It is clear that general practice is not working and needs fixed.
Patients aren’t being assessed in a timely manner, the workload is continually expanding and there aren’t sufficient staff to run the service optimally.
90% of all contacts within the NHS occur with a GP, and the number of patients with multiple long-term conditions is rising with people living longer with illness. On average each person is consulting their GP more often.
The DUP wants to see resources redirected into primary and community care, and the number of doctors, and subsequently general practitioners, trained increase substantially following the HSC workforce strategy and Medical Student Places Review. In advance of that however we also need to look at all the other factors contributing to the present situation including the system and structures.
Practices have historically operated as a small business, providing services as a private contractor. However the composition of the primary care workforce has changed, and less trained GPs want to take on a partner role in that type of business model.
We need to explore alternative models, which could still permit those who wish to remain partners to do so. Any new system should be designed in such a manner that existing practice arrangements could remain, particularly since individual GPs may have invested substantial sums in them doing so.
More GPs have been retiring and reducing hours than could be balanced by those newly qualified, increasing the pressure on those they leave behind. Doctors have been abandoning the salaried GP role in practices too, leaving a large cohort of trained GPs in Northern Ireland who are choosing not to work in primary care, or only working very limited hours. There is justification for a bold substantive offer that could transform work-life balance in order to incentivise the return of some of this readily available valuable existing resource.
Indemnity should be provided for primary care as is the case in other parts of the UK, and pay and conditions must enthuse and motivate staff. As well as any financial incentivisation, support for training, freedom to pursue professional development areas of interest, long-term rostering or guaranteed leave are elements that can be employed in a range of different specialisms where there are workforce gaps.
Working as part of a much larger team is attractive to many doctors. It means, in simple examples such as arranging annual leave or if a colleague is off sick, there is a much broader group to carry the burden rather than just one or two colleagues.
Having larger groups of GPs and multidisciplinary staff also provides the scope for additional services to be offered, innovations and enhanced integration with secondary care, the community/voluntary sector and local government through area-integrated partnerships.
Examples for alternative larger or medium-sized employer models might include via a trust or a not-for-profit organisation for instance. There are already seventeen GP Federations set up as community interest companies covering the entire Northern Ireland population. Doctors and other staffcould be employed in a manner more akin to their counterparts in health and social care trusts.
Much of the present primary care estate is no longer fit for purpose. The Primary Care Infrastructure Development programme which aims to roll out new Primary and Community Care centres in a number of our larger towns should be reinvigorated and accelerated.
Technology needs to be embraced and better utilised. The morning rush to obtain an appointment by phoning the practice is utterly unacceptable for a modern service, and new ways need to be provided. This will include the ability to seek assistance and obtain an appointment online via your mobile phone. There is no reason why primary care and public services should be any less equipped for modern communications than business and retail for instance, and individuals should have digital access to their medical information.
While many patients will continue to prefer a face-to-face consultation, YouGov found patients would prefer a same day video consultation by 61% to 21% over waiting longer to be seen face to face.
It is essential that continuity of care and the longstanding personal patient- GP relationship is retained. GPs need to be free to operate at the level they have been trained for, with members of the multidisciplinary team providing appropriate support within their competencies where medical attention is not required.
The multidisciplinary primary care teams including social workers, physiotherapists and mental health practitioners, piloted through DUP Confidence and Supply funding in Down, Londonderry and Belfast should be rolled out fully Province-wide.
Democratic Unionist Party proposals for General Practice include:
- a new Health Minister should quickly establish a working group involving clinicians, service users and officials, to consider an alternative employer model which could co-exist alongside traditional small-scale partner-run practices.
- refocusing resources into primary and community care.
- increasing year on year the number of GPs trained.
- incentivising GPs currently not working or working limited hours back into general practice.
- providing indemnity for primary care.
- reinvigorating the Primary Care Infrastructure Development programme with locations for the next phase of new Primary and Community Care centres announced as one of the early decisions of a new Health Minister.
- progress on technology in primary care including access to an electronic health and care record for every Northern Ireland citizen, and the ability to arrange appointments that suit the individual.
- full rollout of multidisciplinary primary care teams across Northern Ireland.
