1:23:31 > 1:23:34Our GPs say they're facing burn-out.
1:23:34 > 1:23:38I've gone to a practice where I sent the doctor home,
1:23:38 > 1:23:41where a doctor could barely finish a sentence.
1:23:41 > 1:23:44Overworked and underresourced,
1:23:44 > 1:23:48they say stress is driving doctors away and is killing off recruitment.
1:23:48 > 1:23:53I think it's very, very hard to justify recommending anybody
1:23:53 > 1:23:57to be any sort of doctor in the NHS at the moment.
1:23:57 > 1:24:02GPs say the crisis is forcing them to think about leaving the NHS.
1:24:02 > 1:24:05If I want to continue doing what I do,
1:24:05 > 1:24:07it may ultimately have to be outside the NHS.
1:24:07 > 1:24:10But I know that it's not what I want for my patients.
1:24:10 > 1:24:13With a surge of practice closures already under way,
1:24:13 > 1:24:15doctors say it may be too late
1:24:15 > 1:24:18to the save the ailing front-line health service.
1:24:19 > 1:24:23So, is general practice on its death bed?
1:24:23 > 1:24:25Yes, I believe it's on life support.
1:24:46 > 1:24:49Belfast in late January.
1:24:49 > 1:24:52GPS from all over Northern Ireland
1:24:52 > 1:24:55have gathered for a special conference.
1:24:55 > 1:24:59They're here to debate an important but difficult question,
1:24:59 > 1:25:01and for them, it's crunch time.
1:25:03 > 1:25:06We need to make a decision today on undated resignations,
1:25:06 > 1:25:09and by that I mean leaving the National Health Service
1:25:09 > 1:25:11in Northern Ireland.
1:25:11 > 1:25:13GPS in Northern Ireland say they're facing
1:25:13 > 1:25:16a crisis caused by years of government neglect
1:25:16 > 1:25:21that has made general practice toxic and dangerous.
1:25:21 > 1:25:23We have...
1:25:23 > 1:25:26the smallest workforce, the highest workload
1:25:26 > 1:25:31and the lowest funding of any of the four nations in the United Kingdom.
1:25:31 > 1:25:34Daily, we have practices closing, practices collapsing.
1:25:34 > 1:25:38Young doctors don't want to be GPs, older doctors are retiring.
1:25:38 > 1:25:41The GPs' committee votes unanimously
1:25:41 > 1:25:45to sign the undated NHS resignations.
1:25:45 > 1:25:50The BMA will now ask every GP practice to sign the letters,
1:25:50 > 1:25:53but what could such a controversial move mean?
1:25:53 > 1:25:58The service would end up as a fee-led service where people attend
1:25:58 > 1:26:01and pay, probably the model not entirely developed,
1:26:01 > 1:26:04but something akin to what happens in the Republic of Ireland.
1:26:04 > 1:26:06We don't have enough GPs trained.
1:26:06 > 1:26:09We may not be able to provide a safe service within the NHS,
1:26:09 > 1:26:11moving forward.
1:26:11 > 1:26:13So effectively you may become a private health service.
1:26:13 > 1:26:17Indeed, that is a very real and distinct possibility.
1:26:19 > 1:26:22Away from the conference, Dr Ursula Brennan,
1:26:22 > 1:26:26a GP in South Belfast, allows us to shadow her.
1:26:26 > 1:26:28'A working day starts anywhere between
1:26:28 > 1:26:30'seven and eight o'clock in the morning.
1:26:30 > 1:26:33'I have two very small children, one at a year old
1:26:33 > 1:26:36'and a three-and-a-half-year-old who's in nursery.'
1:26:36 > 1:26:40She arrives at work around 8:30.
1:26:40 > 1:26:42- This is up next this morning.- Yes.
1:26:42 > 1:26:45- And there's visits arranged for today.- Yes.
1:26:45 > 1:26:47On a typical day,
1:26:47 > 1:26:52she will see 15 patients before morning surgery ends at 11:30.
1:26:52 > 1:26:55Basically, here, behind the kneecap?
1:26:55 > 1:26:57She has ten minutes to see each patient
1:26:57 > 1:27:01and complete any necessary paperwork.
1:27:01 > 1:27:02She agrees to keep a video diary,
1:27:02 > 1:27:08which shows how her work begins to build from the moment she starts.
1:27:08 > 1:27:11'Hi. This is just a normal day in general practice.'
