The hospital waiting list crisis is resulting in a two-tier health service that risks "leaving behind patients who are unable to afford" private treatment, a leading doctor has warned.
The new chair of the Royal College of General Practitioners (RCGP) in Northern Ireland is the latest senior medical professional to speak out about the dire state of the local NHS.
Dr Laurence Dorman said an increasing number of patients were being forced to pay for private treatment because of waiting lists.
People who cannot afford to pay for treatment are being "left behind", he added.
It emerged last week that one in five cancer patients here receives a diagnosis after going to an emergency department (ED).
The Northern Ireland Cancer Registry has carried out research which shows that a quarter of bowel cancers are being diagnosed in EDs. Medics have said this is happening because patients are waiting so long for hospital appointments after going to a GP with symptoms.
Speaking as he took up his new post, Dr Dorman said: "GPs are the first point of contact for patients and the increasing waiting list for specialist services is putting huge strain on our services.
"While waiting for specialist services, patients rely on their GP to review their condition and perform essential tasks, such as medication management and blood test monitoring.
"Many patients feel they have no option other than to purchase private medical care, which risks leaving behind patients who are unable to afford it, increasing our health inequalities further.
"It also risks patients accessing investigations such as scans, which are unnecessary and could be avoided if they had access to good and comprehensive NHS care." Figures from the Department of Health show nearly 300,000 people here are on a waiting list for a first appointment with a consultant, which is 23,500 more than the previous year - a rise of 8.5%.
Some patients can expect to wait five years just for a first outpatient appointment.
They can subsequently wait several years for diagnostic tests before moving on to another waiting list for surgery, if required.
This means that in some cases people are waiting up to a decade for treatment.
Dr Dorman said transformation of the way that healthcare was delivered was urgently required.
He said family doctors can play a key role in helping to alleviate the suffering being experienced by patients.
He also welcomed the introduction of allied health professionals in GP surgeries.
Dr Dorman became chair at the RCGP (NI) AGM last week, succeeding Dr Grainne Doran, who was chair of the college for three years.