Struggling NHS is reaching crisis point
Crisis is a much over-used word but a report by the BMA last year saying that general practice in Northern Ireland is facing a crisis appears to be an accurate assessment of the situation.
Certainly it is the case in Portadown where up to 5,000 patients of a GP practice are facing an uncertain future. They were faced with the shock announcement that the practice was to close next week, but it has been given an 11th hour reprieve while new doctors are sought.
The problem is that if the practice does have to close, there is nowhere else in the town for the patients to go as other practices there are already overstretched.
It all smacks of a lack of forward planning by health authorities with staffing issues as the practice having been flagged up two years ago.
But the health authorities - and Health Minister Michelle O'Neill in particular - have been well warned of the problems within general practice.
Last year the BMA said a survey showed that the situation was particularly serious in rural areas. In Fermanagh there were fears that three out of four practices were in danger of closing.
This is another sign of the NHS creaking at the seams and some of the problems facing family doctors and hospitals are similar - an ageing and growing population with many people having life-long complex conditions. As patients well know, it is difficult to get a GP appointment and with many GPs reluctant to work nights or weekends, patients then divert directly to hospital A&E departments creating another pressure point in the system.
Undoubtedly GPs are well rewarded for the services they provide, but it is a daunting profession involving making potentially life and death decisions. As well, many young doctors are reluctant to move to small rural practices where the workload can be particularly demanding.
As with all parts of the Health Service it is a question of resources. The BMA wants an annual 10% of the health budget - which takes up nearly half of the Northern Ireland block grant - invested in GP services and also the recruitment of an additional 40-plus GP trainees annually.
But there are many parts of the NHS which could make equally compelling cases for greater investment and the only way to make finite resources stretch further is to take tough decisions on priorities and the size of the acute hospital estate.