The Doctor Won't See You Now Spotlight


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The Doctor Won't See You Now

GPs in Northern Ireland are threatening to quit the NHS and go private because they say they are under-resourced and facing a huge work load. Chris Moore investigates.


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Our GPs say they're facing burn-out.

1:23:311:23:34

I've gone to a practice where I sent the doctor home,

1:23:341:23:38

where a doctor could barely finish a sentence.

1:23:381:23:41

Overworked and underresourced,

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they say stress is driving doctors away and is killing off recruitment.

1:23:441:23:48

I think it's very, very hard to justify recommending anybody

1:23:481:23:53

to be any sort of doctor in the NHS at the moment.

1:23:531:23:57

GPs say the crisis is forcing them to think about leaving the NHS.

1:23:571:24:02

If I want to continue doing what I do,

1:24:021:24:05

it may ultimately have to be outside the NHS.

1:24:051:24:07

But I know that it's not what I want for my patients.

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With a surge of practice closures already under way,

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doctors say it may be too late

1:24:131:24:15

to the save the ailing front-line health service.

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So, is general practice on its death bed?

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Yes, I believe it's on life support.

1:24:231:24:25

Belfast in late January.

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GPS from all over Northern Ireland

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have gathered for a special conference.

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They're here to debate an important but difficult question,

1:24:551:24:59

and for them, it's crunch time.

1:24:591:25:01

We need to make a decision today on undated resignations,

1:25:031:25:06

and by that I mean leaving the National Health Service

1:25:061:25:09

in Northern Ireland.

1:25:091:25:11

GPS in Northern Ireland say they're facing

1:25:111:25:13

a crisis caused by years of government neglect

1:25:131:25:16

that has made general practice toxic and dangerous.

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We have...

1:25:211:25:23

the smallest workforce, the highest workload

1:25:231:25:26

and the lowest funding of any of the four nations in the United Kingdom.

1:25:261:25:31

Daily, we have practices closing, practices collapsing.

1:25:311:25:34

Young doctors don't want to be GPs, older doctors are retiring.

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The GPs' committee votes unanimously

1:25:381:25:41

to sign the undated NHS resignations.

1:25:411:25:45

The BMA will now ask every GP practice to sign the letters,

1:25:451:25:50

but what could such a controversial move mean?

1:25:501:25:53

The service would end up as a fee-led service where people attend

1:25:531:25:58

and pay, probably the model not entirely developed,

1:25:581:26:01

but something akin to what happens in the Republic of Ireland.

1:26:011:26:04

We don't have enough GPs trained.

1:26:041:26:06

We may not be able to provide a safe service within the NHS,

1:26:061:26:09

moving forward.

1:26:091:26:11

So effectively you may become a private health service.

1:26:111:26:13

Indeed, that is a very real and distinct possibility.

1:26:131:26:17

Away from the conference, Dr Ursula Brennan,

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a GP in South Belfast, allows us to shadow her.

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'A working day starts anywhere between

1:26:261:26:28

'seven and eight o'clock in the morning.

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'I have two very small children, one at a year old

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'and a three-and-a-half-year-old who's in nursery.'

1:26:331:26:36

She arrives at work around 8:30.

1:26:361:26:40

-This is up next this morning.

-Yes.

1:26:401:26:42

-And there's visits arranged for today.

-Yes.

1:26:421:26:45

On a typical day,

1:26:451:26:47

she will see 15 patients before morning surgery ends at 11:30.

1:26:471:26:52

Basically, here, behind the kneecap?

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She has ten minutes to see each patient

1:26:551:26:57

and complete any necessary paperwork.

1:26:571:27:01

She agrees to keep a video diary,

1:27:011:27:02

which shows how her work begins to build from the moment she starts.

1:27:021:27:08

'Hi. This is just a normal day in general practice.'

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I'm just about to start within the next kind of 10 or 15 minutes.

1:27:111:27:16

Just looking at the screens, it looks like a pretty standard day.

1:27:161:27:20

I've got a full surgery. I think everybody's fully booked.

1:27:201:27:23

Not much capacity for any extras at the minute, but we'll manage.

1:27:231:27:27

Aside from the paperwork relating to her own patients,

1:27:291:27:33

Dr Brennan shares with her GP partners

1:27:331:27:35

the daily telephone calls list.

1:27:351:27:38

I think it's about 40 prescriptions that require action now

1:27:411:27:44

before the patients are going to be collecting them through the day.

