GP SERVICE IN WORST STATE FOR 70 YEARS
BMA chief on why services are in their worst state since health service was founded
GRIM VERDICT OF TOP NI FAMILY DOCTOR
GP services in Northern Ireland are in the worst state they have been in since the creation of the National Health Service 70 years ago, a senior medic has warned.
Dr Tom Black said a combination of underfunding, ever-increasing workload and a chronic shortage of family doctors has left the service in disarray.
While he welcomed recent investment to try and save GP surgeries here, he hit out at health officials and politicians for allowing the crisis to happen in the first place.
The situation has become so bad that trainee doctors are turning their backs on a career in general practice as they believe the risks of a patient coming to harm are too high, he said.
Dr Tom Black delivered the damning verdict as he steps down today as chair of the British Medical Association’s (BMA) GP committee in Northern Ireland after eight years at the helm.
“It’s sad that we can’t attract young doctors into general practice,” he added.
“We’re now seeing the investment we’ve been asking for and we appreciate the efforts of the Department of Health, although I don’t think it should have got to this stage.”
Dr Black, who has been a GP for more than 30 years, said general practice had become almost unrecognisable compared to when he started out in the profession.
“I used to have a piece of paper above my desk with all the waiting times printed on it so I could tell patients how long they would wait for an appointment when I referred them,” he said.
“I don’t have that anymore, with the exception of cancer care and acute emergency care, patients can expect to wait years.
“I don’t even bother to refer my patients into the NHS mental health services now because it’s such a frustrating experience for them.
“It’s unreasonable to ask any patient to wait years for any health service, we don’t wait for years for anything else in life but we wait for years for something that is so important, and that seems strange to me.
“We have patients waiting years for a hip replacement and they become addicted to strong painkillers, people waiting for mental health services who end up having to use more drugs than maybe they would use if they were getting counselling.
“There are patients who are waiting an excessively long time for a gall bladder operation and have to take a long time off work.
“The pressure all this puts on general practice is considerable, and even more so for the patient.
“Many of my patients are going private, they’re collecting money from their families so they can get the scan or whatever other treatment they need.
“That’s not how we envisaged the health service and it’s extremely out of step with the other three countries in the UK.”
Dr Black said patients should expect to see sweeping changes to the health service here in coming years.
In particular, he said the number of acute hospitals in Northern Ireland must be cut to improve care.
“Among the three other nations in the UK, having 10 acute hospitals for a population of less than two million people would be regarded as an indulgence,” he claimed.
“As it stands, we are spreading available resources across too many hospital sites.”
He said it was imperative that the public accepts that the best care may not be provided at the nearest hospital.
“If you have a drug dealer in Los Angeles and one of them gets shot, do they drive to the big acute trauma hospital or phone an ambulance and go to the nearest hospital?” he asked.
“They go to the major trauma centre that is further away, but that’s because they are expert at treating those patients.”
Dr Black also said the way patients interact with their GP will change in coming years.
“We’re likely to see a lot more artificial intelligence, where pa- tients go to an NHS app and it will follow a certain algorithm and offer the patient advice or make them an appointment with the GP or a counsellor or a physiotherapist, whatever is the best thing for them,” he said.
“We have fewer GPs now per head of the population than in the 1950s, there are on average 2,000 patients per GP, and that can increase to 3,000 in some areas.
“The average GP is doing in a day 35 consultations, 180 prescriptions, 35 hospital letters, 50 blood results, phone calls, house calls and paperwork, and that simply isn’t sustainable and we have to become more efficient.
“The investment by the Department of Health that is allowing us to bring in multi-disciplinary teams to surgeries will start to make a dent in the workload,” Dr Black added.
“Transformation of the health service has obviously been held up considerably by the failure of the politicians and the collapse of the Assembly.
“Failing to have a Health Minister for the best part of two years is a very rapid way to create chaos within the health service.
“I think the situation in terms of a crisis is the worst it has ever been since 1948, although I think we’re turning a corner and hopefully it isn’t too late.
“If we want to make the health service better, we’re going to have to bring in changes and we need a Health Minister to drive through decisions that might go against the wish of their population.
“If we don’t do that we will continue to have long waits, patients will continue to have to use their personal money to pay for outpatient appointments and operations, and I don’t think that’s fair.”
‘I don’t even bother to refer my patients to NHS mental health services because it’s such a frustrating experience for them’
‘We have patients waiting for a hip replacement who become addicted to strong painkillers’
‘Many of my patients are going private, they’re collecting money from their families so they can get treatment’
‘We have fewer GPs now per head of population than we did in the 1950s’
‘The average GP’s day is 35 consultations, 180 prescriptions, 35 hospital letters, 50 blood results, phone calls, house calls and paperwork... that just isn’t sustainable’
‘Failing to have a Health Minister for the best part of two years is a very rapid way to create chaos’