NHS crisis in Northern Ireland means some practices won't last until mass resignation

Northern Ireland's GP crisis runs so deep that vulnerable practices could be forced to close before plans for a co-ordinated mass resignation can go ahead, LMC leaders have warned.

Northern Ireland LMCs conference chair Dr Frances O'Hagan
Northern Ireland LMCs conference chair Dr Frances O'Hagan

LMCs in Northern Ireland voted on Saturday to press ahead with plans to collect undated resignations from practices across the country. When undated resignations have been collected from 60% of practices in the country, GPC Northern Ireland (NIGPC) will trigger a co-ordinated mass withdrawal from the NHS.

NIGPC chair Dr Tom Black – whose Derry practice is among those that have already signed undated contract resignations – told GPonline he expected the 60% threshold to be reached by this summer.

Armagh GP Dr Frances O’Hagan, who chaired the 2017 Northern Ireland LMCs conference, said there was a 'nice steady trickle of undated resignations coming in' from practices across the Southern LMC area. But she warned that some practices were unlikely to survive long enough to take part in the resignation plans.

Dr Black has warned that around 6% of practices in the country could be forced to close in the coming year, and that every one- or two-partner practice is at risk.

LMC leaders told the LMCs conference in Belfast that even larger practices in urban areas were struggling to cope. The GP workforce crisis is so extreme that single-handed GPs in parts of Northern Ireland have been unable to take any annual leave over the past year, because locum cover is impossible to secure.

With less than a month to go until the new financial year begins, the country’s GPs are without an agreed contract deal for 2017/18. Following this week’s snap general election, a new government is in the process of being formed, and the NIGPC has been told that interim funding – let alone a serious financial rescue package for GPs – is impossible because there is ‘no executive, no budget and no funding’.

While many GPs in England remain unconvinced that the GP Forward View – which pledged a £2.4bn uplift in annual GP funding by 2020/21 - will solve the GP crisis, Northern Ireland’s GP leaders point out that they can only dream of a similar pledge.

GP funding

England's GP contract also came with a further £238m package of funding, which left Dr Black telling the conference that GPs in Northern Ireland were effectively two uplifts behind other UK countries.

Dr O’Hagan told GPonline: ‘In our area we don’t know if we’ll get to 60% because practices are closing already. People are leaving or retiring, and actual contracts being handed back are superseding the plan for mass resignation.’

Long-term underfunding of general practice in Northern Ireland had forced practices into a ‘GP-only model’ because they lacked the necessary funding to build wider practice teams, she warned. ‘And now there aren’t any GPs.'

Around a quarter of GPs in Northern Ireland are over 55, and young GPs were simply unwilling to take on many roles becoming vacant, particularly at small rural practices where partners working long hours were finding it almost impossible to take leave for holidays or training.

A new Northern Ireland Assembly government is expected to be formed within the next three weeks, but Dr O'Hagan said she was not confident that this would bring positive changes for general practice.

GP workforce

'I can’t see anything changing,' she said. 'They just don’t seem to care. We had a rescue plan agreed before Christmas, but we are now two rescue plans behind England. We get £100 per patient less.

'[Northern Ireland's general practice has been] built into a GP-only model and now there aren’t any GPs. We haven’t had the money to build our practice teams - and if they aren’t going to give us that money, it is going to fall apart, or rather it is falling apart.'

With two- or three-year waits for hospital treatment in Northern Ireland, the health debate always focused on acute care, Dr O'Hagan said.

GP leaders warned at the LMCs conference that reports had been warning for a decade that investment in general practice, more GPs and GP training posts were vital to avert a crisis, but that governments had not acted on these warnings.

'I don’t know why they don’t recognise the crisis,' said Dr O'Hagan. 'We’ve been warning for 10 years this will happen. People will have to wait and see - when there’s nobody there to open the front door [at their local GP practice], then they’ll realise.'

Dr Black agreed that 'nothing would influence Northern Ireland's health service to invest in GPs 'until they're not there'. He told the LMCs conference on Saturday that he believes GPs would be back in the health service within three hours of resigning en masse.

'How long would we be out of the health service? The answer is less than three hours,' he said. 'After that time, everything breaks down.'

He 'guaranteed' that politicians would act swiftly to bring GPs back into the fold, but added: 'If we are outside the health service more than three weeks we won’t go back.'

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