The population of Northern Ireland is getting older with more people over the age of 65 years and even bigger increases of people over the age of 75 years. As you get older, there’s a tendency to accumulate more diseases which are long-term such as high blood pressure, diabetes, arthritis and dementia. Unfortunately, most of the NHS is set up as single disease services so the heart doctor won’t help your arthritis and the diabetes doctor won’t sort out your mental health.

The natural place for multiple long-term conditions to be sorted out together would be in general practice but funding for GPs has been cut in half over the last 20 years and every GP is working harder than ever but suffering non-stop complaints about access.

So is access to GPs good or bad in Northern Ireland? The health committee at the Stormont Assembly tell us that the average patient here attends their GP nine times a year which is more than double the Republic of Ireland rate. So if twice as many appointments isn’t enough what would be and what is causing this huge demand?

In Northern Ireland as a whole we’re providing 45 million prescriptions, 40 million blood tests and hundreds of thousands of vaccinations not to mention a lot of X rays and scans. Despite all this we have endless waiting lists and waiting times that are an embarrassment to our society.

There’s no doubt that if the population is older it will need more appointments with the GPs but most practices don’t have enough funding or staff to provide more appointments. My practice had a full-time GP for every 1500 patients when I started in 1992 but now has 2300 patients for each full-time GP. Every single day is a struggle now as a result.

There’s a common theme in medical journals that the medical profession is over diagnosing patients and we now have perfectly well patients who have been diagnosed with conditions they didn’t know they had due to increased technology and screening programmes. One of the leading psychiatrists in the UK states that “it is time to scale down our mental health awareness“ as we’re now seeing 57% of young people with a mental health issue and the risk is that services become overwhelmed by minor conditions while patients with severe disease have to wait in a queue. Ricky Gervais jokes that all his friends have ADHD although one guy had to go to four different clinics before he got the diagnosis. If an ADHD diagnosis becomes aspirational and trendy what happens patients with severe ADHD who are unable to access services.

One of my particular concerns is that patients from deprived areas develop these multiple illnesses 10 to 15 years earlier in life. PIP payments indicate how much disability exists in a community and there are now 222,000 PIP claimants in NI concentrated in the deprived areas with more than 40% of adults in some parts of Belfast and Derry affected. This compares to 10% average in the UK.

The solution is to focus funding closest to the patient in primary care. Focus the funding on those patients with the greatest need and that means focusing on high deprivation populations. This is a challenge for Stormont.