Grey matter: a view of healthcare from across the water

Dr Grainne Doran, chair of the Royal College of General Practitioners Northern Ireland (RCGPNI), reflects on the current crisis facing general practice in Northern Ireland and the political instability that is stalling necessary action to address the challenges

Dr Grainne DoranGeneral practice in Northern Ireland (NI) is currently facing significant pressures in terms of workforce shortages, increasing workload and a prolonged lack of investment. Despite a number of successes over the past few years the RCGP’s Put Patients First campaign in NI is facing its most significant challenge yet. At the core of this lies political instability and government inaction – since 2014 there have been four different health ministers and, following the a snap Assembly election in March and no agreement following political negotiations, the future hangs in the balance.

The case for reform

So where does this leave general practice in Northern Ireland? The short answer is – in a state of crisis.

With limited workforce planning in place and no increase in investment in over a decade, recruiting the GPs necessary to meet the needs of the population and managing the increasing workload have never been more challenging.

In March 2016 the NI Department of Health published the Review of GP-led Primary Care report, written in collaboration with primary care stakeholders. The report outlines nine recommendations that aim to ensure the future of general practice is sustainable. The GP profession in Northern Ireland consider this report as our local version of the GP Forward View; RCGPNI has been actively lobbying the government for equivalent investment in general practice to implement the findings.

In October 2016 the latest health minister, Michelle O’Neill, announced her vision for the future of health and social care, Health and Wellbeing 2026: Delivering Together. This vision for reform emphasised the value of general practice and highlighted primary care as the foundation of our health service. While a number of commitments were made to support general practice at the time of the announcement, including an increase in GP training places to 111 and the expansion of the primary care multidisciplinary team, no additional resource was allocated.

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 A call for urgent action

Two months later the minister finally accepted the recommendations in the GP-led Primary Care Report; however, once again, the promises to take action fell short of any actual investment to deliver on this.

Regardless of political uncertainty, RCGPNI has continued to push hard to ensure general practice remains a top priority for the new government and has been calling for urgent action to address the increasing pressures in general practice at the earliest opportunity once decision-makers are reinstated.

Writing an open letter to political leaders earlier this year I called for parties to come together and show ‘true leadership’ by putting the needs of patients before political indifference. Keeping a firm focus on general practice, RCGPNI released two separate manifestoes in advance of the Assembly election in March. Our patient manifesto, compiled by the RCGPNI Patients in Practice group, encouraged service users to have their say and raise their own health priorities on the doorsteps whenever political candidates called looking for support.

We are hopeful that, once the political institutions are resumed, the united support from parties to prioritise health care reform and general practice will ensure that the verbal commitments we have heard in recent months will be swiftly put into action.

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