Northern Ireland

General practice ‘in the most difficult position it has ever been in’

Dr Alan Stout, chairman of the BMA Northern Ireland general practitioners committee, highlighted the challenges (PA)
Dr Alan Stout, chairman of the BMA Northern Ireland general practitioners committee, highlighted the challenges (PA)

General practice in Northern Ireland is in the most difficult position it has ever been in, Dr Alan Stout, chairman of the BMA Northern Ireland general practitioners committee, has warned.

Dr Stout said practice contract hand-backs, financial pressures, staffing pressures and rising patient need were among the challenges.

Speaking at the BMA Local Medical Committee (LMC) conference in Belfast on Saturday, he also referred to the collapse of Stormont, saying that for health service transformation, a local government, a health minister and local and multiyear budgets are needed.

The Stormont Assembly and Executive has been effectively collapsed for more than a year and a half, amid a stand-off between the DUP and the UK Government over post-Brexit trading arrangements.

In the absence of ministers, senior civil servants are leading government departments with limited powers.

“Let me be absolutely clear, the crisis is not the fault of the hard working, committed GPs and it is not the fault of our LMC or other GP representatives,” Dr Stout said.

“We have and we continue to lobby, to advise and to warn of the problems we face and the problems that are coming rapidly at us, but we see so little to help us or to even give us some hope.

“It is impossible at this point not to reflect on the past six years and how we got to such a difficult position.”

He said the Bengoa Report, with proposals to transform the health service, gave optimism and hope when it was published in 2016.

But he said report author Rafa Bengoa had been proved right in his warning that implementing it “would always be the biggest challenge”.

“Not only have all the predictions in the plan relating to us being on a burning platform come true, but the actions proposed are still all the correct ones, they have just not been actioned,” he said.

“Front and centre of these was building a strong, well-staffed foundation in primary care.

“This would be vital to everything we tried to do in the future, be it elective care, urgent care, out-of-hospital care, early discharge, preventative medicine, population health, the list goes on and on.

“Instead we have seen the collapse and the struggles we are all too familiar with. We can never be surprised when we see the crises.”

He said during his time in the chair he had worked with just one health minister.

“For health to work, for it to evolve and for us to transform, we absolutely need local government, a health minister and local and multiyear budgets,” he said.

“Without local, public accountability we see doctors and staff being held accountable time and again for things that are totally out of their control, and this is simply unacceptable.

“In my time as chair I have unbelievably only had one health minister, Robin Swann, and this coincided with a global health crisis that none of us ever want to revisit.

“It demonstrated very clearly how local politics can and should work, how decisions can be made and how the system can flex, react and can change very, very quickly.

“We will never, ever underestimate just how difficult that time was, and we are still feeling the effects of it, and to be left with no political lead and local accountability now, as we try so hard to rebuild and to recover, is utterly disgraceful.”

Dr Stout said a plan has been created to save general practice, but there has been “no movement” on its key actions.

“If the Department (of Health) are committed to general practice, as they say they are, then they need to recognise that the power to stem the tide of practice hand-backs is in their hands,” he said.

“Messaging is critical, the prospect of help is vital, and additional simple things like updating and publishing the SFE, increasing payments for vaccinations and enhanced services, along with inflation, as well as actually funding GPs for the number of patients they have, would make a huge difference

“We not only see the problems, but we see all of the solutions too.”