1:27:441:27:47

Hospital letters, I think we're amounting about 10 or 15.

1:27:471:27:50

Telephone calls, I think we're not too bad at the minute.

1:27:501:27:53

We're probably running between... about 30 to be done.

1:27:531:27:56

And I don't think there's any home visits in yet,

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but, really, just in the time that I've been talking,

1:27:591:28:02

there may be one on.

1:28:021:28:04

So, listen, I will catch up with you in a wee minute.

1:28:041:28:06

When we next see her, 30 minutes later,

1:28:081:28:11

she's already under a bit of time pressure.

1:28:111:28:14

I've seen the first couple of patients this morning,

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and it's difficult to keep to time,

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because people come with more than one problem.

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Every patient requires different actions

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that eat into Dr Brennan's limited time schedule.

1:28:271:28:31

One phone call for a drug change for a patient

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can result in several phone calls

1:28:341:28:37

in terms of linking in with district nursing,

1:28:371:28:39

linking in with the community diabetes specialist team...

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GPs say their workload has increased by 76% in the past 12 years.

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That all began with the signing of a new NHS contract in 2004.

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And even though GPs no longer had to do out-of-hours or weekend work,

1:28:561:29:01

they took on a big workload from hospitals -

1:29:011:29:04

the management of chronic diseases, like heart disease and diabetes.

1:29:041:29:09

When we set out, it was controlling diseases that people had.

1:29:091:29:14

Now it's more chronic-disease management, so a lot of the work

1:29:141:29:17

that used to be done in hospitals has moved towards general practice.

1:29:171:29:21

All this extra work represents a major increase in GP consultations.

1:29:211:29:26

They've risen by 63% since 2004,

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underlining the vital role of GPs as the first point of contact

1:29:311:29:35

for patients in the health service system.

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-NEWSREEL:

-'This leaflet is coming through your letterbox one day soon.

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-'Or maybe you've already had it.'

-When founded in 1948,

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the NHS put GPs at the front line of the health service.

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'The doctor in his surgery, the doctor in your home, will be free.'

1:29:541:30:00

The National Health Service promised free health care

1:30:001:30:04

for everyone and assured patients it would relieve money worries

1:30:041:30:08

in times of illness.

1:30:081:30:09

'Choose your doctor now. That's most important.'

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In 1948, a GP's job was much sought after, a prestigious post.

1:30:141:30:21

By contrast, today doctors shun general practice.

1:30:211:30:24

But why is that?

1:30:241:30:26

The BMA say the GP workload is a key discouragement to young doctors.

1:30:311:30:36

Taking on what once was hospital work, they added bureaucracy and

1:30:361:30:41

the complexities of treating the ageing patient population.

1:30:411:30:45

It's more attractive to young doctors to go into

1:30:451:30:48

consultancy work or become locums with regular hours and without

1:30:481:30:52

the financial responsibilities associated with running a practice.

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In Northern Ireland, the average GP patient list is 1,641,

1:30:571:31:03

the highest in the UK.

1:31:031:31:06

Growing patient lists add to the pressures on GPs to manage

1:31:061:31:10

the complexities of more chronic illnesses,

1:31:101:31:13

and all against the clock.

1:31:131:31:15

In practices, you've doctors seeing 35 patients a day,

1:31:151:31:20

writing 178 scrips per day,

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doing 35 results, 35 hospital discharge letters,

1:31:221:31:26

and that's the average day.

1:31:261:31:29

What I just described was the average day for a GP.

1:31:291:31:31

Does anyone think that that's a safe level of work?

1:31:311:31:35

It's too much work crammed into too short a period of time.

1:31:351:31:40

And Tom Black says he witnessed first-hand

1:31:421:31:45

the consequences of an excessive workload

1:31:451:31:48

leaving a doctor at the point of physical and mental exhaustion.

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I've gone to a practice where I sent a doctor home,

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where a doctor could barely finish a sentence...

1:31:571:32:01

trying to cope with a workload where the doctor hadn't slept for days.

1:32:011:32:07

That's not a job that we want our profession doing,

1:32:071:32:13

it's not a service that we want our community relying on.

1:32:131:32:17

Good afternoon, doctors' surgery.

1:32:181:32:20

The BMA says that the demands of the workload

1:32:201:32:23

can put intense pressure on individual GPs.

