Rural story on Northern Ireland crisis goes viral

In recent weeks a story on the Primary Care crisis in Northern Ireland written by our colleague Michael Smyth has stimulated enormous discussion on the WONCA Working Party on Rural Practice Google group. If you are not a member, find out what all the fuss is about as Michael writes for WONCA News: "it is a commentary of recent events in General Practice as they happen in Northern Ireland. It is a difficult situation and is being played out mainly in rural areas initially as these seem to be the most vulnerable. They are for the most part unavoidably small and the demographics is that many, especially in my area have GPs over 55 yrs and approaching retirement. On retirement there are no younger doctors interested in taking over responsibility for the practices. I hope this is helpful in demonstrating the difficulties faced in rural practices as part of the NHS."

Primary Care Crisis in Northern Ireland

March 2017

Primary Care and the very existence of the NHS in Northern Ireland (NI) is threatened like never before.

The 'canaries in the mine' are those unavoidably small practices in rural areas. I have been one of those canaries. My solo GP rural practice closed last December having been unable to recruit a replacement GP. Fortunately for me being close to retirement age, this allowed me to escape the cage. The domino effect has put pressure on neighbouring practices and this is likely to increase with impending retirement of other GPs in the area. 30% of the GPs in my rural county of Fermanagh are due to retire in the next 2 yrs.

NIGPC believe a staggering 13 practices could close going from 18 down to five. This in the most rural part of NI. Anyone who believes this will not affect access to quality general practice for these rural communities is deluded. In the whole of Northern Ireland there are 950 full-time GPs. 25% over 55 yrs old. There are now fewer GPs in NI than there was in the 1950’s and exponentially increasing workload for the same reasons elsewhere in the UK. Now even some urban practices are collapsing with the pressure on the remaining intolerable.

We need more GPs urgently retaining those who are retiring.
Further increase in training places.
A minimum of 10% of the health budget going to Primary care.
A Stabilisation fund. Reduced bureaucracy and workload.

GPs in NI can only look on with envy at how the devolved governments in other parts of the UK are attempting to steady the ship.

Here in NI over the past 10 yrs despite repeated warnings from primary care leaders, there has been a lack of strategic leadership from the Dept of Health NI and the local devolved government. Thus, the rudderless ship of the NHS has foundered on the rocks. Blown there by the perfect storm of increasing demand and decreased resources. The question now is can it be refloated before it is smashed as the storm intensifies.

NI primary care is in the invidious position of having the oldest workforce in the UK coupled with not enough younger GPs in training. Although the training numbers were increased recently after sustained pressure from the professional bodies it seems too little too late. We have the lowest number of GPs to patient ratio in the UK. NIGPC believe 20 GP practices face closure across NI this year affecting 120.000 patients.

To add insult to injury from the beginning of this month we longer have a functioning devolved government in NI due to what seems to be intractable political differences between the ruling parties. Previously the main thing that those tasked with offering strategic leadership was to welcome several rescue plans, the latest being the “Bengoa” report.
Although this plan is promising in the medium to long term it is likely with no functioning government to remain on the shelf along with its predecessors.

To relieve the severe pressure on General Practice the professional bodies have had some success by organising Federations of practices to work collaboratively. They are in their infancy but are already starting to employ allied professionals such as practice pharmacists to help with the workload.

We still need a crisis plan from the Dept of Health and government for the here and now. With no functioning government this is very doubtful.

NIGPC have proposed Plan B for which they recently received overwhelming support from the profession. The nuclear option of leaving the NHS. When 60% of GPs sign resignation letters over the next 3-6 mths NHS Primary Care will no longer exist in NI.

Sorry for such a depressing report but I believe it illustrates the dire situation NI Primary Care finds itself with rural practice very much on the frontline.

Yours sincerely,
Dr Michael Smyth FRCGP

PS please see link to NIGPC website with further information on how we got here.

Link to NHS By choice and not by chance report. Prof Val Wass, Chair of the WONCA Working Party on Education chaired the taskforce which produced this relevant report.

To join the WONCA Working Party on Rural Practice Google Group please contact Dr John Wynn-Jones (Chair)