Rural GP tells patients to 'go private' as hospital waiting lists spiral
With 6,500 patients on his books following the closure of a nearby GP surgery, a Co Antrim doctor has spoken of his fears for the future of rural services during a period of unprecedented pressures
FOR GP John McSparran, the Northern Ireland health service has become "so defunct" he is telling patients to pay for private treatment if they can afford it.
Dr McSparran, who has been based in the Glens of Antrim Medical Centre practice in Cushendall for more than 20 years, also feels a "political will" is lacking to bring about radical change and tackle spiralling hospital waiting lists as well as major shortfalls in community care.
Highlighting multiple expert reports commissioned by government over the past two decades, the 52-year-old said common themes running through them - including axing half of the north's acute A&E hospitals - have never been implemented.
"There's a complacency I feel that exists within those in administration - whether that be MLAs or within the Department of Health etc - that nobody seems to care to do enough about this," the Cushendun man said.
"You've had your Compton report, your Bengoa, every one of them has been saying more or less the same thing.
"But it seems there's no political will there at the minute to get into government to do these things.
"And the sad thing is, if you had an election tomorrow you would get the same herd mentality that goes on. People will just go back to voting down along their sectarian lines. Realistically we're going to have to try to do something to change the thing."
The experienced medic, who is also a leading GAA figure and former chair of the Antrim County Board, singled out dire waiting times for suspected cancer cases as an example of how dramatically patients are being failed.
"It's got so bad that a 'red flag' patient referral by a GP to a gastroenterology hospital consultant takes three months minimum. Now that's someone you suspect as having cancer and will take at least three months to be seen," he said.
"The targets would have been ideally to be seen within two weeks but it just doesn't happen.
"If they have the money I tell patients to go private as the system is so defunct now."
When waiting lists peaked in Northern Ireland in 2005/06 under direct rule minister Shaun Woodward, tens of millions of pounds were spent to provide NHS surgery in the private sector.
Criticised as a 'sticking plaster' approach, it did at least produce results in the short-term.
"We would have had a situation in years gone past that the private sector would have been used - while that may not have been ideal, it was still getting patients sorted out. I know it was like sticking your finger in the dyke in many ways, but now there's nothing," Dr McSparran said.
Last May, the Department of Health announced a £15m investment in GP services in Northern Ireland as part of a 'transformation fund'.
The sector has struggled particularly with recruitment and retention, with many rural areas severely affected by closures of smaller practices.
In Co Fermanagh, one village was without a GP for the first time in a century as a record number of surgeries were forced to shut and merge over the past two years.
The department funds are going towards the creation of 'new era' projects for GP services that will see groups of health professionals from different disciplines - including mental health specialists, physiotherapists and social workers - based at GP practices and working alongside doctors and specialist nurses.
While Dr McSparran supports the idea, he said this was an initiative he and colleagues rolled out two decades ago in his practice - but which are now being removed as part of 'cost-cutting' plans.
"Back in the early 1990s we took a decision to build a new purpose-built health centre. Included in that was a dental practice, physio room, podiatry - and all that was done with initiative of the particular GPs at that stage and with approval of the local health board.
"Now we've been told by the health service we can no longer provide this, which leaves us with a purpose-built room - which was actually expanded a couple of years ago - lying empty. More importantly it is directly impacting on patients who will forced to travel 18 miles for physio with a very limited bus route.
"We're being told that is being done on the basis of cost whereas all the initiatives and all the reports that exist nowadays tend to indicate that we should be moving these services closer to the patient.
"Not all our patients would have seen the physio in our health centre because there was a limit as to how often that service was available, but it certainly facilitated those who were unable to travel and those who were not fit to travel."
Dr McSparran referred to one of patients, 90-year-old Danny Murphy, who he said has been stuck on a waiting list for four years for a hip replacement.
"If he ever does get his hip done, he will require physiotherapy after it. Is somebody telling me that it's reasonable to ask him to get on a bus and go to Ballycastle or Ballymena? It's just outrageous.
"This man, who is very compos mentis and was an active member of the community, has been left to languish on a on a wheelchair and is bunged up with painkillers - all of which of course is a cost in itself.
"If you were to calculate the input that man has had in terms of medication, occupational therapy and walking aids over the years, it would have been cheaper to do the operation at the time than go through all the waiting."
One of the most significant challenges he believes has led to a "gradual weardown" within the profession has been an increase in 'hospital work' being transferred to GPs - but "without any support".
"If you look for example at GP visits to nursing homes and the complex profile of patients. When I was a junior doctor doing work in geriatrics, the patients in the wards in those days were better and required less input than patients we have in nursing homes today.
"Now we've got a situation where essentially most of our nursing homes are acute geriatric wards in the community and there's no support or recognition for that."
He also raised serious concerns about the impact of "centralisation" and cuts to the "crucial" rural district nursing service, following the removal of a nursing post from their health centre.
Criticising the layers of bureaucracy this development has created in terms of GPs accessing vital equipment for terminally ill patients, the medic branded it a "nonsense process".
"Since the cuts, now what we have to do is submit a letter of referral to a central area to get a district nurse to go out to one of our patients. Prior to this it it was just a matter of popping round the corner and speaking to the district nurse directly. Fortunately we have absolutely wonderful district nurses and they will still come in to see us as we know them so well," Dr McSparran said.
"But the reality is if we didn't have a local woman doing district nursing the situation would be vastly different and the service would suffer inmeasurably.
"For example a terminally ill patient who was needing a syringe driver - instead of writing a letter of referral, electronically or not, to explain what we wanted, we were previously able to have that direct conversation with that particular nurse and we were able to gets things signed immediately. Nowadays we have to go through a nonsense process of referring it and god knows how long it could sit languishing in an administrative system."
Despite his frustration, the father-of-two remains passionate about the importance of his profession and attracting new blood.
His patient numbers - there are a total of four doctors at the Cushendall practice - have significantly increased due to the closure of a neighbouring surgery in Glenarm following the retirement of its only doctor.
"Some of my colleagues would say that in 20 years' time General Practice is not going to exist in the format it's in now, because there is significant difficulty in getting doctors to take on a junior partnership, particularly in rural areas," he said.
"Personally I feel that General Practice at the minute is only thing that is holding the health service together. For that reason alone, I think it's totally unfeasible to think that General Practice could change dramatically from its current structures."