1:32:231:32:27

That means when there are exceptional circumstances,

1:32:281:32:32

such as the departure of a doctor,

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it does not take a great deal to put individual practices

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into a state of crisis.

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Efforts to stop the closure of a GP practice in Portadown have failed.

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When first one then two and three of the four doctors in the

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Bannview practice in Portadown left, no replacements could be found.

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The sole remaining doctor found herself trying to cope

1:32:571:33:00

with 5,200 patients. It was too much.

1:33:001:33:04

In the end, the health trust took over the practice.

1:33:041:33:08

Dr Shauna Heanan was the last doctor in Bannview.

1:33:081:33:12

In her letter of resignation,

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she gave an emotional account of her final hours in the practice.

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On the day when I had to admit that I couldn't cope any more,

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I had done 40 to 50 phone calls to patients,

1:33:231:33:27

two overfull surgeries which kept growing in number as more

1:33:271:33:30

patients phoned, three house calls, 200 acute scrips,

1:33:301:33:35

150 blood results.

1:33:351:33:37

I left work in tears that day.

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I hadn't slept in four to five days,

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couldn't remember the last time I could eat a proper meal

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and couldn't concentrate.

1:33:461:33:48

A GP at another Portadown practice knows first-hand

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about the pressures of being the sole practitioner.

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He struggled to cope and came close to walking away.

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The main reason was that, you know, I just could not get

1:34:031:34:07

any time away from the practice.

1:34:071:34:09

I was just about coping with the 12-14-hour days,

1:34:091:34:13

but when you cannot get any annual leave at all,

1:34:131:34:16

it just becomes completely unsustainable,

1:34:161:34:19

it becomes unsafe from a clinical point of view,

1:34:191:34:21

it becomes unhealthy from a personal point of view

1:34:211:34:25

and it significantly disrupts family life.

1:34:251:34:28

He says the pressure left him a broken man with a broken practice.

1:34:281:34:32

And the final straw came in October 2015,

1:34:341:34:37

when he made a concerted effort to plan ahead

1:34:371:34:39

for a few days off in 2016.

1:34:391:34:42

Myself and my practice manager, we sent out a total of 2,000 e-mails

1:34:421:34:47

and texts to see if we could find any sort of locums who were

1:34:471:34:52

prepared to work in my practice to give me some time off.

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And those 2,000 contacts resulted in one day.

1:34:551:35:01

September 5th 2016 was the only day.

1:35:011:35:04

Did that shock you?

1:35:041:35:06

That was one of the final straws that said,

1:35:061:35:09

"Right, I can no longer go on like this."

1:35:091:35:12

Whatever the pressures today on single-handed GPs,

1:35:201:35:24

it's worth remembering that for a long time sole practitioners were

1:35:241:35:28

a significant part of the bedrock of the National Health Service.

1:35:281:35:33

I'm heading up the Antrim coast to meet a doctor

1:35:331:35:36

who's lived that utopian dream.

1:35:361:35:38

Ben Glover is 78. He should have retired 18 years ago.

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Instead, he holds open surgery three times a day.

1:35:471:35:50

I think when I came here the oldest patient had been born in 1888,

1:35:521:35:56

so I've covered from 1888 up until the present!

1:35:561:36:00

When Ben Glover qualified, he was determined to become a GP,

1:36:001:36:05

but was told he would have to wait for a practice.

1:36:051:36:07

There were 65 in my year when I qualified,

1:36:071:36:10

and I think over 30 of them went to America or Canada.

1:36:101:36:15

And it was quite difficult then to get a practice.

1:36:151:36:18

I was told by an older GP, "Start applying now, sonny,

1:36:181:36:22

"because you'll not get a practice for about ten years."

1:36:221:36:26

But within two years, he found himself in the picturesque

1:36:261:36:30

surroundings of Glenarm.

1:36:301:36:31

It was 1966, and he found life as a GP was not too stressful.

1:36:311:36:37

We had a motorboat, and we'd go out fishing,

1:36:371:36:39

lobster fishing and stuff like that,

1:36:391:36:41

but if there was any emergency call come in,

1:36:411:36:43

my wife would hang a towel outside the window at the front of

1:36:431:36:47

the house and we'd know we had to come in and see somebody.

1:36:471:36:50

Even at times of acute demand he managed on his own,

1:36:521:36:56

as he did in administering emergency polio inoculations in 1977.

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Well, I was given 500 doses this morning,

1:37:021:37:05

and we'll continue until they're all used up.

