Larne GP warns of system 'collapse' after handing back contract to Department of Health

Northern Ireland GP Dr Ian Lalsingh
Northern Ireland GP Dr Ian Lalsingh -Credit:Submitted

A Northern Ireland doctor has warned that the GP system here will collapse without urgent action to ensure more stay in the profession.

Dr Ian Lalsingh was speaking after marking his last day as a GP partner in Larne last Friday, where he has spent the last 20 years. Larne Medical Practice was the 18th surgery in Northern Ireland to hand back its contract to the Department of Health last October.

Since then around half a dozen more have followed suit, most recently the Fannin, Hutchinson and Boyd medical practice, operating out of Ballymoney Health Centre, last Friday.

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Earlier this month the Department of Health confirmed that Dr Johnny Burns and Partners have been appointed as the new contractor providing GP services to the patients of Larne Medical Practice with effect from May 1st.

Dr Lalsingh said the decision to hand back the GP contract was not taken but a last resort because there were simply not enough doctors to safely oversee the 8,500 patients on its books.

The two practices in Larne Health Centre merged last year to become the biggest medical practice in the Co Antrim town with six GP partners.

Soon afterwards one of those GPs resigned, which meant there were too many patients for the remaining doctors to oversee safely.

Northern Ireland currently has 318 practices, that's 9% fewer than a decade ago. When GPs operating a medical practice hand their contract back it means they no longer feel able to run it due to various factors including retirement, recruitment problems, staffing or financial pressures.

GPs are also facing problems including increased demand, an ageing population, rising rates of multiple conditions, soaring waiting lists and the after-effects of the Covid pandemic all compounded by the fact that many newly qualified GPs are retiring early or leaving to work elsewhere where conditions are better.

Health Minister Robin Swann has said he is committed to building the workforce and retaining experienced GPs. A 6% funding uplift for GPs and their staff was recently approved while the annual number of GP training places has been increased from 65 in 2015/16 to the current level of 121 (an increase of 86%).

Dr Lalsingh told Belfast Live: "The last six months have been extremely difficult and stressful for our patients and staff who didn't know if they'd have a job on May 1st unless a new provider was found.

"One GP resigning out of six doesn't sound like a lot but most patients don't see any of the other work behind the scenes that a GP partner does, which is considerably more. The more patients we see, the more work we generate for ourselves.

"GPs like anybody else get stressed and burnt out, feeling that they can't keep doing this anymore and they'll walk away. There will be more contract hand backs this year too and we're past the 25 mark since last January with many other practices still at risk.

"The NHS is on its knees generally but general practice is collapsing bit by bit in an uncontrollable fashion really. Unfortunately if general practice fails, the whole of the NHS is going to fail.

"If you think GPs are doing nothing and seeing nobody, underworked and highly overpaid, why would any of us wind up our business and hand back our contract? We are working flat out, hoping things will get better."

Dr Ian Lalsingh marking his last day as a GP partner in Larne last Friday, where he has spent the last 20 years.
Dr Ian Lalsingh marking his last day as a GP partner in Larne last Friday, where he has spent the last 20 years. -Credit:Submitted

The British Medical Association's safe working guidelines state that once GPs have seen their recommended number of consultations, any other patients should be advised to attend the local emergency department instead.

The recommended daily number for each GP is 25 consultations/patients but Dr Lalsingh said he and his colleagues were regularly exceeding that number.

He said: "I was starting work at Larne Health Centre at 8am and was still there at 8pm or later. For the last six months I've routinely been working 12 or 15 hours a day and was still phoning patients at 7 or 8 at night,

"Because of a lack of doctors on the ground to deal with, see and consult with patients, we are routinely working way past the recommended safe working guidance."

At 52 and a GP for 30 years, Dr Lalsingh has no plans to retire and will be joining the team at the Whitehouse Medical Practice in Newtownabbey next month, where he previously trained 21 years ago.

Last month, an audit office report found that extreme pressures on GP services in Northern Ireland have resulted in locum doctors being paid up to £1,000 a day to work in practices run by health trusts.

The report from Auditor General Dorinnia Carville, said that almost one in three GP practices here has sought crisis support services in the last four years.

Last week, Stormont’s Health Minister refused to rule out resigning if a budget agreed by the powersharing Executive is passed in its current form.

Mr Swann broke ranks as the only member of the four-party powersharing administration to refuse to back the spending plan which was agreed by his Executive ministerial colleagues on Thursday.

The Ulster Unionist minister has called on the Stormont Assembly to “strategically review” and change the draft budget, which he has warned could devastate Northern Ireland's already strained health services.

While the health service has been allocated more than half the £14.5 billion resource budget available to the devolved government, Mr Swann has said it falls well short of the money needed to maintain services at safe levels.

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