1:27:11 > 1:27:16I'm just about to start within the next kind of 10 or 15 minutes.
1:27:16 > 1:27:20Just looking at the screens, it looks like a pretty standard day.
1:27:20 > 1:27:23I've got a full surgery. I think everybody's fully booked.
1:27:23 > 1:27:27Not much capacity for any extras at the minute, but we'll manage.
1:27:29 > 1:27:33Aside from the paperwork relating to her own patients,
1:27:33 > 1:27:35Dr Brennan shares with her GP partners
1:27:35 > 1:27:38the daily telephone calls list.
1:27:41 > 1:27:44I think it's about 40 prescriptions that require action now
1:27:44 > 1:27:47before the patients are going to be collecting them through the day.
1:27:47 > 1:27:50Hospital letters, I think we're amounting about 10 or 15.
1:27:50 > 1:27:53Telephone calls, I think we're not too bad at the minute.
1:27:53 > 1:27:56We're probably running between... about 30 to be done.
1:27:56 > 1:27:59And I don't think there's any home visits in yet,
1:27:59 > 1:28:02but, really, just in the time that I've been talking,
1:28:02 > 1:28:04there may be one on.
1:28:04 > 1:28:06So, listen, I will catch up with you in a wee minute.
1:28:08 > 1:28:11When we next see her, 30 minutes later,
1:28:11 > 1:28:14she's already under a bit of time pressure.
1:28:14 > 1:28:17I've seen the first couple of patients this morning,
1:28:17 > 1:28:21and it's difficult to keep to time,
1:28:21 > 1:28:25because people come with more than one problem.
1:28:25 > 1:28:27Every patient requires different actions
1:28:27 > 1:28:31that eat into Dr Brennan's limited time schedule.
1:28:31 > 1:28:34One phone call for a drug change for a patient
1:28:34 > 1:28:37can result in several phone calls
1:28:37 > 1:28:39in terms of linking in with district nursing,
1:28:39 > 1:28:43linking in with the community diabetes specialist team...
1:28:43 > 1:28:51GPs say their workload has increased by 76% in the past 12 years.
1:28:51 > 1:28:56That all began with the signing of a new NHS contract in 2004.
1:28:56 > 1:29:01And even though GPs no longer had to do out-of-hours or weekend work,
1:29:01 > 1:29:04they took on a big workload from hospitals -
1:29:04 > 1:29:09the management of chronic diseases, like heart disease and diabetes.
1:29:09 > 1:29:14When we set out, it was controlling diseases that people had.
1:29:14 > 1:29:17Now it's more chronic-disease management, so a lot of the work
1:29:17 > 1:29:21that used to be done in hospitals has moved towards general practice.
1:29:21 > 1:29:26All this extra work represents a major increase in GP consultations.
1:29:26 > 1:29:31They've risen by 63% since 2004,
1:29:31 > 1:29:35underlining the vital role of GPs as the first point of contact
1:29:35 > 1:29:38for patients in the health service system.
1:29:42 > 1:29:46- NEWSREEL:- 'This leaflet is coming through your letterbox one day soon.
1:29:46 > 1:29:50- 'Or maybe you've already had it.' - When founded in 1948,
1:29:50 > 1:29:54the NHS put GPs at the front line of the health service.
1:29:54 > 1:30:00'The doctor in his surgery, the doctor in your home, will be free.'
1:30:00 > 1:30:04The National Health Service promised free health care
1:30:04 > 1:30:08for everyone and assured patients it would relieve money worries
1:30:08 > 1:30:09in times of illness.
1:30:09 > 1:30:13'Choose your doctor now. That's most important.'
1:30:14 > 1:30:21In 1948, a GP's job was much sought after, a prestigious post.
1:30:21 > 1:30:24By contrast, today doctors shun general practice.
1:30:24 > 1:30:26But why is that?
1:30:31 > 1:30:36The BMA say the GP workload is a key discouragement to young doctors.
1:30:36 > 1:30:41Taking on what once was hospital work, they added bureaucracy and
1:30:41 > 1:30:45the complexities of treating the ageing patient population.
1:30:45 > 1:30:48It's more attractive to young doctors to go into
1:30:48 > 1:30:52consultancy work or become locums with regular hours and without
1:30:52 > 1:30:57the financial responsibilities associated with running a practice.
1:30:57 > 1:31:03In Northern Ireland, the average GP patient list is 1,641,
1:31:03 > 1:31:06the highest in the UK.
