The Government must take action to prevent trusts from taking on more GP contracts, as they ‘may not be best placed to run primary care’, a group of Northern Ireland politicians has said.
In a report published today, the Northern Ireland Assembly’s public accounts committee (PAC) said that contract handbacks by GPs ‘should be a red flag’ that the system is in ‘desperate need of improvement’.
It recognised the contribution made by secondary care trusts in running GP services following contact handbacks, but warned that this could negatively affect services.
It comes as GP leaders in England opposed plans for acute and community trusts to run general practice, after the 10-year health plan introduced powers for ICBs to contract a wider range of providers – including trusts – for neighbourhood services.
The NI PAC committee said that trusts were ‘a port of last resort’ when contracts were handed back, but that recently, given the ‘lack of appetite amongst GPs to act as partners’, trusts have now become ‘the first point of call when a contract is handed back’.
The report said: ‘These trusts may not be best placed to run primary care services, but it is clear to the committee that in many areas there is effectively no exit plan.
‘The involvement of trust-run practices is greater in certain parts of Northern Ireland. The committee is concerned about the concentration of the use of trusts to cope with contract hand backs in specific areas – notably Fermanagh and South Armagh. The committee is clear that this should not result in an inequality of access for patients in those areas.’
It recommended that the Government carry out a review to consider the reasons behind GP contract handbacks, warning that the number of practices handing back their contract has increased in recent years, with 13 practices handing back or giving notice to hand back their contracts in 2022-23.
It added: ‘In the following year, 11 practices handed back or gave notice to hand back their contract, with a further five during 2024-25. The 29 practices that have handed back their contacts over the last three years represent around 9% of the total number of practices in Northern Ireland.
‘Whilst the committee is grateful that the number of handbacks this year has reduced, we do not believe that the sector is now stabilised.’
In response to the report, the RCGP said that trust-run practices are ‘simply not a sustainable nor cost-effective’ long-term solution.
RCGP Northern Ireland chair Dr Ursula Mason said: ‘A GP partner only makes the difficult decision to hand back their contract when financial sustainability and workforce pressure leaves them no other option.
‘The root causes of contract hand backs need to be addressed. Trust-run practices are simply not a sustainable nor cost-effective long-term solution.
‘We therefore call for an incremental increase in the proportion of the health budget allocated to general practice, to allow practices to recruit and retain much needed GPs and practice staff to deliver the care that our patients desperately need.
‘The roll out of the Multi-Disciplinary Teams is necessary to address the current postcode lottery of services and stark inequalities, and the implementation of electronic prescribing will improve safety and free up GP time, but neither are a silver bullet.’
Among other recommendations to improve GP access, the committee said that a workforce strategy for primary care is ‘urgently needed’, and must be produced within the next year.
BMA Northern Ireland GP committee chair Dr Frances O’Hagan said: ‘The report’s findings highlight the urgent need for strategic action by the Department of Health to stabilise a sector in crisis, and contains clear calls for a new primary care strategy, better data on workforce and patient demand, and a renewed focus on the “patient’s voice” in service design. We fully support these recommendations.
‘We acknowledge the report’s comments on patients struggling to access their GPs and agree that the Department need to work with NIGPC to find a solution to these issues. The current access proposals from the Department are harming patient access, not working and will not have the outcome for patients they hope for.’
She added that while the recommendations are ‘robust and timely’, it is vital to recognise that ‘meaningful’ progress will only be possible if the issue of core funding for general practice is addressed.
She said: ‘The report itself notes that current spending levels fall well short of what is required for full implementation of key programmes, such as multi-disciplinary teams, and that the sector faces significant pressures from rising demand and workforce challenges.
‘We have consistently called for additional funding for core services in general practice, including addressing the long-standing inequity around indemnity payments. We want to be able to employ more GPs, more practice nurses and reception staff to provide the care we want to provide for our patients.’
Pulse has contacted the Department of Health for comment.
It comes after GP leaders in Northern Ireland recently declared they have ‘no confidence’ in the current minister of health Mike Nesbitt and in the Department of Health.
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