Dominoes, pass the parcel and the impeding collapse of the Northern Ireland GP service….

You may have seen news coverage of the GP practice closure in Portadown. Basically, a reduction in staff meant that a GP practice was no longer viable but the other GP practices in the town said that they were unable to absorb the 5000 patients from the former practice. Thus, potentially leaving 5000 people without a GP. The latest update is that the Health Department said they have someone to take over the old practice but we await the details.

For years GPs have been warming the government that the service is on the verge of collapse. But as usual in Northern Ireland we govern by inertia or doing bugger all as the man in the street might call it. I have covered the main issues before, if you are new to this saga it is worth a read.

But now it begins. We get to witness the collapse of the GP service in real time. The Portadown case gives us the template of how it will happen.

GP practices are formed as legal partnerships.  What is happening is 25% of GPs are over 55 so they are starting to retire. They are awash with cash so they can afford to retire early or become a locum. There are not enough doctors to replace them so the workload increases for the other doctors in the practice. They call this the domino effect. With the stress of the increasing workload some of the remaining GPs go sod this and they either retire early, become a locum or go off to Canada or Australia for more money and less stress.

Now this is where pass the parcel comes in. The last remaining GP partner in a partnership is legally responsible for all the hassle in winding in a practice. Dealing with staff redundancies, making sure all debts/taxes are paid, dealing with the landlord, health boards etc. As a practice starts to decline the doctors look around and think they don’t want to be the last man standing so there is a rush for the door. Thus, increasing the death spiral further.

There is an extremely lucrative alternative to being in a GP partnership. It is being a GP locum – a roaming doctor for hire. Basically, you get £400 a quid a day but without all the bureaucratic hassle and stress of being a partner. You come in, see some patients, write some scripts but when 5 O’clock comes you are out the door and on the Golf Course for 6.

If you were a doctor what would you choose? The hassle of being in a full-time practice in some grim housing estate or the freedom of being a locum were you could potentially earn up to 10 grand a month without all the grief?

The whole situation is a complete mess with no obvious solution in sight. Training a GP takes 10 years and even then there is very little desire for Junior doctors to become GP’s. The only solution is a complete revamp of our entire healthcare model but we don’t do change in Northern Ireland we only do crisis.

What will happen is more GP Practices will close. More people will just go to A&E at their local hospital increased that already stretched service. The middle classes will go to the various new private GP practices that will start to spring up. The poor as usual will get shafted. Without quick access to a doctor conditions will go undetected; more people will die.

Politian’s are accusing the media of being sensationalist and scare mongering but those of us who follow this issue and talk to GPs on the ground know the storm is coming. If you get the option of private healthcare with your job grab it with both hands. While you are at it It might also be a good idea to cut down on the drink, fags, sugar and take some exercise. You know it makes sense.

For more details on why there is such a shortage of GPs read my other post on this issue:

The Northern Ireland GP crisis. The doctor won’t see you now…

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  • hgreen

    This should be the main news. Sadly the RHI scandal (and Brexit) are overshadowing the ongoing destruction of the NHS by the Tories.

  • notimetoshine

    Well the people of NI have no one to blame but themselves. The chronic mismanagement of our health service and the increasingly dire medical straits we find ourselves in aren’t exactly news. Yet we still vote in the same incompetents time and time again. Real what you sow and all that.

  • lizmcneill

    It’s baffling how they keep getting voted in. Are there that many rich stockbrokers in England? Have they done anything in their last few terms that benefits anyone other than that?

  • Brian O’Neill

    We have full control over how much we spend on health and how we spend it.

    We can’t blame this one on the Tories.

  • hgreen

    What? I wasn’t aware that taxation had been devolved.

  • hgreen

    Then how come the NHS is struggling in GB as well? This is a funding crisis across the whole of the UK pure and simple.

  • notimetoshine

    Well for a start our health system is grossly inefficient, and several reviews have shown this, but our politicians won’t make the choices they have been told to make in those reviews.

    Our politicians could chose to increase funding to the health service, but they haven’t done so. They need to start rationalising services, but they haven’t done so. They need to address social care but they havent done so. They need to fix emergency care, but they haven’t done so.

    Sheer political incompetence, and thats the way the people of NI like it.

  • notimetoshine

    He is right, our assembly chooses how to divvy the money out, not our fault if they don’t have the wit to increase health funding. Though increasing funding wouldn’t help all that much in NI, without serious structural changes. But no one would dare close a hospital here, even when that’s what’s needed.

  • hgreen

    We do not have full control over how much we spend on health. This is a lie. Ultimately what we have available to spend on our public services comes from UK wide taxation, decisions currently made by the Tories. To argue that the issues with the NHS here in NI are the fault of our political leaders is nonsense. Are our NI politicians also responsible for the Red Cross having to step in in GB?

    Apologists for Tory policy and armchair experts like yourself will parrot out the usual nonsense about NHS management costs, structural issues and wastage however there is a funding crisis in the NHS. We expect world class health services but don’t expect to have to pay for it.

  • hgreen

    There is a social care and emergency crisis across the UK. Our politicians are not in position to raise the funding required to address this. It is lazy analysis to blame this on local politicians.

  • notimetoshine

    Well first and foremost I am no Tory. I am among the minority who believes that ideologically driven policy and politics is the root cause of many of the wrongs in western political systems.

    I myself believe and have said repeatedly on these forums that a sustained increase in NHS funding is required to deal with the demographic and technological changes healthcare is facing. The UK has a very efficient health spend for what it provides, which leaves plenty of room for increased spending.

    I can’t find the polling at the moment but there was a recent study that shows there is real public willingness to spend more on the NHS to the tune of a penny or two on income tax. It makes sense only if it is ring fenced obviously, but would be doable.

    As for structural changes, Northern Ireland’s health system is in dire need of structural and management changes. Both the Donaldson and Hayes reports outlined major structural issues, including the problem of the number of hospitals, yet our incompetent local politicos didn’t have the guts or skill to implement those changes. On a UK basis I don’t subscribe to structural change as the panacea that is needed, but to deny its important role is to make the Blair and Brown era Labour mistake; throwing money alone at a problem won’t fix it.

  • notimetoshine

    Well our local politicians are in charge of our local health service. They have been given several reports on how to improve both social care and health care yet have done nothing. Of course there needs to be extra funding, but our health system is a mess, needing structural as well as financial reform.

    Our local politicos have power over their local budget, plenty of fat could have been reallocated to healthcare, but hasn’t been. They chose not to, because they don’t have the skills or ability. Not to mention their inability to address the issue over the number of hospitals, duplication of services and the fact that our accident and emergency waiting times are some of the worst in the UK.

    I would put it to you that it is lazy analysis to blame this on Westminster. Our local politicians should be left with more than a fair share of the blame.