1:31:06 > 1:31:10Growing patient lists add to the pressures on GPs to manage
1:31:10 > 1:31:13the complexities of more chronic illnesses,
1:31:13 > 1:31:15and all against the clock.
1:31:15 > 1:31:20In practices, you've doctors seeing 35 patients a day,
1:31:20 > 1:31:22writing 178 scrips per day,
1:31:22 > 1:31:26doing 35 results, 35 hospital discharge letters,
1:31:26 > 1:31:29and that's the average day.
1:31:29 > 1:31:31What I just described was the average day for a GP.
1:31:31 > 1:31:35Does anyone think that that's a safe level of work?
1:31:35 > 1:31:40It's too much work crammed into too short a period of time.
1:31:42 > 1:31:45And Tom Black says he witnessed first-hand
1:31:45 > 1:31:48the consequences of an excessive workload
1:31:48 > 1:31:52leaving a doctor at the point of physical and mental exhaustion.
1:31:53 > 1:31:57I've gone to a practice where I sent a doctor home,
1:31:57 > 1:32:01where a doctor could barely finish a sentence...
1:32:01 > 1:32:07trying to cope with a workload where the doctor hadn't slept for days.
1:32:07 > 1:32:13That's not a job that we want our profession doing,
1:32:13 > 1:32:17it's not a service that we want our community relying on.
1:32:18 > 1:32:20Good afternoon, doctors' surgery.
1:32:20 > 1:32:23The BMA says that the demands of the workload
1:32:23 > 1:32:27can put intense pressure on individual GPs.
1:32:28 > 1:32:32That means when there are exceptional circumstances,
1:32:32 > 1:32:34such as the departure of a doctor,
1:32:34 > 1:32:38it does not take a great deal to put individual practices
1:32:38 > 1:32:39into a state of crisis.
1:32:41 > 1:32:46Efforts to stop the closure of a GP practice in Portadown have failed.
1:32:47 > 1:32:52When first one then two and three of the four doctors in the
1:32:52 > 1:32:57Bannview practice in Portadown left, no replacements could be found.
1:32:57 > 1:33:00The sole remaining doctor found herself trying to cope
1:33:00 > 1:33:04with 5,200 patients. It was too much.
1:33:04 > 1:33:08In the end, the health trust took over the practice.
1:33:08 > 1:33:12Dr Shauna Heanan was the last doctor in Bannview.
1:33:12 > 1:33:14In her letter of resignation,
1:33:14 > 1:33:18she gave an emotional account of her final hours in the practice.
1:33:20 > 1:33:23On the day when I had to admit that I couldn't cope any more,
1:33:23 > 1:33:27I had done 40 to 50 phone calls to patients,
1:33:27 > 1:33:30two overfull surgeries which kept growing in number as more
1:33:30 > 1:33:35patients phoned, three house calls, 200 acute scrips,
1:33:35 > 1:33:37150 blood results.
1:33:38 > 1:33:41I left work in tears that day.
1:33:41 > 1:33:43I hadn't slept in four to five days,
1:33:43 > 1:33:46couldn't remember the last time I could eat a proper meal
1:33:46 > 1:33:48and couldn't concentrate.
1:33:52 > 1:33:55A GP at another Portadown practice knows first-hand
1:33:55 > 1:33:59about the pressures of being the sole practitioner.
1:33:59 > 1:34:02He struggled to cope and came close to walking away.
1:34:03 > 1:34:07The main reason was that, you know, I just could not get
1:34:07 > 1:34:09any time away from the practice.
1:34:09 > 1:34:13I was just about coping with the 12-14-hour days,
1:34:13 > 1:34:16but when you cannot get any annual leave at all,
1:34:16 > 1:34:19it just becomes completely unsustainable,
1:34:19 > 1:34:21it becomes unsafe from a clinical point of view,
1:34:21 > 1:34:25it becomes unhealthy from a personal point of view
1:34:25 > 1:34:28and it significantly disrupts family life.
1:34:28 > 1:34:32He says the pressure left him a broken man with a broken practice.
1:34:34 > 1:34:37And the final straw came in October 2015,
1:34:37 > 1:34:39when he made a concerted effort to plan ahead
1:34:39 > 1:34:42for a few days off in 2016.
1:34:42 > 1:34:47Myself and my practice manager, we sent out a total of 2,000 e-mails
1:34:47 > 1:34:52and texts to see if we could find any sort of locums who were
1:34:52 > 1:34:55prepared to work in my practice to give me some time off.
