GPs secure government deal to run out-of-hours services in Northern Ireland

The Northern Ireland government has approved proposals for GPs to take back control of out-of-hours services.

Dr Tom Black: out-of-hours agreement secured
Dr Tom Black: out-of-hours agreement secured

GP leaders have been locked in negotiations for months over a strategic framework agreement on the future shape of services.

GPs want to avoid attempts to replicate England's controversial NHS 111 service, instead proposing a GP-led service with increased funding.

Out-of-hours care made headlines in Northern Ireland last summer after recruitment and retention problems left sessions unfilled.

GPC Northern Ireland wants all services run by mutuals, but no return to individual or practice responsibility. Currently three out of five local out-of-hours services are provided by health and social care trusts, and two by GP mutuals.

Health minister Edwin Poots has now approved the Health and Social Care Board (HSCB)-led consultation process and strategic framework.

GPC Northern Ireland chairman Dr Tom Black told GP the framework agreement was the basis for further discussion on mutual organisations, funding arrangements and workforce terms and conditions.

The original proposals from the HSCB, he said, mirrored England’s NHS 111, but NIGPC had resisted a centralised, low-skilled call handler model.

Out-of-hours services were an integral part of general practice, said Dr Black, although NIGPC is not in favour of a return to practice or personal responsibility which would further damage recruitment and retention.

‘We should be responsible for the delivery of out-of-hours care - we should be responsible for ensuring the quality standards, and the service should be delivered by GPs,' he said.

Following agreement on the framework GPC Northern Ireland is working to ensure proper funding, service provision by GP mutuals, and to agree terms and conditions to attract GPs into out-of-hours care.

The government is understood to have proposed a 10% funding increase to the services, but Dr Black has called for a rise closer to 70%.

‘Out-of-hours in Northern Ireland cost £21m, that’s £11 per patient per year. You wouldn't spend that on your hamster insurance,' he said. ‘It would take a 70% increase in funding to reach the level of the lowest funding of the other countries, which is Wales.’

Funding had been been cut from £23m when HSCB took it over in 2004 to £21m today, he said.

Mr Poots said the framework agreement was the next step towards a more effective and efficient out-of-hours service.

Head of general medical services at HSCB Dr Margaret O’Brien said significant improvements had already been made to processes, commissioning and quality standards and the strategic framework would complement and enhance that work.

'The framework also seeks to improve patient access through the development of a single number to access GP out-of-hours services, supporting the ultimate aim of delivering an urgent care number service for Northern Ireland,' she added.

Dr Black welcomed the agreement and the Board’s assurances, but warned: ‘It is vitally important that we learn from the problems experienced during the implementation of a "111" number in England.'

  • See the 3 March issue of GP magazine for an exclusive interview with Dr Black on his vision for general practice in Northern Ireland.

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