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If something happened to me, my practice could collapse says west Belfast GP

West Belfast GP Micahel McKenna. Picture Mal McCann.
Seanín Graham

FEARS about the future of some west Belfast GP surgeries are growing after it emerged a quarter of their doctors are nearing retirement age – with too few others to replace them.

Medics have approached The Irish News privately with concerns about practices that may be forced to “fold” due to a workforce crisis and “failure” by health authorities to plan for the long term.

They disclosed that 15 of the 55 doctors working across 16 practices in one of the north's most socially deprived areas are over 60 and nearing the end of their careers.

The Health and Social Care Board, which is responsible for the GP contract, has been alerted.

There are around 93,000 patients on the books of these west Belfast surgeries.

Two of the practices care for 11,000 patients between them and are run by older GPs who have no-one to hand over to.

One experienced doctor revealed they had recently been approached by younger colleagues flagging up the issue.

“You're talking about a considerable number of the workforce retiring soon and the only reason we're hanging in is because if we left, the practice would probably fold,” he said.

“The younger doctors can see what's coming down the line and they describe it as ‘dominoes about to fall'. If one or two practices go, the patients are allocated to other practices which puts them under major pressure as demands are so high.

“The approach seems to be, let things happen, let things develop. There doesn't seem to be any sort of forward planning. Our younger colleagues were quite emotional as they have also been working for a long time.

“Some doctors have been seeing patients for 30 years and you do develop an attachment to them. They're part of your life. One of the things that keeps me in general practice is that I don't want to let people down.”

Last week Health Minister Robin Swann announced a £5.5 million package for GP services with winter pressures in mind. The funding will also improve telephone systems due to access problems experienced during the pandemic.

In England a £250m package was unveiled to encourage GPs to see more patients face to face by using locums – a move greeted with “huge dismay” by the British Medical Association which said it would not solve problems.

West Belfast GP Dr Michael McKenna is all too aware of the impact of workforce shortages. With just under 3,000 patients on his list, he has been working in a surgery off Falls Road for 20 years.

“If something happened to me tomorrow, my practice would probably fall over,” he said.

“I've been trying to raise the issue. I've been saying we need to do something to try and get some way of retaining trainees that we're bringing in.

“Most of the GPs in west Belfast are working way over per head of population – we have one-and-a-bit doctors in my practice.

“I have made the Health and Social Care Board aware on more than one occasion of the pending problems that are bound to happen.

“It's not just west Belfast but right across Northern Ireland. There are advertisements all over the place for training partnerships which you never saw before because there was always enough people in the workforce to take up the partnerships.”

While the number of GP trainee places has increased in recent years, the Department of Health has come under fire for failing to implement recommendations from workforce reviews.

Workforce planning is the department's remit and GP shortages coincide with haemorrhaging nursing numbers.

A programme to roll out ‘multi-disciplinary' health care teams in practices – including phsyios, mental health professionals and social workers – is under way following successful pilots in Derry, Down and west Belfast.

While Dr McKenna welcomed this initiative, he stressed that attracting new GPs into the profession is key.

“Essentially this is a workforce planning failure but the people who are responsible for the failure won't be fixing it any time soon,” he said.

“So we'll try and fix it ourselves. Part of it will be with training numbers. Another part will be with the multi-disciplinary teams and that's a huge help in terms of workload – however, they need to be rolled out across the board.

“But you still need more doctors. Doctors take responsibility. We're trained to take risk. Other people won't do that.

“Without GPs you create more work, more testing. You put the patients at more risk that they don't need to be at.”

There are 323 general practices across the north, an 8 per cent drop on the 2014 figure.

“Everybody was in a pretty good place until 2014. At that point we were beginning to hear the most important thing was the workforce review and the need to increase GP numbers,” Dr McKenna said.

“There were three workforce reviews and the recommendations were not really undertaken.”

Rural areas, including parts of Co Fermanagh, were severely hit by GP shortages in 2017 resulting in the closure and merger of several surgeries. The village of Roslea was left without a doctor for the first time in 100 years.

The impact has been felt more acutely in towns and cities over past two years, with the out-of-hours Beldoc service covering north and west Belfast suspended for the first time in the summer despite doctors being offered £100 an hour.

Dr McKenna said there has to be a way to incentivise more medics to enter the sector.

“How do you attract and retain a group of trainees within an area? That's one of the difficulties,” he said.

“A challenge that west Belfast has is the deprivation element.

“The other issue is that the working patterns are now changing with less doctors working full-time.

“For those 15 doctors who are close to retirement in west Belfast, you may need 20 or more GPs to replace them.”

A major shift in the gender profile of doctors under 40 (a decade ago it was 50:50 but now it is 70:30 female to male) this will affect work patterns.

“We have quarterly meetings with the board and bring up the problems each time. West Belfast is not in a good place,” Dr McKenna said.

“There's now two practices that have 11,000 patients between them and no obvious succession planning.

“Regardless of age, doctors could turn round and go at any time. The pressure is so intense. They could say they've had enough and hand their contract back.

“Ultimately what we're hoping for is that the increase in GP training numbers will be sustainable. That's going to take years to come through. Most of the GPs coming through are and will be female. Their training period will be extended because they will get married and have families. That's just a fact.

“All I can do is keep raising the issue. Dr Tom Black, when he was chair of the British Medical Association's GP committee, once said that no-one is going to solve this problem for us, we're going to have to solve it ourselves.”

The Irish News contacted the Health and Social Care Board and the Department of Health for comment. Both responded with the statement issued last Friday about the £5.5m funding. In it, Health Minister Robin Swann said work is being done “on a number of fronts” to improve access to services including the wider roll-out of multi-disciplinary teams. The GP out-of-hours service is also being reformed.

“At the same time, work is under way on a review of GP trainee places, to make sure we have enough GPs to meet our primary care needs into the future,” Mr Swann added.

“I am committed to ensuring that we have a GP workforce that is supported, motivated and sustainable and that continues to provide quality care to patients when they need it.”

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