Good morning conference and thank you chair for this opportunity to speak.
General practice in Northern Ireland is in crisis. We have a perfect storm of the highest workload in the UK, the smallest workforce and the lowest funding per capita. This is a recipe for collapse and indeed this is what we’re seeing in all 6 counties; we expect to lose about 20 GP practices this year with individual GPs being caught for redundancy and premises costs.
We met with the department of health recently and asked for funding and implementation of the GP-led review plan but apparently there is no executive, no budget and no funding to do this.
We asked for a 2017/18 contract settlement in the interim but apparently there is no executive, no budget and no funding for this either. So we asked for a contingency plan, essentially a rescue plan for general practice but apparently there’s no executive, no budget and no funding.
We left negotiations empty handed.
There is no rescue plan for general practice, no GP-led review plan, no 2017/18 contract settlement and no contingency plan.
We are now two contracts improvements behind our English colleagues. England has received £2.4bn over four years for the GP Forward View in 2016 on top of the £8.8bn spending on general practice in 2015/16, and a further £250m investment for the 2017/18 contract settlement.
In Northern Ireland in comparison our funding lags behind all of the other three UK countries due to a failure to take decisions and implement actions. Comparison of course is the death of happiness and GPs in Northern Ireland as a result are very unhappy.
Why this difference?
General practice in Northern Ireland isn’t a priority as we have hospital waiting lists of two to three years. There is also a profound institutional ignorance and indeed prejudice against general practice in N Ireland.
Most worryingly there appears to be a move towards nationalizing the GP service into trust hospital structures.
As a result GPs have no alternative but to progress with collecting undated practice resignations and when we reach a critical mass of 60% of practices we will leave the NHS. We can expect no help from politicians, from the department of health or from the NHS in general. This is our problem, we need to own it because the only help we are going to get will be from our own actions.
There is an alternative narrative.
This is one where the GP-led review plan is funded along the lines of the English GPFV with an equivalent investment of £120m of extra funding over the next four years.
A narrative where GP federations develop hubs to provide resilience to hard pressed practices.
A narrative where GP recruitment and retention improves due to demand management, expanded multidisciplinary teams and increased funding for practices.
A narrative where practices working at scale can provide integrated care in the middle ground; where population health initiatives and capitated budgets enhance the quality of care for our patients.
These plans have already been written in the Bengoa Review and need decisions and actions.
Our job as representatives of GPs is:
- To maintain the solidarity and unity of purpose of our members.
- To maintain the quality of and access to care for our patients.
- To maintain the integrity of GP practices through the independent contractor status.
We will do this through the twin track approach of offering our cooperation to implement the transformation of the health service in Northern Ireland that’s planned and needed, but also by preparing to leave the NHS to protect and preserve a high quality GP service for our patients.
It was Tancredi in Di Lampedusa’s The Leopard who said: 'If you want things to stay as they are, things will have to change.'
On behalf of NIGPC I throw down this challenge to the incoming health minister and to the department of health: work with us or work against us. Your choice, but be clear – we will protect the GP service for patients in Northern Ireland at all costs even if this means leaving the NHS.
Thank you and have a good conference.