RCGPNI Chair, Dr Ursula Mason highlights key challenges GPs face on daily basis to the Northern Ireland Health Committee

On 30^th January, RCGPNI Chair Dr Ursula Mason, gave a briefing to the Northern Ireland Health Committee. Dr Mason, who is also Vice Chair of Eastern Federation Support Unit, highlighted the many challenges General Practice in Northern Ireland face on a daily basis.

The issues highlighted will not come as a surprise to colleagues:  workforce planning; chronic underfunding, increased demand, recruitment and retention and GP burnout.

Health Committee Chair, Liz Kimmons acknowledged the many difficulties general practice face daily.  On recent visits to practices, Ms Kimmons saw first-hand the huge amount of work that happens including the role of support staff, the amount of administrative work required, the role of GPs as employers and that they are in a constant state of crisis management.  She recognised issues in recruitment and retention and that it is a ‘thankless job’ as the general public do not see the volume of work that goes on behind the scenes.

Dr Mason highlighted the following key points in her briefing:

Workforce Planning

Workforce challenges are as stark as ever.  There are fewer whole time equivalent GPs than a decade ago with those working in general practice working more intensely, dealing with more complexity and co-morbidities than ever before.

Although workload has already ‘shifted left’ it remains chronically underfunded and lacks appropriate resources resulting in GP numbers remaining stalled.

Early career GPs are leaving to work in places with better terms and conditions and better patient outcomes.  Mid-career GPs are burning out and later career GPs are leaving or retiring at the earliest opportunity.  Increasing numbers from the current 121 to beyond 161 over the next few years would still only return whole time equivalent numbers seen in 2014.  To recruit and retain GPs, significant funding and a fully resource workforce plan is required.

Costs

Practices are struggling to meet the rising costs of basic service delivery through core General Medical Services (GMS) funding.

For some practices this makes recruitment of nursing and support staff unaffordable, and this will be further compounded in April with the increase in employers National Insurance.

Moving incrementally to beyond 10% funding will require a ‘shift left’ effectively to realise the potential of general practice to provide a robust primary care to improve long term health outcomes.

A one percent increase over the next couple of years would help to start turning the corner.  Dr Mason stressed that this cannot wait for a multi-year budget.  It needs enacted now.

Increased Demand

General practice has over 200, 000 contacts per week (figure given by NIGPC Chair, Dr Frances O’Hagan). Patients have better access now than pre pandemic, but the real challenge is that demand has risen and is outstripping capacity.

The early morning scramble for appointments is general practices’ equivalent to an overcrowded Emergency Department.  When patients receive a recorded message to tell them no more appointments are available for the day, it is the equivalent of ambulances stacking up outside ED.

The difficulty is that GPs cannot accurately count the demand rather less put it in the media.

However, the problem is not flow but rather capacity and it relates directly to the numbers of GPs and size of the practice team.  The number of phonelines is irrelevant if the practice team do not have a call navigator to answer them and a GP to see them.  Safe limits are exceeded daily and sustaining this is compounding burnout and, ultimately is not good for patient care.