1:37:051:37:08

Ben Glover retires in just over two weeks.

1:37:091:37:12

His 2,000 patients know just how lucky they've been.

1:37:121:37:16

Most of them will now move to a new practice in Carnlough.

1:37:161:37:20

We know a lot of the surgeries you have to put an

1:37:201:37:23

appointment through, you're talking about maybe ten days to

1:37:231:37:27

a fortnight before you get an appointment.

1:37:271:37:29

So you could be dead by that time.

1:37:291:37:31

There's a lot of people in the village would be elderly who

1:37:311:37:33

have no transport, and they would be primarily with Dr Glover,

1:37:331:37:37

with no means of travel.

1:37:371:37:40

So why not just replace him rather than move his patients?

1:37:401:37:45

The answer is you just can't get anyone.

1:37:451:37:47

The local trust even tried using the blockbusting TV series

1:37:471:37:51

Game Of Thrones to attract doctors to the practice,

1:37:511:37:55

but that, too, failed.

1:37:551:37:58

Well, it's nothing to do with where it is,

1:37:581:38:00

it's the fact that there's no doctors.

1:38:001:38:02

Unfortunately, they haven't trained enough GPs over the years.

1:38:021:38:06

They need at least 120 GP trainees a year,

1:38:061:38:09

and they've only been training 60 here.

1:38:091:38:11

In the past ten years, GP practices have continually declined

1:38:111:38:16

whilst patient numbers have steadily increased.

1:38:161:38:19

The BMA anticipates the closure of another 20 practices next year,

1:38:191:38:24

so the pressure is on to train more GPs.

1:38:241:38:28

They are struggling to get

1:38:281:38:29

the numbers of people to join general practice.

1:38:291:38:32

I think, for example, they have about 111 places and they've

1:38:321:38:35

struggled to get 111 places on the GP training scheme.

1:38:351:38:39

We've created a problem that, within the medical profession,

1:38:391:38:43

being a GP is no longer the high-status person.

1:38:431:38:46

It's not even middle-status in the whole spectrum

1:38:461:38:49

of medical professional people.

1:38:491:38:51

Are you saying that we've created

1:38:511:38:53

a two-tier system within practitioners?

1:38:531:38:57

I think there is a problem of young people graduating as doctors

1:38:571:39:01

then deciding which way they go in the health service,

1:39:011:39:05

and for the moment, my understanding from the outside

1:39:051:39:09

is you're more likely to be incentivised

1:39:091:39:11

to go towards hospital work and being a consultant

1:39:111:39:15

than you are to becoming a GP.

1:39:151:39:17

Yet it's the GPs that are the bread and butter, as they would say,

1:39:171:39:20

the bread and butter of the system.

1:39:201:39:22

In Northern Ireland at present,

1:39:271:39:29

there are over 1,700 doctors in various stages of training.

1:39:291:39:35

Only 245 of them are taking the general practice course.

1:39:351:39:39

And at the end of training, there's no guarantee that any of

1:39:411:39:44

those doctors will become GPs.

1:39:441:39:46

We wanted a chance to speak to some of those training to

1:39:491:39:53

be doctors in Northern Ireland.

1:39:531:39:55

We came to the medical school at Queen's University in Belfast.

1:39:551:39:59

We were introduced to a small group of fourth-year students.

1:39:591:40:02

You can tell a lot by taking a patient's heart rate,

1:40:021:40:05

-taking a patient's pulse.

-That is true, yeah.

1:40:051:40:08

Emer Gates says Queen's University

1:40:081:40:10

should start their main GP training sooner.

1:40:101:40:14

There have been increasing placements

1:40:141:40:15

in general practice in final year,

1:40:151:40:17

but I think, really, general practice we should be seeing

1:40:171:40:20

at an earlier stage, just so that it sets the precedent, really,

1:40:201:40:23

for what we're interested in.

1:40:231:40:25

We got the provis', obviously, to shadow a GP for three weeks.

1:40:251:40:30

The experience was great. I loved it, learnt a lot of new things.

1:40:301:40:34

But it's just not a career for me.

1:40:341:40:36

The problem of recruiting GPs is exacerbated by the fact

1:40:361:40:40

that not only are we not attracting young doctors into general practice

1:40:401:40:44

but those already in it, as we've seen with Dr Glover,

1:40:441:40:47

are getting older.

