It is no secret that the health and social care system is under excruciating pressure but a new Audit Office report into ailing GP services nonetheless offers some alarming insights.
Perhaps the most eye-watering of these is how locum doctors are being paid up to £1,000 per day to cover some of the 13 ‘challenging’ practices which have either handed back or given notice to hand back their contracts.
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These staggering rates of pay will strike many as unconscionable, and while they help to shore up and stabilise GP practices teetering on the brink, they also distort the locum market elsewhere.
That such a situation is even possible is an acute symptom of a wider malaise around workforce planning, including retention and recruitment.
Auditor General Dorinnia Carville, in her report Access to General Practice in Northern Ireland, highlights how a total of 98 practices - more than 30% of the 318 in the north - have had to seek crisis support from a special unit in the Department of Health in the past four years.
A theme of the report is a shortage of doctors, or at least a shortage of appointments for patients to see a GP. Despite the number of GPs increasing between 2014 and 2022 by 9% (there were 1,448 registered on March 31 2023), it is thought that the number of ‘whole-time equivalent’ doctors has actually fallen by 10%.
Locum doctors are being paid eye-watering sums, up to £1,000 per day, to cover some of the 13 ‘challenging’ GP practices which have either handed back or given notice to hand back their contracts
It is hard to be certain about this information because, the department says, “GP work pattern data is not captured”. That is extraordinary where a public service of such vital importance, costing £375 million a year, is concerned. The explanation offered is that GPs are independent contractors and “responsible for hiring, allocating sessions and duties and making payments”, but patients deserve better.
Multi-disciplinary teams comprising GPs, nurses, social workers, physiotherapists and others are seen as key to improving primary and community care and taking pressure away from hospitals. But the roll-out of these has faltered, with only one of the north’s 17 GP Federation areas fully implementing the teams. Again, a lack of staff is holding back wider development and adoption of multi-disciplinary teams.
Ms Carville correctly says that GP practices are facing extreme pressures. These have been driven by “a combination of long-term trends, such as an ageing population and growing waiting lists in secondary care, and more recent issues such as the impact of the pandemic”.
We need to see the Executive pull together to support health minister Robin Swann - who has thus far been decidedly lacklustre - to develop the sustainable long-term plans that will secure general practice into the future. Years of short-term populism at Stormont have been bad for our health.
