Bedrock of NHS is on life support and fading fast
Without major surgery by the Executive, NI general practitioner service doomed, as is health service, claims Dr Tom Black
The GP service is in crisis. Without significant investment we expect it will collapse completely within two years. The NHS, which depends on the GP service as its foundation, could collapse soon after.
The GP crisis is due to an overload of work with a diminishing workforce and a gradual reduction of funding over the last decade. The workload for GPs has more than doubled in the last 15 years but the workforce has not been increased to keep pace with this - in fact it has actually decreased.
Funding for the GP service which once stood at 10% of the health budget has now been reduced to 5%, despite the fact that GPs carry out 90% of NHS consultations. Young doctors are no longer taking up jobs as GPs as they find the demands on them intolerable. As a result practices are closing.
This situation is much worse in Northern Ireland than in England, Scotland or Wales as we spend less on general practice with a higher percentage of our health funding going to secondary care.
There are now four times as many doctors working for hospital trusts here as there are GPs. Despite this we have the longest waits for A&E and hospital outpatient and inpatient services in the UK.
This might seem an illogical outcome given the higher investment in hospital services here, but we are spreading our resources too thinly across too many sites and this makes hospital services inefficient.
Another part of the health service struggling is GP out-of-hours (OOH). Two out of the five out-of-hours services in Northern Ireland have been declared unsafe. Spending on GP OOH is now lower than it was in 2003 despite total health funding roughly doubling during this period.
So what are the solutions for the GP crisis?
The first thing to state is that the NHS in Northern Ireland has become unworkable for GPs and their practices, and GPs will now consider whether they need to leave the NHS if urgent measures aren't adopted. Staying in without these urgent measures will result in the complete destruction of the GP service.
We need a rescue plan for collapsing practices and this needs to begin in Fermanagh where more than half of the GP practices are at risk of closure in the next two years.
We need to increase GP training numbers from 85 to 111 per year now in accordance with the Department of Health's own workforce recommendations and increase the exposure of medical students to general practice.
We need a programme of investment in staff to help GPs with their workload while we're waiting for more GPs to be trained. We have made a small start with practice pharmacists but we need to provide every practice with more nurses and mental health workers. We also need to stop the removal of health visitors and district nurses from practices. All of these measures will improve the lives of our patients.
We need a transformation of the health service in Northern Ireland. This need for a transformation has already been recognised in speeches by the Health Minister and the Minister for Finance. It has been clearly signposted in the three big health reviews in the last 16 years.
The Bengoa Review on the minister's table will no doubt tell us something similar but we have paralysis by analysis in Northern Ireland and we hope that the Executive and Assembly can provide the political leadership we need and take difficult decisions. We know only too well that there will be opposition if the minister moves forward with a transformation. But without change the NHS in Northern Ireland is going to collapse.
We have a health service here based on 20th century disease profiles that no longer exist. A modern health service fit for the 21st century needs to be based on health promotion, health prevention and care for chronic diseases. In this modern service we need to build up community, GP and mental health services and keep patients out of hospital.
We need to be able to care for patients with chronic diseases by ensuring that they can access expert generalists in the community. This in turn will help prevent unnecessary hospital admissions.
This is a challenge for Health Minister Michelle O'Neill and MLAs. Without transformation the health service in Northern Ireland will collapse. GPs in Northern Ireland are not prepared to stand back and wait for this to happen.
Dr Tom Black is Chair of the BMA's Northern Ireland General Practitioners Committee