‘Primary Care Sector in Crisis’ Needs Radical Change Says Assembly Committee Report on Accessing GP Services

An Assembly Committee says the primary care sector here is in crisis – and is calling for radical change - in a new report which exposes serious failings in how access to GP services is provided.

In its, Report on Access to General Practice in Northern Ireland*, the Public Accounts Committee (PAC) outlines a litany of shortcomings and sets out 10 recommendations for change.

Among those organisations which gave evidence to the Committee were the British Medical Association NI (BMA NI); the Royal College of General Practitioners NI (RCGP NI); the Patient and Client Council (PCC) and the Department of Health (DoH).

The Committee also launched its own call for evidence in February of this year and received more than 15,000 responses to it from the public**. Many respondents reported repeated, unsuccessful attempts to contact their GP practice – with more than half rating their experience as ‘poor’.  Many highlighted the wider personal consequences of this including stress and anxiety as well as, in some cases, financial costs associated with private consultations or extensive telephone calls.

In evidence to the Committee, Department of Health officials said measuring the demand for GP services was ‘too difficult’ and that it did not hold figures for how many full-time equivalent (FTE) GPs are actually employed across Northern Ireland***.  The Committee also heard that there is no workforce strategy for primary care here which it believes has further negative impacts on GP recruitment, training and planning for the future.

Daniel McCrossan, Chairperson of the Public Accounts Committee said: “Being able to see your GP is a cornerstone of basic medical care – but too often accessing this service has felt impossible for many.

“What we have learned from our Inquiry is that the primary care sector is in crisis and requires urgent intervention and stabilisation. It beggars belief that some of the fundamental building blocks of primary care are not in place. 

“Members were told that there are significant issues relating to GPs’ workload, due partly to the pressures on hospitals. The scale of demand appears to be greater here than elsewhere: the BMA NI told us that on average, a patient sees a GP nine times a year, whereas in Ireland it is three times a year.

“To steady the sector and improve access to GP services for patients, the Committee has identified a number of short and long term measures that the Department needs to action now – these must also be underpinned by a comprehensive strategy for primary care.

“The overwhelming response to our own survey emphasises just how important access to GPs is to the general public. Patients told us there was a confusing patchwork of approaches when it came to contacting different GP practices in different areas – from queuing at surgeries and waiting for call backs or phoning first thing in the morning.  Few seemed aimed at improving patients’ experiences.

“As public representatives, we are too used to hearing from constituents in despair at failed efforts to reach their GP – something which causes untold distress to both patients and their loved ones – and is totally unacceptable.

“We understand GPs are independent contractors but our view is that the Department must do more work with them to ensure all patients have appropriate and fair access to services.

“We were shocked to learn there were many instances where partners handed back GP contracts but were immediately re-employed in the same places as locum doctors – at a significantly high cost. This is an inappropriate practice and an unacceptable way of using public money.”

Diane Forsythe, Deputy Chairperson of the Public Accounts Committee said: “Improving access to primary care depends on strong and effective working relationships between the Department of Health and GPs – which just aren’t there at the moment. Everyone involved must work together to deliver better outcomes for those in need.

“We are calling on the Department of Health to produce an overall strategy for primary care in Northern Ireland, within a year of this report being published. It should encompass a workforce strategy and set out the future direction for services, reflecting its own aspirations for a strong primary care sector.

“We also heard that there is a lack of interaction between the Department of Health and the Patient and Client Council (PCC), especially in the area of access to primary care.  We welcome the Department’s acceptance that it could increase how the ‘patient’s voice’ feeds into plans to increase the public’s ability to access their GPs.

“The PCC said it has seen a 70% rise in complaints about GP services between 2022 – 23. This contrasts starkly with figures from the Department’s own Strategic Planning and Performance Group (SPPG) which said it had seen a downward trend in such complaints for the same period.

“The importance of digitisation was also highlighted in the course of our Inquiry, and the Committee agrees that introducing e-prescribing**** could help create better efficiencies and reduce the burden on GPs. It is evident that the increasing pace of IT has not been matched by delivery across the Health sector.  We are recommending the introduction of e-prescribing as a matter of urgency and expect the Department to have completed a business case within six months.

“It is important to note that there have been some positive moves in developing the primary care delivery model but so far this has been slow and small scale.  To safeguard services, and to build for the future, the Department must be more proactive in leading the conversation on future delivery models if they would be better for patients, better for the public purse and better for attracting and retaining GPs.”

Among the 10 recommendations the Committee is making in its report are that the Department of Health develops a public education programme within the next 12 months to ensure that people have a greater awareness of the most appropriate avenues of care, whether via a GP practice, pharmacist, minor injuries unit or emergency department.  PAC is also recommending that the Department reviews the data it holds on patient experience in primary care – including on complaints about GP practices - and that information is shared so that improvements can be made.

Ends

For further information please contact Felicity Templeton, Assembly communications office on 07977 635930 / felicity.templeton@niassembly.gov.uk

Notes to editors

*The Committee’s, Report on Access to General Practice in Northern Ireland can be found here. 

**Details of the Committee’s survey findings can be found here. The 15,000 members of the public who completed the online survey was the largest-ever response to a Northern Ireland Assembly consultation.

***The Committee heard that there are around 2,000 GPs on the ‘performers list’ in Northern Ireland. This list includes all GPs who work in General Medical services, including GPs in training. However, this number is a headcount and does not reflect the total amount of full-time equivalent GPs working in Northern Ireland.

**** e-Prescribing is the system of sending prescriptions electronically from a prescriber to a pharmacy, improving efficiency and patient convenience.

• PAC’s work on this area was prompted by an Northern Ireland Audit Office (NIAO) report in March 2024, called: Access to General Practice in Northern Ireland
• The Public Accounts Committee (PAC) is a Standing Committee. It is PAC’s statutory function to consider the accounts, and reports on accounts, of the Comptroller and Auditor General (C&AG) (Northern Ireland Act 1998, Section 60(3)). PAC also considers value for money reports which follow an examination on the ‘economy, efficiency and effectiveness’, with which a public sector body has used its resources. These examinations take place under Article 8 of the Audit (Northern Ireland) Order 1987 (‘the 1987 Order’). 
• Further information on the Committee Membership, its work and remit can be found here

For further information please contact Felicity Templeton, Assembly communications office on 07977 635930 / felicity.templeton@niassembly.gov.uk