Councillors told GP morale at an 'all time low'
Members of Derry City and Strabane Council heard how morale amongst GPs is at an all time low during a special council meeting to discuss the GP Call First system.
Dr. Laurence Dorman, Chair of Northern Ireland Council of Royal College of General Practitioners told elected representatives that he was ‘very worried about some of my colleagues and their mental health and the stresses and strains they are having’.
He explained that morale was low ‘not because they feel they have an unmanageable workload' but 'because they are unable to give the service they were trained to do’.
“All of our GPs are passionate," he added. "This is their vocation, they want to give their patients the best service possible and that’s very difficult when they are dealing with 40 to 50 more consultations per day. They are then going home at 6 o'clock to put their children to bed and at 9 o'clock they are going to log on remotely from home to do their bloods and their letters."
Addressing the chamber, Dr. Dorman said: “Our system is in crisis.
“General practice provides around 95% of the care people need throughout their life, yet it receives only approximately 8% of the health budget.
“In September 2022, there were 189,000 consultations in general practice in Northern Ireland, 43% of these were face to face.
“We are keen to ensure our patients understand that when patients phone us and speak to the GP on the telephone that’s the start of their consultation. The telephone is not a replacement for the consultation, it's just the start of the consultation.
“During that conversation we get together as partners and the GP and patient can decide whether that needs to go for further investigations, for a script directly to the pharmacy saving everybody journey time and environmental issues or whether there are patients who need to come in to us and see us directly face to face either for physical examination or for that more physical contact if they feel uncomfortable discussing things over the telephone.”
Imploring councillors for their help, he continued: “We want the highest quality of care for our patients in the community but we need support with this.
“Our workforce is very, very stretched at the moment and unfortunately historically we haven’t invested in growing the GP workforce as we should have done. A lot of our GPs are over the age of 55 and are facing retirement so we need investment to increase our workforce but we also need new ways of thinking.”
Councillors heard from Dr. Paul Molloy, Secretary Western Local Medical Committee, that practices in the Derry City and Strabane council area were ‘actually doing very well’ and were ‘reasonably well staffed’ in comparison to areas like Tyrone and Fermanagh.
Referring to the Call First phone system, he said: “The perception is that when Covid hit we all started doing telephone triage but that’s not the truth.
“Telephone triage was invented because practices were in crisis long before Covid and practices weren’t able to deal with the demand from patients to see them all face to face.
“Most of the practices here were still doing face to face so it was a considerable change for them.”
He urged councillors to complain to their MLAs adding: “The ability for us to get a budget is totally dependent on our ability to get all these services rolled out but at the minute we are in limbo, everything is having to be stood down, meetings are being stood down because we can’t do anything and that’s totally down to the political system in Northern Ireland.”
Dr. Ciaran Mullan, Chair Western LMC said: We are trying to make people understand that when people are unwell or perceive themselves to be unwell that the Phone First isn’t a substitution for any other way of accessing care, frequently it is the start of their care.
“It was put in place not because of the pandemic but as a way that we can task who really needs to be sitting in front of us.
“The beauty of phone access and coming through to highly qualified staff is that you can be appropriately dealt with and if somebody is sitting in front of me that there is a real need for them to be in front of me.”
Sinn Féin Patricia Logue first acknowledged the pressures GPs are under before saying: “We are only telling you what people are saying to us. A lot of people are self diagnosing, they are going to chemists, they are going on the internet and there has been a high rise of cancer patients being diagnosed at the latter stage of cancer and while Covid may have played a part in that, a lot of people are not getting access to their GP.
“They may have had one or two symptoms but when you go to the GP they feel you have a better conversation, you have an examination and one thing can lead to another and then the person is referred.
“A&E and Out of Hours are picking up the slack. A lot of people are not phoning the GP because they are saying there is no point in even trying.”
Independent Paul Gallagher called the phone system ‘not fit for purpose’ adding: “There are people who are on the phone first thing in the morning for long periods and by the time they get through appointments are gone. People feel they have to justify what they are phoning up about in order to get to see a GP.
“On the other hand if you’ve got money, you will see and hear advertised access to GP services for £70 in Ballykelly and you will be seen when you want.
“Some patients that have gone that road and are in a waiting room waiting to see a GP and it was the same GP that they couldn’t get access to in their own local practice so there’s an element creeping into this saying if you can pay you can get access to GP services.”
Responding, Dr. Molloy commented: “With regards to private appointments I am totally and absolutely opposed to private NHS treatment and care. I don’t think people should have to do it.
“The last six months of last year whenever someone was with me and I referred them to the hospital for treatment I didn’t mention it but now you have to mention it because the waiting lists are so long.
“If someone comes to me and I’m worried they may have cancer of the bowel and I’m referring them for red flag treatment that’s supposed to be two weeks but it could be into months at the minute. For me I have to mention that to the person that there’s an ability to go private.”
All councillors had a similar story of patients making numerous calls in an attempt to get a GP appointment.
Aontú councillor Emmet Doyle spoke of the disparity between practices.
“One practice you can call up and get your appointment and then another practice I’m getting sent screenshots where people have made up to 150 calls trying to get through for an appointment,” he said. “The disparity between practices concerns me."
Appreciating the difficulties with the system, Dr. Laurence Dorman commented: “Our experience is that once they get through 80% of patients were happy with the service they received.”
Margaret O'Brien, Head of General Medical Services added: “We are seeing between 190 up to 200,000 consultations carried out per week by our practices and approximately 45% are face to face. I think seeing it in context like that shows the demand for our GP services and what our practices are actually facilitating on a day by day basis.
“GP practices are open and have stayed open throughout Covid which wasn’t actually the case in other parts of the UK and I think it’s important to highlight that.”
Gearóid Cassidy, Director of Primary Care explained the telephone system allows for a ‘more efficient and timely service for lots more people’.
He continued: “Through the pandemic it allowed us to keep the system open when due to infection control measures, otherwise practices may have had to close their doors for a period of time.
“There is dissatisfaction in some quarters or a level of confusion about what the service is and what it's meant to be. I would emphasise that it is where consultations start on the telephone, where it is necessary a face to face appointment will be provided and that’s on the judgement of the GP.
“We are doing the work to understand the issues and address them as well as we can.”
With most members agreed getting MLAs back to work would be the first step to resolving some of the issues, People Before Profit councillor Shaun Harkin said: “I’ve spoken to GPs who are very frustrated and we are in a real danger of seeing the GP service collapse and in some other areas that’s already happening and the last thing we want to do is lose this vital service.”
Agreeing with the elected representative, Dr. Mullan commented: “Councillor Harkin mentioned the word collapse which is alarmist but ultimately it's true.
“We are talking about practices under pressure handing their contracts back to the board and it's essentially the department and then we are faced with patches of the community not having access to GP care.”
Dr. Molloy concluded: “There have always been challenges with appointment systems and trying to meet demands and the Phone First has addressed some of it but just having a simple face to face with a waiting room full of patients isn’t the answer either when you don't have the staff to be able to deal with them.”