An open letter to Sir Jeffrey Donaldson…

Dear Jeffrey,

Like you, I believe that the interests of the people of Northern Ireland are best served by remaining within the United Kingdom. The cultural, economic and social ties with Great Britain offer both stability and unique opportunities.

While there are many factors which support this position, time and again opinion polls indicate that foremost among them is the NHS. The promise of universal healthcare free at the point of need is the strongest incentive to be a UK Remainer (to coin a phrase). For most of us throughout our lives we have taken the NHS for granted, it is part of the fabric of this place. But, we both know that things are not good in the NHS, chronically underfunded, stressed to breaking point by Covid it is now in a critical condition, effectively on life support.

Let me take General Practice, the area I know best, having worked as a GP for many years. General Practice is the foundation upon which the whole edifice of the NHS is built. Prior to Covid, ninety percent of all patient contacts took place in Primary Care. The GP, uniquely within the NHS, knows the patient, their medical history, their family, sometimes over several generations, their home environment and their occupational history. The personal relationship between GP and patient enables good communication, better recognition of people’s problems, more accurate diagnoses, good decision making and treatment advice, fewer drug prescriptions and better compliance. All this underpinned by trust between doctor and patient.

But it is contingent upon the patient having a GP who knows them and whom they can get to see when needed. Seeing a GP face to face confers benefit even before any treatment is prescribed. The consultation itself is therapeutic. The patient benefits, their sense of wellbeing is increased and they become more confident and less anxious. Referrals to hospital or other services are more appropriate, specialist treatment can commence more promptly, and treatment outcomes are better.

But General Practice is overwhelmed. A huge percentage of consultations now take place over the phone. Some patients feel they are more likely to see Lord Lucan than their GP. When General practice becomes overwhelmed A&E becomes overwhelmed. Many attending A&E could and should have been treated in the community; unnecessary tests and investigations are performed, waiting lists swell, diagnoses are delayed, people become sicker and mortality rates rise.

This is the situation we are now in. According to the BMA on almost every measure our health and care system performs much worse than anywhere else in the UK. Patients on waiting lists are dying before their first appointment. The system is collapsing even though we have a superbly trained workforce.

To turn this around will be enormously challenging. It will require new models of care, greater efficiency, innovation and undoubtedly increased funding. It will require more than a functioning Executive but, one thing is certain, it will not happen without a functioning Executive. The ship has been drifting for far too long, strong and decisive political leadership is needed.

So, the dilemma facing us is that the very institution that most commends the Union to the people of Northern Ireland is disintegrating before our eyes, accelerated by the lack of a functioning Executive. Even more importantly people are getting sicker and dying. I believe that, like me, you entered politics to help your constituents. You will help them most, and the cause of the Union most, by urgently restoring our political institutions, an act of true political leadership.

Your fellow Unionist,

Dr John Kyle MRCGP