care is compromised such as out-of-hours.
– Similar to the NIGPC Rescue Plan Group, the department must establish a task-force to provide support to vulnerable or at risk practices which could include the provision of management resources, clinical input, proactive support that can be called in at short notice. This needs to be developed in liaison with the Local Medical Committees (LMCs).
It wouldn't take a genius to see it all root back to Tory austerity. After reading this article you might feel angered at the depth and gravity of the situation and consider this a real crisis, because frankly that's exactly what it is. But where do we need to look to see the route of this problem? We can’t afford to put money into health but we can afford £200bn on Trident, £250bn to bail out the £Pound post Brexit and spend a vast fortune on government contracts such as Atos, Maximus, G4S and so on. Ridiculous and daming from a government who couldn't care less so long as they and their friends are comfortable. Tax breaks for millionaires whilst NI can’t afford to pay and maintain GP surgeries, but we can afford £150m on faster broadband, and there's just something morally wrong with that. We can’t afford to pay our nurses enough to live on but we can afford to give our MPs a pay rise and ensure they can claim enough in expenses that some or most in society can only dream of as a wage. In 2015 Health Secretary Jeremy Hunt told the BBC in a televised interview that extra money was needed to pay for more doctors and nurses to help cope with growing demands on the NHS, but has actually done very little about it if anything at all since.
What has happened to this country and its priorities? They appear to be tax breaks for the rich and corporations while the rest of us suffer great hardships is what happened. What fools we are. Austerity that has clearly failed with a bigger and continuously growing national debt and deficit than the last two Labour governments combined. We need an alternative approach. There is an alternative and in my opinion, the alternative sits on the opposition front benches. A government in waiting we know and love called the Labour party. Jeremy Corbyn is a man of great integrity, and a great man who will strive to help the people. Now more than ever, we need the Labour party. Failure to elect Corbyn in the next general election will leave us all in such a very dire situation that we may never be able to come back from, but in truth the most important action for Northern Ireland is that another general election cannot come fast enough!
Matt Beeching for Political Provocateur