1:34:55 > 1:35:01And those 2,000 contacts resulted in one day.
1:35:01 > 1:35:04September 5th 2016 was the only day.
1:35:04 > 1:35:06Did that shock you?
1:35:06 > 1:35:09That was one of the final straws that said,
1:35:09 > 1:35:12"Right, I can no longer go on like this."
1:35:20 > 1:35:24Whatever the pressures today on single-handed GPs,
1:35:24 > 1:35:28it's worth remembering that for a long time sole practitioners were
1:35:28 > 1:35:33a significant part of the bedrock of the National Health Service.
1:35:33 > 1:35:36I'm heading up the Antrim coast to meet a doctor
1:35:36 > 1:35:38who's lived that utopian dream.
1:35:42 > 1:35:47Ben Glover is 78. He should have retired 18 years ago.
1:35:47 > 1:35:50Instead, he holds open surgery three times a day.
1:35:52 > 1:35:56I think when I came here the oldest patient had been born in 1888,
1:35:56 > 1:36:00so I've covered from 1888 up until the present!
1:36:00 > 1:36:05When Ben Glover qualified, he was determined to become a GP,
1:36:05 > 1:36:07but was told he would have to wait for a practice.
1:36:07 > 1:36:10There were 65 in my year when I qualified,
1:36:10 > 1:36:15and I think over 30 of them went to America or Canada.
1:36:15 > 1:36:18And it was quite difficult then to get a practice.
1:36:18 > 1:36:22I was told by an older GP, "Start applying now, sonny,
1:36:22 > 1:36:26"because you'll not get a practice for about ten years."
1:36:26 > 1:36:30But within two years, he found himself in the picturesque
1:36:30 > 1:36:31surroundings of Glenarm.
1:36:31 > 1:36:37It was 1966, and he found life as a GP was not too stressful.
1:36:37 > 1:36:39We had a motorboat, and we'd go out fishing,
1:36:39 > 1:36:41lobster fishing and stuff like that,
1:36:41 > 1:36:43but if there was any emergency call come in,
1:36:43 > 1:36:47my wife would hang a towel outside the window at the front of
1:36:47 > 1:36:50the house and we'd know we had to come in and see somebody.
1:36:52 > 1:36:56Even at times of acute demand he managed on his own,
1:36:56 > 1:37:02as he did in administering emergency polio inoculations in 1977.
1:37:02 > 1:37:05Well, I was given 500 doses this morning,
1:37:05 > 1:37:08and we'll continue until they're all used up.
1:37:09 > 1:37:12Ben Glover retires in just over two weeks.
1:37:12 > 1:37:16His 2,000 patients know just how lucky they've been.
1:37:16 > 1:37:20Most of them will now move to a new practice in Carnlough.
1:37:20 > 1:37:23We know a lot of the surgeries you have to put an
1:37:23 > 1:37:27appointment through, you're talking about maybe ten days to
1:37:27 > 1:37:29a fortnight before you get an appointment.
1:37:29 > 1:37:31So you could be dead by that time.
1:37:31 > 1:37:33There's a lot of people in the village would be elderly who
1:37:33 > 1:37:37have no transport, and they would be primarily with Dr Glover,
1:37:37 > 1:37:40with no means of travel.
1:37:40 > 1:37:45So why not just replace him rather than move his patients?
1:37:45 > 1:37:47The answer is you just can't get anyone.
1:37:47 > 1:37:51The local trust even tried using the blockbusting TV series
1:37:51 > 1:37:55Game Of Thrones to attract doctors to the practice,
1:37:55 > 1:37:58but that, too, failed.
1:37:58 > 1:38:00Well, it's nothing to do with where it is,
1:38:00 > 1:38:02it's the fact that there's no doctors.
1:38:02 > 1:38:06Unfortunately, they haven't trained enough GPs over the years.
1:38:06 > 1:38:09They need at least 120 GP trainees a year,
1:38:09 > 1:38:11and they've only been training 60 here.
1:38:11 > 1:38:16In the past ten years, GP practices have continually declined
1:38:16 > 1:38:19whilst patient numbers have steadily increased.
1:38:19 > 1:38:24The BMA anticipates the closure of another 20 practices next year,
1:38:24 > 1:38:28so the pressure is on to train more GPs.
1:38:28 > 1:38:29They are struggling to get
1:38:29 > 1:38:32the numbers of people to join general practice.
