BMA Northern Ireland chair opens surgery to private patients

The BMA Northern Ireland chair has opened the country’s first ‘hybrid’ GP practice, which accepts private patients, in a bid to stay afloat.

On Tuesday, Dr Tom Black, a GP partner at Abbey Medical Practice in Derry, opened up his surgery to fee-paying patients who are not already on his 6,800-patient list.

He told Pulse that the practice had ‘zero choice at all in the matter’ and that the practice would have closed otherwise.

Abbey Medical Practice had been losing money every month for over a year due to ‘lack of funding’ from the Northern Ireland Department of Health.

Dr Black said the practice has a ‘very big overdraft’ from awarding staff an 8% pay uplift in the absence of central funding for the DDRB-recommended 6% uplift last year – he would have faced a workforce crisis without this uplift, with receptionists leaving for better-paid jobs in supermarkets.

The funding problems in Northern Ireland are caused by issues at Stormont, where there have been no political leaders, including a health minister, since May 2022.

Dr Black said he would not allow ‘Stormont incompetence’ to cause his 100-year-old practice to close, and asserted that the Department of Health will not stop the new hybrid model.

But he told Pulse this was not an easy decision: ‘I should be furious, and somewhere at the back of my brain I am furious that I’ve had to do this, because I never wanted to work privately. I never wanted to be in a position where I had to see patients privately.’

Under the model, income from private patients – charged at a rate of £75 per appointment – will be redirected entirely towards the NHS practice and paying off the overdraft.

Dr Black highlighted that doctors seeing private patients will be working for free.

‘I worked on Tuesday for free, I don’t get paid and I don’t get a day in lieu,’ he said.

‘We’re guaranteeing that the same number of appointments and the same number of doctors will continue in the NHS practice. But those same doctors will work harder on their days off doing private,’ he added.

The BMA NI chair told Pulse the move is ‘transformational’ and he has ‘full confidence’ it will be a success given the high demand for private appointments in his area, which stems from long waiting lists.

He said the same hybrid model could be replicated across other struggling practices in Northern Ireland, with multiple GPs having already reached out to ask how the model was implemented.

‘It’s my impression as BMA leader that given that the Department has no funding that GPs will have to look to self-sufficiency to maintain the integrity of their service,’ Dr Black said.

In response to Dr Black’s new hybrid model, GP Committee NI chair Dr Alan Stout wrote in a post on X: ‘I would listen very carefully to the GP with 40 years of experience in perhaps the most challenging demography in the whole of the UK.

‘If Tom Black can’t make it work, no one can. This is the beginning of the end of the NHS as we know it.’

The Department of Health said the ‘implications’ of Dr Black’s proposal are ‘currently being considered’, and pointed to the GMS regulations which restrict GPs from charging patients who are on their registered list for NHS services.

A spokesperson said: ‘The Department recognises that GPs and their practice teams are continuing to work to care for patients in the face of increasingly challenging circumstances.

‘In 2022/23, 13 GP practices handed back their contract. Stabilisation of GP practices is a key concern and the Department continues to support General Practice with the aim of ensuring people can continue to access high quality, sustainable services now and in the future.’

Last year, Dr Black told Pulse he had taken measures to close the practice list to new patients due to unmanageable workload, despite the Department of Health (DoH) rejecting his initial application.

Dr Black highlighted that his surgery is located in an area of high deprivation where patients can wait five or six years for secondary care treatment.

LMC leaders across Northern Ireland recently voted to ‘fully explore’ whether industrial action is an option for GP partners, saying they are ‘appalled’ by the DoH’s ‘inaction’ to address general practice pressures.

In a exclusive interview with Pulse last year, Dr Stout said GPs across the country could walk away from their NHS contract and come up with an ‘alternative option’ if the problems facing the profession are not solved.

Since July 2022, 19 practices across NI have handed back their contract – and during that time the country has been without a first or deputy first ministers, with civil servants only permitted to make decisions that follow policy previously set by ministers.

And Government investment in general practice decreased by 7% in real terms between 2021/22 and 2022/23.