1:40:471:40:49

In fact, a quarter of the current GP workforce in Northern Ireland

1:40:491:40:54

are aged 55 and over,

1:40:541:40:56

and that means the loss of around 300 doctors in the next five years.

1:40:561:41:02

Nowhere is the problem of an ageing workforce

1:41:041:41:06

putting general practice at risk more acute than in Fermanagh,

1:41:061:41:11

where four recent retirements have led to practices closing.

1:41:111:41:14

And GPs there believe there's more to come.

1:41:141:41:18

The doctors say with the number of practices likely to be cut

1:41:181:41:22

from 18 to just 5, our largest county is already struggling to cope

1:41:221:41:28

with patient needs, and the GPs are left wondering

1:41:281:41:32

what the future holds.

1:41:321:41:33

I think that, of the 18 practices that we would have had last year,

1:41:341:41:38

we'd probably end up with five across three sites.

1:41:381:41:41

That's what the GPs in that area tell me,

1:41:411:41:43

that they won't have the workforce to sustain anything other

1:41:431:41:46

than general practice in three towns.

1:41:461:41:49

We will see patients having to travel to see their GP.

1:41:491:41:52

They could be travelling 20, 30, 40 miles in some cases.

1:41:521:41:56

According to figures from the Department of Health,

1:41:571:42:00

the planned closure of four Fermanagh practices

1:42:001:42:03

has the potential to displace nearly 8,000 patients.

1:42:031:42:07

Nearby practices are on full alert,

1:42:071:42:10

concerned about how many of those patients

1:42:101:42:12

they might be asked to absorb.

1:42:121:42:14

Dr John Porteous is one of five GP partners

1:42:171:42:20

in the Maple Practice in Lisnaskea.

1:42:201:42:22

They're worried a knock-on effect

1:42:221:42:24

could put their own practice at risk.

1:42:241:42:27

Effectively, you know, if one practice closes,

1:42:281:42:33

there's pressure on the neighbouring practices,

1:42:331:42:35

a domino effect, as you've heard it called.

1:42:351:42:38

And our concern is, as a practice in the middle of all of this,

1:42:381:42:42

that it would put our own viability at risk,

1:42:421:42:47

and we obviously can't afford for that to happen.

1:42:471:42:51

For the moment, they say they can manage cover in one of the

1:42:511:42:54

recently closed practices in Rosslea.

1:42:541:42:57

If we go down, then that's south-east Fermanagh

1:42:571:43:00

in very, very serious bother.

1:43:001:43:03

And is that a dangerous situation?

1:43:031:43:06

I think it's a catastrophic situation.

1:43:061:43:08

I think we're seeing the outworkings of that now.

1:43:081:43:10

They do need to waken up and smell the coffee and get on with it now.

1:43:101:43:14

We need to rectify that situation as soon as possible.

1:43:141:43:17

This view is shared by Dr Michael Smyth,

1:43:191:43:22

who retired last December,

1:43:221:43:24

closing his practice in Maguires Bridge.

1:43:241:43:27

They would have checked in here at reception.

1:43:271:43:31

I felt that, in an increasingly dysfunctional system,

1:43:311:43:36

it was becoming both dangerous

1:43:361:43:41

and more difficult to deliver good-quality care.

1:43:411:43:45

Dr Smyth is saddened and shocked that GPs feel

1:43:451:43:49

they have been pushed to the verge of quitting the NHS.

1:43:491:43:53

So, is general practice on its deathbed?

1:43:531:43:56

It's... Yes, I believe it's on life support.

1:43:571:44:01

Back in Lisnaskea,

1:44:011:44:03

practice manager Maria Nugent-Murphy has been involved

1:44:031:44:06

in detailed talks with local health authorities

1:44:061:44:08

about amalgamating with other practices

1:44:081:44:11

to ensure the survival of general practice in the area.

1:44:111:44:15

I would say we are at capacity, definitely, at the minute.

1:44:151:44:18

We were getting quite scared about what was happening around us,

1:44:181:44:21

especially when advertisements went out

1:44:211:44:24

and no replacements were being found.

1:44:241:44:26

But it's stretching you a bit further than you want to go.

1:44:261:44:28

Yes, it is, definitely, yes.

1:44:281:44:31

Really, we see a more sustainable solution

1:44:311:44:35

as being in one centre, one hub.

1:44:351:44:38

And that's really where we feel things need to go

1:44:381:44:41

to be sustainable in the long term.

1:44:411:44:44

That's something John Compton agrees with.