1:38:32 > 1:38:35I think, for example, they have about 111 places and they've
1:38:35 > 1:38:39struggled to get 111 places on the GP training scheme.
1:38:39 > 1:38:43We've created a problem that, within the medical profession,
1:38:43 > 1:38:46being a GP is no longer the high-status person.
1:38:46 > 1:38:49It's not even middle-status in the whole spectrum
1:38:49 > 1:38:51of medical professional people.
1:38:51 > 1:38:53Are you saying that we've created
1:38:53 > 1:38:57a two-tier system within practitioners?
1:38:57 > 1:39:01I think there is a problem of young people graduating as doctors
1:39:01 > 1:39:05then deciding which way they go in the health service,
1:39:05 > 1:39:09and for the moment, my understanding from the outside
1:39:09 > 1:39:11is you're more likely to be incentivised
1:39:11 > 1:39:15to go towards hospital work and being a consultant
1:39:15 > 1:39:17than you are to becoming a GP.
1:39:17 > 1:39:20Yet it's the GPs that are the bread and butter, as they would say,
1:39:20 > 1:39:22the bread and butter of the system.
1:39:27 > 1:39:29In Northern Ireland at present,
1:39:29 > 1:39:35there are over 1,700 doctors in various stages of training.
1:39:35 > 1:39:39Only 245 of them are taking the general practice course.
1:39:41 > 1:39:44And at the end of training, there's no guarantee that any of
1:39:44 > 1:39:46those doctors will become GPs.
1:39:49 > 1:39:53We wanted a chance to speak to some of those training to
1:39:53 > 1:39:55be doctors in Northern Ireland.
1:39:55 > 1:39:59We came to the medical school at Queen's University in Belfast.
1:39:59 > 1:40:02We were introduced to a small group of fourth-year students.
1:40:02 > 1:40:05You can tell a lot by taking a patient's heart rate,
1:40:05 > 1:40:08- taking a patient's pulse. - That is true, yeah.
1:40:08 > 1:40:10Emer Gates says Queen's University
1:40:10 > 1:40:14should start their main GP training sooner.
1:40:14 > 1:40:15There have been increasing placements
1:40:15 > 1:40:17in general practice in final year,
1:40:17 > 1:40:20but I think, really, general practice we should be seeing
1:40:20 > 1:40:23at an earlier stage, just so that it sets the precedent, really,
1:40:23 > 1:40:25for what we're interested in.
1:40:25 > 1:40:30We got the provis', obviously, to shadow a GP for three weeks.
1:40:30 > 1:40:34The experience was great. I loved it, learnt a lot of new things.
1:40:34 > 1:40:36But it's just not a career for me.
1:40:36 > 1:40:40The problem of recruiting GPs is exacerbated by the fact
1:40:40 > 1:40:44that not only are we not attracting young doctors into general practice
1:40:44 > 1:40:47but those already in it, as we've seen with Dr Glover,
1:40:47 > 1:40:49are getting older.
1:40:49 > 1:40:54In fact, a quarter of the current GP workforce in Northern Ireland
1:40:54 > 1:40:56are aged 55 and over,
1:40:56 > 1:41:02and that means the loss of around 300 doctors in the next five years.
1:41:04 > 1:41:06Nowhere is the problem of an ageing workforce
1:41:06 > 1:41:11putting general practice at risk more acute than in Fermanagh,
1:41:11 > 1:41:14where four recent retirements have led to practices closing.
1:41:14 > 1:41:18And GPs there believe there's more to come.
1:41:18 > 1:41:22The doctors say with the number of practices likely to be cut
1:41:22 > 1:41:28from 18 to just 5, our largest county is already struggling to cope
1:41:28 > 1:41:32with patient needs, and the GPs are left wondering
1:41:32 > 1:41:33what the future holds.
1:41:34 > 1:41:38I think that, of the 18 practices that we would have had last year,
1:41:38 > 1:41:41we'd probably end up with five across three sites.
1:41:41 > 1:41:43That's what the GPs in that area tell me,
1:41:43 > 1:41:46that they won't have the workforce to sustain anything other
1:41:46 > 1:41:49than general practice in three towns.
1:41:49 > 1:41:52We will see patients having to travel to see their GP.
1:41:52 > 1:41:56They could be travelling 20, 30, 40 miles in some cases.
