OPINION: Can our GP service cope in this NHS? by Derry GP Dr Tom Black

‘Want’ of course is the keyword because patients in Northern Ireland go to their GP about twice as often as patients in the Republic of Ireland who are healthier and live longer.

We now have many conditions to deal with that simply weren’t on the curriculum when educating medical students 40 years ago. I’ll focus on three areas which have attracted a lot of attention in the last year and continue to use up a sizeable part of the capacity of NHS leaving fewer appointments for other patients.

Last summer about 30% of the access from patients in my practice was for adults trying to get a diagnosis of ADHD. There isn’t such a service here for adults and these patients became frustrated, the GP Service couldn’t cope and other patients complained that they couldn’t get through on the phone. I asked one of these patients why this situation had exploded ; “it’s trending on TikTok” they said. I think we’d all agree that the NHS isn’t there to respond to social media trends which block the service for vulnerable patients.

The other two examples are obesity and anxiety disorders. These two issues were marginal 40 years ago but they are now two of the most common conditions with respect to GP access and time.

NHS surveys tell us that about a quarter of teenagers have a mental health disorder and 57% of students have a mental health issue. We have concerns that there’s over diagnosis particularly where there’s conflation of normal responses to life‘s difficulties with mental health disorders. People have redefined grief and stress as mental illness and not only are the NHS mental health services overwhelmed but patients with the most severe conditions such as schizophrenia and bipolar disorders struggle to access services as a result.

The final area is obesity as it is causing a huge burden on the NHS due to diabetes, cancer, heart attacks, high blood pressure, arthritis-the list is endless and this is now a problem whereas 40 years ago it was on the margin.

Obesity is now very topical because of the variety of very expensive drugs available which will help people lose weight. Given the ten billion pounds cost are we as a society willing to fund the service knowing that there won’t be money available for other vital NHS services. The government’s response is to start pilot programs for those with the most severe conditions but there is a risk that patients will feel that they have to gain weight to qualify for these pilots (this has happened before).

Society has reached its tolerance level for paying tax for the NHS and we should now be prioritising our issues for funding. Instead politicians relying on votes, trying to avoid bad publicity are failing to make the hard choices needed and as a result patients with the most critical needs are being marginalised by those better able to advocate for themselves.

Life is messy but we can do better than this.