1:44:441:44:47

He says GPs need to change the way they work.

1:44:471:44:51

Well, I think the sort of changes,

1:44:511:44:53

for example, issues where there are partners in the practice

1:44:531:44:56

who are advanced nurses or pharmacists, they have to think

1:44:561:45:01

about what they're being asked to do differently.

1:45:011:45:04

They have to look at how they work.

1:45:041:45:06

Are small, single-handed or two-handed practices

1:45:061:45:10

really the way forward when you think of the next ten years?

1:45:101:45:13

And I think those sort of challenges are there,

1:45:131:45:15

and that does mean some amalgamations of general practices,

1:45:151:45:19

it does mean general practices working in much broader networks.

1:45:191:45:22

So you're talking about some kind of a hub.

1:45:221:45:25

I think so, yes. Hubs, of course, are the way forward,

1:45:251:45:28

but hubs are no use if it's just simply the restatement

1:45:281:45:31

of five traditional practices into a building

1:45:311:45:34

and nobody does anything to change how you operate in that building.

1:45:341:45:38

That's been the solution for Dr MacDonald,

1:45:381:45:40

who's merged his practice with three partners

1:45:401:45:43

inside the hub at Portadown Health Centre.

1:45:431:45:46

The clinical burden is pretty much the same, and that's fine.

1:45:461:45:50

I can share the administrative burden.

1:45:501:45:52

I find that now we can hopefully cover holidays between ourselves.

1:45:551:46:00

What's been happening with you since I last saw you?

1:46:001:46:02

Nevertheless, even hubs can mean a heavy workload,

1:46:021:46:05

as we see back in Belfast with Dr Brennan,

1:46:051:46:08

who has three GP partners.

1:46:081:46:10

I've seen a very complex mix of patients this morning,

1:46:111:46:15

some patients with multiple problems.

1:46:151:46:17

I'm just going to go back. I have a couple of patients waiting for me.

1:46:171:46:21

Half an hour later, and Dr Brennan has seen her last patient

1:46:221:46:26

but has more still to do.

1:46:261:46:28

I've just finished my surgery.

1:46:321:46:34

Running probably about 20, 25 minutes late,

1:46:341:46:37

which is just an ordinary day.

1:46:371:46:40

I think there's probably about 10, 15 people still looking for me

1:46:401:46:45

this morning who need me to call them back.

1:46:451:46:47

And I think there's two or three home visits, which we will, erm,

1:46:471:46:52

need to do over lunchtime.

1:46:521:46:55

I talked to Dr Brennan after her busy morning surgery.

1:46:551:46:58

I'm on my half-day off.

1:46:581:46:59

I'm going to be doing more work this afternoon, as well.

1:46:591:47:02

And then my day doesn't stop there.

1:47:021:47:04

So, when I get the children to bed, so around eight o'clock,

1:47:041:47:07

I'll dial in again to try and do some preparatory work for tomorrow.

1:47:071:47:10

I think that many of us are coping at the moment

1:47:101:47:12

and we're continuing to provide a really safe service,

1:47:121:47:15

but if there is something unforeseen, I think that...

1:47:151:47:18

you know, we've talked, and the word has been used, about domino effect.

1:47:181:47:21

Very quickly, practices can become in crisis, actively in crisis.

1:47:211:47:24

-If they come into difficulties...

-PHONE RINGS

1:47:241:47:27

..it will have an impact on adjoining practices, so...

1:47:271:47:30

I'm sorry, I'm going to have to take that.

1:47:301:47:32

-Yes, of course.

-Sorry.

1:47:321:47:34

Hiya.

1:47:341:47:36

GPs may have good lines of communication with their

1:47:361:47:38

patients, but when it comes to the Government, they feel sidelined.

1:47:381:47:42

And the BMA says the turnover of health ministers,

1:47:421:47:46

four in the past three years, has had an adverse impact

1:47:461:47:49

on making decisions on the future of general practice.

1:47:491:47:53

It's very frustrating,

1:47:531:47:55

because you form a relationship with the minister, you have a plan,

1:47:551:47:59

you have a way forward, and the next thing, they're gone.

1:47:591:48:02

And the last two ministers have had, what,

1:48:021:48:04

less than a year each in post.

1:48:041:48:06

In fact, the last three, probably,

1:48:061:48:08

have all had less than a year each in post.

1:48:081:48:10

And it is very frustrating.

