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One in three NI GP practices has reached ‘crisis’ point, finds watchdog

One in three NI GP practices has reached ‘crisis’ point, finds watchdog

Around one in three GP practices across Northern Ireland sought ‘crisis support’ over the last four years, according to the country’s public spending watchdog. 

A new report by the Northern Ireland Audit Office (NIAO) looking at access to general practice revealed that 98 practices, out of the total 318, turned to a crisis response team between 2019 and 2023. 

The watchdog also highlighted that during the year up until March 2023, a total of 13 practices handed back their contract, and the BMA pointed out that there have been a further five hand-backs since then. 

At some ‘challenging’ practices taken over by trusts, rates of up to £1,000 per day have been offered in order to ‘attract’ locums, according to the report.

Pulse reported on this issue in 2022, when some locum rates in England were ‘in excess of’ £1,000, following similar reports in Northern Ireland.

The NIAO report examined the various challenges GPs face, including workforce and investment, and warned that ‘extreme pressures continue to build on the primary care sector’.

To help alleviate these pressures, the watchdog urged the NI Department of Health to focus on long term planning with a focus on sustainability. 

‘It is clear that the issues impacting general practice are complex and will require a sustained, long-term response to ensure that general practice is sustainable and an attractive place to work,’ the report argued. 

It continued: ‘Ultimately, effective services will only be achieved if the Department develops a longer term, funded plan that can deliver a joined-up approach to the challenges facing general practice.’

The auditors made a number of recommendations to the Government, including a call for a costed GP workforce strategy, similar to NHS England’s long-term workforce plan.

On funding, the report stated that general practice received £375m in 2022/23, with a real terms funding cut of around 7% compared to the previous financial year. 

This total figure was also just 5.4% of the total health and social care spend in Northern Ireland. 

The report also examined the Government’s failure to roll out multidisciplinary teams in general practice, which were launched in 2018 and badged as a ‘key component of health service transformation’. 

An ‘incremental’ rollout was planned over a five-year period, but as of March 2023, MDTs had been introduced in only one out of the 17 GP Federation areas across Northern Ireland. 

The auditors cited a lack of available staff as a ‘key constraint’, and estimated the Department of Health would need to fund an additional £91m package to ‘sustain operation of the full programme’. 

On contract hand-backs, the watchdog found that alternative providers had been found for the 13 practices who had taken this step – but that in nine of those cases, the solution was only ‘temporary’. 

These temporary arrangements included health and social care trusts taking over five practices.

While the Department of Health has said that these arrangements prevented practice closures and list dispersal, NIAO pointed out the need to ‘identify solutions which will be effective in maintaining sustainable GP services in the long term’. 

Where trusts have taken over as contractor, the NIAO found that ‘this had the effect of increasing costs, often substantially’.

Specifically on staffing, the report said: ‘Whilst Trusts have access to a range of staff which can help stabilise practices, GP cover is often sourced from locums.

‘However the need to attract locums to challenging practices has resulted in high rates being paid – up to £1,000 per day.

‘Stakeholders told us that whilst it may immediately stabilise the practice, it had the effect of distorting the locum market for other practices.’

Recommendations to the Department of Health

  1. Urgently improve the collection of activity data in general practice to better understand the volume and nature of activity and to inform decision making;
  2. Improve GP workforce data so that it can capture a measure accounting for the proportion of standard sessions provided by a GP;
  3. Develop a national workforce plan for general practice including the overall number of GPs needed over defined timescales;
  4. Review and where necessary refresh GP retention schemes;
  5. Develop credible plans for the future roll-out of MDTs across Northern Ireland, taking account of constrained funding and availability of staff;
  6. Undertake work to stabilise GMS services and to increase the sustainability of the service and contain costs associated with supporting failing practices;
  7. Share across the sector any lessons learned from trusts managing primary care services;
  8. Consider what actions might be taken in the short term to improve patient access to services.

Source: Northern Ireland Audit Office

In response to the report, BMA NI GP Committee chair Dr Stout said that the fact general practice funding was ‘just 5.4%’ of the overall budget is ‘one of the most damning findings’. 

‘This is an astonishingly low amount at a time when practices are facing spiralling costs, rocketing inflation, inadequate staffing, and a huge increase in patient demand. It is the absolute key factor in so many of the other problems listed in this report,’ he said. 

Dr Stout also pointed out that the report did not look at how ‘spiralling GP indemnity costs is a significant barrier to recruitment and retention’. 

He added: ‘We can only hope its recommendations do not also fall on deaf ears and that properly funded, long-term, sustainable interventions to save primary care are actioned before it is too late.’

The Department of Health said it ‘welcomes’ the report and ‘will consider the recommendations in full’.

‘There is no short-term fix to issues within General Practice. The issues impacting general practice are complex and will require a sustained, long-term response,’ a spokesperson said.

Pulse has reported on several contract hand-backs since spring 2022, revealing last year that close to one in 20 GP practices across Northern Ireland had taken this step in just one year. 

But earlier this month, Dr Stout urged practices to hold off handing back their contracts as current negotiations between the union and the Government have shown ‘definite encouraging signs’. 

The talks come following two years of a political void in Northern Ireland, during which there were no ministers or Executive, and civil servants were only able to make decisions in line with previous policy.

But a power-sharing agreement was finally reached in late January and a health minister appointed, with the GPC NI saying ‘one of the very early tasks’ must be GP contract negotiations.



Please note, only GPs are permitted to add comments to articles

Michael Johnson 20 March, 2024 11:17 am

This is not a new problem.
The progressive reduction in core funding with money diverted to other pet projects has left a lot of the less financially saavy, or historically less well funded practices on the brink of failure.
Most plod on in the hope it will improve whilst their drawings drop and the practice beings to fail.

The answer is obvious.
Increase the global sum.
Incentivise practices to take on younger partners with sweeteners. No ARRS please in NI
We need our young GP’s employed, not PA’s.

Mark Cathcart 20 March, 2024 11:40 pm

A valuable resource to use to help enhance gp funding in Northern Ireland indeed
It merely confirms the messages coming from general practice here for many years and the subsequent decline that we have seen over the past decade,
Politicians of all colours knew the problems and chose to do nothing about it, we are at the mercy of local politics and we are approaching a situation of complete collapse of gp services in my area
The indemnity issue was not highlighted, unlike E&w, our practice pays full rate indemnity for our clinical staff amounting to 55000 pounds every year, a cost not endured elsewhere in the UK
So as bma finalise their contract negotiations with the DoH soon, there is virtually no time left to rescue our service, I am not hopeful that we will be rescued as previous experience has shown me that crisis management is the preferred policy rather than long term planning
We are in the last chance saloon and unless drastic action is taken immediately then our nhs gp will disappear completely
It is now 5 minutes to midnight, I wonder do our politicians understand the impact of what total gp collapse here would entail?
I doubt it

john mccormack 25 March, 2024 5:34 pm

Federations should be abandoned (a lot of money wasted in bureaucracy with no clear benefit to general practice and frequently obstructive) and all the money redirected towards individual practices so they can decide what their needs are and how best to address them