1:41:57 > 1:42:00According to figures from the Department of Health,
1:42:00 > 1:42:03the planned closure of four Fermanagh practices
1:42:03 > 1:42:07has the potential to displace nearly 8,000 patients.
1:42:07 > 1:42:10Nearby practices are on full alert,
1:42:10 > 1:42:12concerned about how many of those patients
1:42:12 > 1:42:14they might be asked to absorb.
1:42:17 > 1:42:20Dr John Porteous is one of five GP partners
1:42:20 > 1:42:22in the Maple Practice in Lisnaskea.
1:42:22 > 1:42:24They're worried a knock-on effect
1:42:24 > 1:42:27could put their own practice at risk.
1:42:28 > 1:42:33Effectively, you know, if one practice closes,
1:42:33 > 1:42:35there's pressure on the neighbouring practices,
1:42:35 > 1:42:38a domino effect, as you've heard it called.
1:42:38 > 1:42:42And our concern is, as a practice in the middle of all of this,
1:42:42 > 1:42:47that it would put our own viability at risk,
1:42:47 > 1:42:51and we obviously can't afford for that to happen.
1:42:51 > 1:42:54For the moment, they say they can manage cover in one of the
1:42:54 > 1:42:57recently closed practices in Rosslea.
1:42:57 > 1:43:00If we go down, then that's south-east Fermanagh
1:43:00 > 1:43:03in very, very serious bother.
1:43:03 > 1:43:06And is that a dangerous situation?
1:43:06 > 1:43:08I think it's a catastrophic situation.
1:43:08 > 1:43:10I think we're seeing the outworkings of that now.
1:43:10 > 1:43:14They do need to waken up and smell the coffee and get on with it now.
1:43:14 > 1:43:17We need to rectify that situation as soon as possible.
1:43:19 > 1:43:22This view is shared by Dr Michael Smyth,
1:43:22 > 1:43:24who retired last December,
1:43:24 > 1:43:27closing his practice in Maguires Bridge.
1:43:27 > 1:43:31They would have checked in here at reception.
1:43:31 > 1:43:36I felt that, in an increasingly dysfunctional system,
1:43:36 > 1:43:41it was becoming both dangerous
1:43:41 > 1:43:45and more difficult to deliver good-quality care.
1:43:45 > 1:43:49Dr Smyth is saddened and shocked that GPs feel
1:43:49 > 1:43:53they have been pushed to the verge of quitting the NHS.
1:43:53 > 1:43:56So, is general practice on its deathbed?
1:43:57 > 1:44:01It's... Yes, I believe it's on life support.
1:44:01 > 1:44:03Back in Lisnaskea,
1:44:03 > 1:44:06practice manager Maria Nugent-Murphy has been involved
1:44:06 > 1:44:08in detailed talks with local health authorities
1:44:08 > 1:44:11about amalgamating with other practices
1:44:11 > 1:44:15to ensure the survival of general practice in the area.
1:44:15 > 1:44:18I would say we are at capacity, definitely, at the minute.
1:44:18 > 1:44:21We were getting quite scared about what was happening around us,
1:44:21 > 1:44:24especially when advertisements went out
1:44:24 > 1:44:26and no replacements were being found.
1:44:26 > 1:44:28But it's stretching you a bit further than you want to go.
1:44:28 > 1:44:31Yes, it is, definitely, yes.
1:44:31 > 1:44:35Really, we see a more sustainable solution
1:44:35 > 1:44:38as being in one centre, one hub.
1:44:38 > 1:44:41And that's really where we feel things need to go
1:44:41 > 1:44:44to be sustainable in the long term.
1:44:44 > 1:44:47That's something John Compton agrees with.
1:44:47 > 1:44:51He says GPs need to change the way they work.
1:44:51 > 1:44:53Well, I think the sort of changes,
1:44:53 > 1:44:56for example, issues where there are partners in the practice
1:44:56 > 1:45:01who are advanced nurses or pharmacists, they have to think
1:45:01 > 1:45:04about what they're being asked to do differently.
1:45:04 > 1:45:06They have to look at how they work.
1:45:06 > 1:45:10Are small, single-handed or two-handed practices
1:45:10 > 1:45:13really the way forward when you think of the next ten years?
1:45:13 > 1:45:15And I think those sort of challenges are there,
1:45:15 > 1:45:19and that does mean some amalgamations of general practices,
1:45:19 > 1:45:22it does mean general practices working in much broader networks.
1:45:22 > 1:45:25So you're talking about some kind of a hub.
