Access to General Practice in Northern Ireland - Media Release

Almost one in three GP Practices has sought crisis support services in the last four years, as extreme pressures continue to build on the primary care sector. That is among the findings of a report on Access to General Practice in Northern Ireland, published today (Wednesday 20 March 2024) by the Auditor General, Dorinnia Carville. The report considers a range of challenges facing the sector, including funding and workforce, and highlights the urgent need for long term planning to address these. 

Practices are under extreme pressure

As well as making it harder for patients to access GP services, the report notes that, in the past four years, 98 practices (over 30 per cent of all practices here) have sought support from the General Practice Improvement and Crisis Response Team, which supports the development and implementation of recovery plans for practices identified as ‘at risk’. In addition, between March 2022 and March 2023, a total of 13 GP practices in Northern Ireland either handed back or gave notice to hand back their contracts.

Alternative providers have been put in place for those 13 practices, with Health and Social Care Trusts taking over five contacts. However, in nine of those cases, this is a temporary arrangement (including all five Trust takeovers). The need to attract locums to these practices has resulted in Trusts paying high rates – up to £1,000 per day in some cases. The report notes concerns that, while paying such rates may help immediately stabilise practices, it may have distorted the locum GP market, resulting in higher costs being incurred more generally.

A number of factors can be behind decisions to hand back contracts, and the report notes views raised from the health sector around perceived financial risks, as well as the continued difficulties in securing sufficient clinical workforce.

Workforce challenges continue

The report also highlights particular challenges around maintaining GP workforce levels. The total number of GPs increased by around 9 per cent between 2018 and 2023. However, the report cautions that this headcount data masks changing patterns of GP work, which indicate there has actually been an overall decrease in whole time equivalents. As a result, while GP numbers may be rising, it is likely that fewer GP sessions are being delivered.

The Department has sought to grow the workforce by increasing the number of GP training places, with the total number of places increasing from 65 in 2014 to 121 in 2024. The report found that many of the increased training places had been taken up by international medical graduates, who are less likely to remain in Northern Ireland after this training, pointing to a need for proactivity to nurture their retention.

There has been limited progress in the rollout of multi-disciplinary teams within primary care settings

Today’s report also considers progress in the rollout of multi-disciplinary teams (MDTs) in Northern Ireland. MDTs involve establishing a range of clinical staff, working alongside GPs, to both expand the services available in primary and community care and to provide improved care to patients.
Considered a key component of health service transformation, MDTs were launched in September 2018, with a planned incremental roll-out across Northern Ireland over five years. However, by March 2023, MDTs had been fully introduced in only one of the 17 GP Federation areas across Northern Ireland and partly introduced in seven areas. Only around 161,000 (8 per cent) of registered patients currently have access to the full range of MDT roles.

Again, the report cites a lack of available, qualified staff as a key constraint in the rollout. The Department has previously advised that future roll out will be dependent on available funding. The report notes that an additional £91 million would be required annually to sustain the operation of a full programme of MDTs.

Commenting on the findings, Dorinnia Carville stated:
“For most people GPs are their first point of contact with the healthcare system and the gateway to other services. Today’s report reflects the extreme pressures GP practices are facing. These pressures 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.”

“Measures taken to date have largely been short-term, which can be costly for public finances. At the same time, progress on delivering more meaningful transformation, such as the planned rollout of multi-disciplinary teams to work alongside GPs, has been significantly delayed. Ultimately this results in patients not receiving the timely support and access to treatments that they need.”

“It is important to note that there are no quick or easy solutions. What is essential now is the development of sustainable long-term plans to address the significant challenges facing GP services in Northern Ireland.”