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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