Dr Alan Stout was recently elected as Chair of the Northern Ireland general practitioners committee. Here he outlines the challenges facing GPs in Northern Ireland.
In past few years we have talked about general practice being in a crisis and close to collapse, and its true that there are still practices in real trouble across Northern Ireland. The dedication of individual GPs is often the only reason that the situation has not got worse.
The underlying issue is that we have a growing population, with patients living longer and with much more complex conditions and needs. This is combined with an ageing group of GPs, and fewer younger doctors choosing to come into the profession. The strategy that care should be provided close to patient’s homes with primary care alternatives to hospital is the right one, so it is critical that we have a strong foundation in primary care, and this will fail without enough GPs.
For GPs we are seeing an increasing trend towards what is termed a ‘portfolio career’ where GPs don’t just work in a practice every day, they will choose to work in another setting or service as well, so they can develop a wider range of skills. This is a good development, but we must be aware of the impact on numbers and the delivery of core service. We are also keen to continue to promote the partnership model of general practice, and we need to make this an attractive proposition for young GPs and to start to minimise the costs and the risks involved.
The health service as a whole is evolving, and general practice will be a large part of this, with an extended team and new ways of working developed particularly around the ageing population.
There will be an increased role in primary care for nurses, physiotherapists, mental health workers and pharmacists, and they will often be the first point of contact. There will also be the ongoing development of new models for out of hospital care. The value of a GP as a Generalist, but also with the knowledge and the continuity of care that they can provide to patients will be vital to this. It will be a challenge for everyone involved but is the right direction of travel.
There have been some very welcome recent developments with the establishment of the first phase of multi-disciplinary teams and the continued roll out of practice-based pharmacists. These both extend the primary care team, will help ease the pressure on GPs and will also help to develop new models of care. It is critical this rollout continues at pace and the funding is committed and recurrent. We cannot lose site of the need for core funding and sustainability of practices as the foundation alongside this.
Unfortunately, the lack of a government is affecting the whole health system. The Department of Health are still progressing the vital transformation agenda despite this constraint, and are working as closely as possible within the agreed policy laid down in ‘Delivering Together’. The delivery and the transformation of the health service is too important to wait for the politics to sort itself out.
BMA Northern Ireland
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