There are not enough GPs to deal with the pressures

Last week we had a visit from our two new MLAs in the city, Ciara Ferguson and Pádraig Delargy.

By Dr Paul Molloy
Thursday, 25th November 2021, 6:58 pm

The purpose of the visit was twofold. Firstly to show that General Practice is open and secondly to demonstrate the work of our MDT (multidisciplinary team).

We are in the midst of another winter. We are well into our vaccination campaign. On Sunday past we gave the third COVID booster to over 2000 people in one day!

Despite upgrading of phone systems, I am still hearing of patient complaints. Patients are telling me they have to wait for a long time to get through.

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These cases are hard to argue with and I can understand completely the frustrations.

I have written this type of article now several times over the past 18 months. I tend to look at it from both sides.

I am a strong believer that the service we deliver in primary care should be like any other. It should be customer driven and be responsive. If there are problems it’s up to me to fix them. The service should be user friendly and easy to access when someone feels the need to use it.

When I look at it from the other perspective, prior to COVID many many practices in the west were already in trouble.

The main issue is GP numbers and a lack of new GPs filling posts of those retiring. They just aren’t there.

I’ve heard complaints that GPs are greedy and they keep their lists large to earn more money.

I can reassure you that every GP I know would gladly swap quality of life and a sustainable work pattern for money. There just aren’t GPs there to offer jobs to.

Processes are in place (albeit too late) to increase GP places. The numbers of GPs in training has increased as has the emphasis on GP in medical school.

The BMA had asked for and recommended these changes 10 or more years ago and thankfully they are now actioned but too late to avoid a workforce crisis!

In March 2020 we had to move to a phone consultation system. We can only have 8 patients safely in our waiting room at any one time despite it sitting about 30-40.

So again I’d ask, how could we possibly have 5/6 face to face surgeries running at the time?

If you had leukaemia or COPD and you booked your appointment to arrive to a waiting room of 30 people, would you feel safe?

In the face of prior and new pressures practices (indeed any business if under severe pressure) find it hard to implement change.

It sounds to me like phone systems could be better and we could use other systems to make access easier, but trying to change a system in the face of relentless daily pressure is tricky. It doesn’t mean however that we should not try. Many practices are, and will upgrade their systems.

We do not really see an immediate end to this COVID situation and for that reason personally I think it is unlikely that we will revert to the old system.

The new model is here and will probably stay.

We are also still faced with staff illness due to flu/ COVID and more worryingly due to stress and even as a result of harassment which they feel they cannot cope with.

The staff are the front line. If you have a complaint, make it to the Practice Manager or a GP. Please don’t shout it at the receptionist or person answering the phone, even though you may feel it warranted.

10% of the population of NI contact their GP every week. That’s between 200,000 and 230,000 people with 50% converted to face to face appointments.

That’s a staggering figure. Demand has increased, the population increases and unfortunately we don’t have a ready supply of extra GPs to help.

In the Derry area we are lucky to have extra staff which form a Multidisciplinary team. We have a first contact Physio, 2 Social workers, a Mental health worker, an Advanced Nurse Practitioner and a Practice Pharmacist.

They have been a life saver to say the least.

They help us by doing a bit of work we used to have to do but doing it as an expert in their field.

On the day of the visit we heard how the interventions from these practice based professionals really makes a difference to patients lives but also to the ability to manage workload on the practice.

Unfortunately only 5 out of 17 federation areas in NI have these teams in place.

I represent my colleagues in the SW federation which includes Tyrone and Fermanagh and they are really struggling.

If you take all the issues in Derry and multiply them, you arrive at their position. They really really need this extra help or practices will continue to collapse

Hopefully our politicians will accelerate the process.

These teams will help give some extra capacity while we adapt to these new times, ways of working and wait for our new GPs.

Thank you for reading this and for your understanding and patience.