The Department of Health’s Winter Preparedness Plan 2023/2024 has been branded as “disappointing” by the Royal College of Emergency Medicine, while general practice representatives have stated that funding included in the plan is not new and that the plan will “add pressure”.
Published in October 2023 with “severe pressures expected on services”, the Winter Preparedness Plan 2023/2024 saw the Department of Health stating that the “importance of all parts of the system working together has never been more critical”.
Despite this, criticism of the plan from various types of medical practitioners has followed the publication. Criticism has especially been acute from those representing general practitioners (GPs). The Royal College of General Practitioners Northern Ireland (RCGPNI) has focused on its contention that the £3.4 million in funding provided to general medical services and out of hours services to support GP practices to increase their capacity “in light of the anticipated increase in demand over the winter” announced as part of the plan is “not new” funding. Winter pressure funding, while ad hoc, has recurred for several years. However, factoring in inflationary price increases, the new allocation falls below levels awarded in recent years.
“We are surprised that we were not consulted on this plan or measures around unscheduled care, and we are concerned that this plan does not go far enough to prepare the emergency care system for what will likely be a tough winter ahead.”
Michael Perry, Vice Chair, Royal College of Emergency Medicine Northern Ireland
Speaking at the Health and Social Care (HSC) Summit, at which the Winter Preparedness Plan was unveiled, RCGPNI chair Ursula Mason detailed that 200,000 consultations are happening per week across general practice in Northern Ireland, a rate which “cannot go on” and has left GPs “badly” in need of support to sustain the service.
Mason added that a “turn down, or, in some cases, stoppage” of funding for GP elective care services is “devastating and will add to pressure for both primary and secondar care”. RCGPNI board member Rebecca McGinley also called the plan “very disappointing” and stated that “GP is in crisis and unfortunately the winter plan does not look like it will help us”.
Alan Stout, Chair of the Northern Ireland General Practitioners Committee (NIGPC), also stated that the unveiling of the plan had left him “more concerned than ever that we are not going to have a functioning GP service by the end of this winter” and that “massive escalating costs [are] threatening viability and virtually no help [is] visible”.
Data released by the Department just two days after the publication of the Winter Preparedness Plan shows that total investment in general practice stood at £374.775 million in 2022/23, an annual decrease of 0.82 per cent overall decrease and a 6.92 per cent decrease in real terms.
According to the Department of Health, between 2014 and 2022 there was a 9 per cent decrease in the number of GP practices in Northern Ireland.
Also included in the Winter Preparedness Plan are a raft of measures and goals in an attempt to get to grips with the various crises engulfing the provision of emergency care, however, criticism has been levelled at a failure to significantly increase the number of acute beds to meet rising need.
Measures taken include the opening of a new emergency department with a dedicated ambulance handover zone at the Ulster Hospital, the provision of hospital ambulance liaison officers at the main emergency departments by the Northern Ireland Ambulance Service to facilitate the smooth transfer of patients into hospitals, and the provision of 98 additional beds across Antrim Area Hospital, the Ulster Hospital, and the Royal Belfast Hospital for Sick Children. The Belfast Trust has also opened a 25-bed medical rapid assessment unit and will maintain 24 additional step-down beds to facilitate discharge and 19 more will be opened this winter.
Targets included state that ambulance handovers should be completed within 15 minutes of arrival and no later than two hours, with average ambulance response times aimed at being 10 minutes for Category 1 calls and 36 minutes for Category 2 calls. All trusts have also committed to discharging all simple discharges from a hospital bed within four hours of being declared fit to go home, with the target for complex discharges set at 48 hours.
Michael Perry, Vice Chair of the Royal College of Emergency Medicine Northern Ireland commented that the plan was “disappointing”: “There is a welcome increase of some capacity, but there remains an urgent need for more acute beds. The focus on the front door by creating handover zones with liaison officers is wrong. A&E departments should not be extended…
“We welcome key performance targets, these should encourage better flow throughout our hospitals, but the omission of targets around A&E waiting times is a misstep. We are surprised that we were not consulted on this plan or measures around unscheduled care, and we are concerned that this plan does not go far enough to prepare the emergency care system for what will likely be a tough winter ahead.”
In an effort to manage demand and capacity pressures, HSC trusts will jointly establish a regional control system which will have responsibility for ensuring system wide co-ordination, with each trust allocated recurrent funding of £697,000 to establish early review teams. These teams will be responsible for completing reassessments of need within two to eight weeks of hospital discharge, with the aim of “releasing capacity back into system if the patient’s needs have reduced following return home”.
Department of Health Permanent Secretary Peter May, who unveiled the plan in the absence of a minister for health, admitted that the winter will see the health system operating over capacity. “Addressing these challenges substantively requires long-term planning and budgetary certainty. While the current environment does not provide these, we are taking the steps we can both for this winter and beyond within the severe budgetary constraints that exist.
“Even with these mitigation efforts, the system will inevitably be operating above capacity over a sustained period, leading to too many patients facing delays for care. Everyone in the health and care system will once again work relentlessly to prioritise and treat the sickest people quickest.”