1:45:25 > 1:45:28I think so, yes. Hubs, of course, are the way forward,
1:45:28 > 1:45:31but hubs are no use if it's just simply the restatement
1:45:31 > 1:45:34of five traditional practices into a building
1:45:34 > 1:45:38and nobody does anything to change how you operate in that building.
1:45:38 > 1:45:40That's been the solution for Dr MacDonald,
1:45:40 > 1:45:43who's merged his practice with three partners
1:45:43 > 1:45:46inside the hub at Portadown Health Centre.
1:45:46 > 1:45:50The clinical burden is pretty much the same, and that's fine.
1:45:50 > 1:45:52I can share the administrative burden.
1:45:55 > 1:46:00I find that now we can hopefully cover holidays between ourselves.
1:46:00 > 1:46:02What's been happening with you since I last saw you?
1:46:02 > 1:46:05Nevertheless, even hubs can mean a heavy workload,
1:46:05 > 1:46:08as we see back in Belfast with Dr Brennan,
1:46:08 > 1:46:10who has three GP partners.
1:46:11 > 1:46:15I've seen a very complex mix of patients this morning,
1:46:15 > 1:46:17some patients with multiple problems.
1:46:17 > 1:46:21I'm just going to go back. I have a couple of patients waiting for me.
1:46:22 > 1:46:26Half an hour later, and Dr Brennan has seen her last patient
1:46:26 > 1:46:28but has more still to do.
1:46:32 > 1:46:34I've just finished my surgery.
1:46:34 > 1:46:37Running probably about 20, 25 minutes late,
1:46:37 > 1:46:40which is just an ordinary day.
1:46:40 > 1:46:45I think there's probably about 10, 15 people still looking for me
1:46:45 > 1:46:47this morning who need me to call them back.
1:46:47 > 1:46:52And I think there's two or three home visits, which we will, erm,
1:46:52 > 1:46:55need to do over lunchtime.
1:46:55 > 1:46:58I talked to Dr Brennan after her busy morning surgery.
1:46:58 > 1:46:59I'm on my half-day off.
1:46:59 > 1:47:02I'm going to be doing more work this afternoon, as well.
1:47:02 > 1:47:04And then my day doesn't stop there.
1:47:04 > 1:47:07So, when I get the children to bed, so around eight o'clock,
1:47:07 > 1:47:10I'll dial in again to try and do some preparatory work for tomorrow.
1:47:10 > 1:47:12I think that many of us are coping at the moment
1:47:12 > 1:47:15and we're continuing to provide a really safe service,
1:47:15 > 1:47:18but if there is something unforeseen, I think that...
1:47:18 > 1:47:21you know, we've talked, and the word has been used, about domino effect.
1:47:21 > 1:47:24Very quickly, practices can become in crisis, actively in crisis.
1:47:24 > 1:47:27- If they come into difficulties... - PHONE RINGS
1:47:27 > 1:47:30..it will have an impact on adjoining practices, so...
1:47:30 > 1:47:32I'm sorry, I'm going to have to take that.
1:47:32 > 1:47:34- Yes, of course. - Sorry.
1:47:34 > 1:47:36Hiya.
1:47:36 > 1:47:38GPs may have good lines of communication with their
1:47:38 > 1:47:42patients, but when it comes to the Government, they feel sidelined.
1:47:42 > 1:47:46And the BMA says the turnover of health ministers,
1:47:46 > 1:47:49four in the past three years, has had an adverse impact
1:47:49 > 1:47:53on making decisions on the future of general practice.
1:47:53 > 1:47:55It's very frustrating,
1:47:55 > 1:47:59because you form a relationship with the minister, you have a plan,
1:47:59 > 1:48:02you have a way forward, and the next thing, they're gone.
1:48:02 > 1:48:04And the last two ministers have had, what,
1:48:04 > 1:48:06less than a year each in post.
1:48:06 > 1:48:08In fact, the last three, probably,
1:48:08 > 1:48:10have all had less than a year each in post.
1:48:10 > 1:48:12And it is very frustrating.
1:48:12 > 1:48:14During the life of the Stormont Assembly,
1:48:14 > 1:48:18there have been a series of reports on the health service.
1:48:18 > 1:48:21The most recent was published in October last year.
1:48:21 > 1:48:25The reality is that the current model is unsustainable.
