Northern Ireland GPs to play bigger role after health review

GPs are set to have a whole new range of roles under the review of health and social care in Northern Ireland.

The review, led by chief executive of the Health and Social Care Board John Compton, has called for care to be brought closer to home with services traditionally provided by hospitals being transferred into the community.

Announcing the publication of the review on Tuesday, health secretary Edwin Poots said: ‘There will be a significant shift from provision of services in hospitals to provision of services in the community, in the GP surgery, closer to home, where it is safe and effective to do this.'

The five local commissioning groups in Northern Ireland - in charge of the commissioning of health and social care locally - will be responsible for developing ‘population plans’ based on the shift of care from hospitals into the community, the review said.

New roles for GPs

  • GPs will be able to undertake minor procedures in their surgeries and services such as oral surgery, X-rays and other diagnostic tests will also be made available locally. 
  • In order to reduce hospital follow-ups, it will ‘become the norm’ for GPs, along with hospital specialists, to provide outpatient appointments in the community.
  • GPs will provide ‘in-reach’ end-of-life care for patients both in nursing homes and in family homes, the review said.
  • More GPs with a special interest will be employed in the community and specialist hospital clinicians will support GPs to plan how services are delivered.

In order to improve integration within the health care system, 17 integrated care partnerships will be established across Northern Ireland, the review said.

The partnerships will join up local services including GPs, community health and social care providers, hospital specialists and representatives from the independent and voluntary sector.

Improving communication
The review has also called for patients to have better control over their care. Clinicians across primary and secondary care need to improve their communication and better integrate services and electronic care records will be introduced to give clinicians better access to patient records.

Multidisciplinary teams will form community-based support programmes for patients with long-term conditions.

This will provide them with a named point of contact, possibly their GP and direct admission to hospital care, bypassing A&E, when needed as agreed between the GP and hospital specialist.

Dedicated community-based clinics will be set up where patients can access a range of health and social care services, with input from GPs with a special interest and hospital specialists alongside community pharmacy, allied health professionals, nursing care and social work support.

Patients will have better access to telehealth equipment, enabling them to monitor their own conditions and alert health professionals when their condition deteriorates.

Urgent care will be ‘largely’ provided by GPs and an urgent care model will be implemented to reduce A&E attendances and ensure each community has local access to urgent care, the review said

The review recommended the creation of an urgent number to work alongside the emergency 999 number to advise patients on which service would best suited to their needs, be it A&E, an urgent care centre, minor injuries unit, GP out-of-hours service or to wait for a GP appointment the following day.

Under the review in 2014/15 funding for family health services and primary care services will increase by £21m, with the budget increasing from £871m to £892m - a 2% increase.

Community services will also receive a budget increase, raising funds from £477m to £518m. This represents a £41m increase, equating to a 9% of the budget.

Response to the review
Responding to the review, the Northern Ireland RCGP welcomed an increased role of GPs within primary care. However it also called for clarification for a number of issues it believed to be unclear.

Chairman of the Northern Ireland Council of RCGP Northern Ireland, Professor Scott Brown, said: ‘While we recognise and welcome the shift from the provision of some types of care from the secondary to the primary and community sectors, we would however urge that this is managed from the bottom-up and is not enacted top-down.’

‘As part of this process we note the creation of integrated care partnerships but call on the minister to provide much greater clarity on the role of these in relation to the health trusts, primary care partnerships and the local commissioning groups.

‘The college has long advocated a system of federations of practices, and welcomes the steps outlined in the review in that direction, but in order to provide for the most effective form of local commissioning, it is imperative that clear guidelines are issued in relation to how this structure should operate and that, consequently, control of provision is truly allocated to local level,’ Professor Brown said.

The college rejects the review’s call for an urgent number for urgent care, arguing that pilots of NHS 111 in England have resulted in an increase in acute sector workload.

Chairman of the Northern Ireland GPC Dr Tom Black said; 'The clear emphasis is on changing the centre of gravity of healthcare from secondary to primary care. GPs recognise they have a role to play but the challenge for primary care is how this change is managed. 

'The proposed changes cannot take place without sufficient resources being put in place.  General practice is already working to capacity with over 10.5 million consultations taking place per year, and will need investment in staff and facilities in order to meet an increased workload.'

GP Tom Black, Chairman of the BMA’s GP committee in Northern Ireland said,

"The clear emphasis is on changing the centre of gravity of healthcare from secondary to primary care.  GPs recognise they have a role to play but the challenge for primary care is how this change is managed.  

"The proposed changes cannot take place without sufficient resources being put in place.  General practice is already working to capacity with over 10.5 million consultations taking place per year, and will need investment in staff and facilities in order to meet an increased workload.  Chairman of the Northern Ireland GPC Tom Black said:

'The clear emphasis is on changing the centre of gravity of healthcare from secondary to primary care.  GPs recognise they have a role to play but the challenge for primary care is how this change is managed.  
'The proposed changes cannot take place without sufficient resources being put in place.  General practice is already working to capacity with over 10.5 million consultations taking place per year, and will need investment in staff and facilities in order to meet an increased workload. 

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