1:48:101:48:12

During the life of the Stormont Assembly,

1:48:121:48:14

there have been a series of reports on the health service.

1:48:141:48:18

The most recent was published in October last year.

1:48:181:48:21

The reality is that the current model is unsustainable.

1:48:211:48:25

It was chaired by Professor Rafael Bengoa,

1:48:251:48:28

an internationally renowned expert on health reform

1:48:281:48:31

who has previously advised the European Union

1:48:311:48:34

and the Obama administration.

1:48:341:48:37

In his report,

1:48:371:48:38

Professor Bengoa acknowledged that there should be more GPs trained

1:48:381:48:43

and that GP practices should have a dedicated support team,

1:48:431:48:46

a named social worker, health visitor and district nurse

1:48:461:48:50

to alleviate the workload on doctors.

1:48:501:48:53

It was seen as a positive step

1:48:531:48:54

towards fixing the problems in the health service

1:48:541:48:57

and enjoyed the full support of the then Executive.

1:48:571:49:01

I'm delighted that the Executive has endorsed a direction of travel

1:49:011:49:05

for how we're going to transform health and social care.

1:49:051:49:07

We had a very clear choice to make.

1:49:071:49:10

We either try and manage the change

1:49:101:49:13

or we either manage the chaos that would come

1:49:131:49:17

if we didn't tackle the huge issues that there are.

1:49:171:49:20

The entire Executive have bought into this ten-year strategy.

1:49:201:49:24

But, as we know, within a few months the Executive collapsed,

1:49:241:49:28

and that unity of political purpose

1:49:281:49:31

over the way ahead for our health service has stalled.

1:49:311:49:35

It's absolutely critical that we now get ourselves an Executive,

1:49:351:49:38

the Executive publicly recommits to the Bengoa report

1:49:381:49:42

with the First, the Deputy First Minister and the Health Minister all

1:49:421:49:46

standing, if you like, firmly, saying,

1:49:461:49:48

"This is what we're going to do",

1:49:481:49:50

because without that, you lose the support of professionals.

1:49:501:49:54

They become disappointed and disillusioned.

1:49:541:49:56

We've reached a point in Northern Ireland where something

1:49:561:49:58

has to be done. If we as GPs have to leave the NHS to fix this, we will.

1:49:581:50:03

At the moment, the NHS is toxic to general practice.

1:50:031:50:07

But is the threat to leave the NHS a realistic one,

1:50:071:50:12

or is it simply being used as a bargaining tool?

1:50:121:50:16

For some members of the public,

1:50:161:50:18

the idea of having to pay for treatment has already taken hold.

1:50:181:50:22

I had a consultation recently where a patient came to see me

1:50:241:50:27

and she assumed that it had already happened and that we were charging,

1:50:271:50:30

and she reached down at the end of the consultation to give me money.

1:50:301:50:34

And I just became really quite upset,

1:50:341:50:38

because it's not what I signed up to do.

1:50:381:50:43

It's not just about tactics or about playing a game,

1:50:431:50:47

it's a profound statement about where our NHS is going.

1:50:471:50:50

I want people to pay attention to that,

1:50:501:50:52

and I want people to understand they have workforce issues,

1:50:521:50:55

they have training issues, they have new-models-of-care issues,

1:50:551:50:59

and they want a solid understanding from government

1:50:591:51:03

and a commitment from government to effect a change into the future.

1:51:031:51:07

Few GPs want to leave the NHS,

1:51:071:51:09

but some have become extremely pessimistic about its future.

1:51:091:51:14

I think it's very, very hard to justify recommending anybody

1:51:141:51:19

to be any sort of doctor in the NHS at the moment.

1:51:191:51:22

And I don't take any pleasure from saying that.

1:51:221:51:24

That's just the cold facts.

1:51:241:51:26

The BMA has been casting an envious eye

1:51:261:51:29

towards England and Scotland, where GP budgets have been boosted.

1:51:291:51:33

The most recent, an increase of £71 million,

1:51:331:51:37

was announced in Scotland last Friday.

1:51:371:51:39

Here, the Department of Health says it recognises

1:51:391:51:42

there's more to be done to improve GP services,

1:51:421:51:46

but without a health minister or an Assembly,

1:51:461:51:49

GPs are left wondering when that help is going to come.

1:51:491:51:52

GPs in Northern Ireland are threatening to quit the NHS and go private because they say they are under-resourced and facing a huge work load. Chris Moore investigates.