1:48:25 > 1:48:28It was chaired by Professor Rafael Bengoa,
1:48:28 > 1:48:31an internationally renowned expert on health reform
1:48:31 > 1:48:34who has previously advised the European Union
1:48:34 > 1:48:37and the Obama administration.
1:48:37 > 1:48:38In his report,
1:48:38 > 1:48:43Professor Bengoa acknowledged that there should be more GPs trained
1:48:43 > 1:48:46and that GP practices should have a dedicated support team,
1:48:46 > 1:48:50a named social worker, health visitor and district nurse
1:48:50 > 1:48:53to alleviate the workload on doctors.
1:48:53 > 1:48:54It was seen as a positive step
1:48:54 > 1:48:57towards fixing the problems in the health service
1:48:57 > 1:49:01and enjoyed the full support of the then Executive.
1:49:01 > 1:49:05I'm delighted that the Executive has endorsed a direction of travel
1:49:05 > 1:49:07for how we're going to transform health and social care.
1:49:07 > 1:49:10We had a very clear choice to make.
1:49:10 > 1:49:13We either try and manage the change
1:49:13 > 1:49:17or we either manage the chaos that would come
1:49:17 > 1:49:20if we didn't tackle the huge issues that there are.
1:49:20 > 1:49:24The entire Executive have bought into this ten-year strategy.
1:49:24 > 1:49:28But, as we know, within a few months the Executive collapsed,
1:49:28 > 1:49:31and that unity of political purpose
1:49:31 > 1:49:35over the way ahead for our health service has stalled.
1:49:35 > 1:49:38It's absolutely critical that we now get ourselves an Executive,
1:49:38 > 1:49:42the Executive publicly recommits to the Bengoa report
1:49:42 > 1:49:46with the First, the Deputy First Minister and the Health Minister all
1:49:46 > 1:49:48standing, if you like, firmly, saying,
1:49:48 > 1:49:50"This is what we're going to do",
1:49:50 > 1:49:54because without that, you lose the support of professionals.
1:49:54 > 1:49:56They become disappointed and disillusioned.
1:49:56 > 1:49:58We've reached a point in Northern Ireland where something
1:49:58 > 1:50:03has to be done. If we as GPs have to leave the NHS to fix this, we will.
1:50:03 > 1:50:07At the moment, the NHS is toxic to general practice.
1:50:07 > 1:50:12But is the threat to leave the NHS a realistic one,
1:50:12 > 1:50:16or is it simply being used as a bargaining tool?
1:50:16 > 1:50:18For some members of the public,
1:50:18 > 1:50:22the idea of having to pay for treatment has already taken hold.
1:50:24 > 1:50:27I had a consultation recently where a patient came to see me
1:50:27 > 1:50:30and she assumed that it had already happened and that we were charging,
1:50:30 > 1:50:34and she reached down at the end of the consultation to give me money.
1:50:34 > 1:50:38And I just became really quite upset,
1:50:38 > 1:50:43because it's not what I signed up to do.
1:50:43 > 1:50:47It's not just about tactics or about playing a game,
1:50:47 > 1:50:50it's a profound statement about where our NHS is going.
1:50:50 > 1:50:52I want people to pay attention to that,
1:50:52 > 1:50:55and I want people to understand they have workforce issues,
1:50:55 > 1:50:59they have training issues, they have new-models-of-care issues,
1:50:59 > 1:51:03and they want a solid understanding from government
1:51:03 > 1:51:07and a commitment from government to effect a change into the future.
1:51:07 > 1:51:09Few GPs want to leave the NHS,
1:51:09 > 1:51:14but some have become extremely pessimistic about its future.
1:51:14 > 1:51:19I think it's very, very hard to justify recommending anybody
1:51:19 > 1:51:22to be any sort of doctor in the NHS at the moment.
1:51:22 > 1:51:24And I don't take any pleasure from saying that.
1:51:24 > 1:51:26That's just the cold facts.
1:51:26 > 1:51:29The BMA has been casting an envious eye
1:51:29 > 1:51:33towards England and Scotland, where GP budgets have been boosted.
1:51:33 > 1:51:37The most recent, an increase of £71 million,
1:51:37 > 1:51:39was announced in Scotland last Friday.
1:51:39 > 1:51:42Here, the Department of Health says it recognises
1:51:42 > 1:51:46there's more to be done to improve GP services,
1:51:46 > 1:51:49but without a health minister or an Assembly,
1:51:49 > 1:51:52GPs are left wondering when that help is going to come.