Out of Hours Service: Armagh

Oral Answers to Questions — Health – in the Northern Ireland Assembly at 2:45 pm on 16th January 2017.

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Photo of Danny Kennedy Danny Kennedy Deputy Speaker 2:45 pm, 16th January 2017

2. Mr Kennedy asked the Minister of Health for her assessment of the pressures on the Armagh GP out of hours service. (AQO 890/16-21)

Photo of Michelle O'Neill Michelle O'Neill Sinn Féin

The out of hours base in Armagh city is open each weeknight and for three slots on both Saturday and Sunday. The Southern Health and Social Care Trust seeks to ensure that a safe and sustainable GP out of hours service is available across all five bases in the trust area, including Armagh. In 2015-16, the Southern Trust out of hours service received nearly 94,000 initial patient telephone calls. The service provided over 5,000 home visits and 52,000 GP, nurse or pharmacist telephone assessments, and 36,000 patients had appointments in the Southern Trust out of hours centres. Despite the increasing pressure facing the service, more than 85% of people contacting the trust's GPs out of hours were triaged within 20 minutes.

The Southern Trust has taken a number of actions to support the out of hours service, including the introduction of nurse practitioners and clinical pharmacists to support GPs in managing the service. Patient and staff safety is of the highest priority, and, in the event that there are insufficient clinical staff to cover all out of hours bases across the trust area, resources may be consolidated in fewer bases. Where this is the case, all patients calling out of hours services continue to receive telephone advice and are offered an appointment at an alternative base or a home visit, as deemed clinically appropriate, following the initial telephone triage.

There has been significant investment in GP-led services over recent years. I set out in 'Health and Wellbeing 2026' the importance of primary care, and I have confirmed my intention to invest significantly in primary care. The future model of primary care must be focused on keeping people healthy and well and must be based on multidisciplinary teams embedded in general practice. I have already announced plans to have named district nurses, health visitors and social workers for every GP practice to support the development of new roles such as physician associates and advanced nurse practitioners and to continue to invest in practice-based pharmacists. I also intend to invest in technology to help transform the way general practice works and informs the services to patients. To that end, I have confirmed the further roll-out of the askmyGP system.

I have also said I will bring forward a public consultation on the role of GP federations. Further detail on our approach to building multidisciplinary teams will follow over the next number of months on how we are going to do that and how we are going to secure what I have set out in 'Delivering Together'. Given my focus on supporting and investing in primary care, I have also announced an increase to 111 GP training places over the next two years. This year, 2016-17, saw the investment of up to £7 million in GP services following contract negotiations, building on investment of up to £5 million made last year.

Photo of Patsy McGlone Patsy McGlone Deputy Speaker

Just before we move on, I advise the Minister about the two-minute rule.

Photo of Danny Kennedy Danny Kennedy Deputy Speaker

The early part of the Minister's response highlighted the need for the retention of GP services in Armagh and, indeed, in County Armagh. How will the Minister react and, more importantly, what will the Minister do to deal with the current wider GP crisis highlighted by the comments today by the chairman of the Northern Ireland General Practitioners Committee, Dr Tom Black, warning that Northern Ireland GPs will vote to leave the National Health Service because of the crisis in the political institutions?

Photo of Michelle O'Neill Michelle O'Neill Sinn Féin

I think my track record speaks for itself in what I have done, in the early days in office, on investing in primary care to make sure that we support our GPs. I have taken on board the whole review and the recommendations that were put forward under the GP-led review. I am as committed today as I was when I announced I would take on board all those suggestions and make sure that we implemented them.

The situation we are in today is not of my making. It is absolutely down to the arrogance of the DUP. It is down to the RHI scandal. Let us be very clear about where we are in relation to the current situation and why we are in the scenario that we are in.

I set out a vision for transforming health and social care that very clearly put it at its core that we need to invest heavily in primary care and bring care closer to people's homes. That is absolutely the vision I am wedded to and will continue to be wedded to until I leave office. I would much prefer to be driving forward with that transformation agenda, but there is a crisis of confidence in these institutions because of the actions of the DUP. As a result of the actions of the DUP and because of its continued arrogance and disrespect towards the public, I believe that the public are rightly entitled to have their say on the future, and that will include GPs.

Photo of Patsy McGlone Patsy McGlone Deputy Speaker

Members, please be advised that you should have a little respect for the Minister when she is responding and likewise for anyone else who has the Floor.

Photo of Justin McNulty Justin McNulty Social Democratic and Labour Party

I thank the Minister for her answers thus far. The Minister responded to my questions for written answer on the matter confirming that 2,779 shifts in the out of hours service in the Southern Trust went unfilled in the last 18 months. She went on to confirm that the Armagh base was closed on 242 occasions over the same period. Will the Minister explain why her Department continues to close the Armagh base, given that her Department has also closed the minor injuries unit in the city?

Photo of Michelle O'Neill Michelle O'Neill Sinn Féin

From 20 December to 2 January, the Armagh base was open 18 out of 28 times, which is 64%. Although the Armagh base may be closed, the GP out of hours is a trust service, and patients in Armagh will be provided with a service. When it is closed, it affects only appointments, and patients will be offered an appointment in one of the other bases. Normally, the Armagh base has one GP; however, on six of the occasions that the Armagh base was open, it was staffed by two GPs, and on one occasion it was staffed by three GPs. The GP out of hours service is provided to all the Southern Health and Social Care Trust population and is delivered by GPs, triage nurses, nurse practitioners and pharmacists from bases throughout the trust.

That is in relation to performance, but the issues faced by the Southern Trust in relation to out-of-hours services are pretty typical of issues with out-of-hours services across the piece. This points to the need to train more GPs, and I have already set out what I am going to do. It points to the need to look at other services that can be provided in the community and how else we can provide additional nurses. I have said that we need to enhance the role of advanced nurse practitioners, and we need to look at placing pharmacy at the centre of GP services. I have set out the direction that we need to take to fix a poor picture in relation to the stress and pressure that I have no doubt GPs are under. The situation in the Southern Trust is symptomatic of the wider issues and the need to transform health and social care.

Photo of Catherine Seeley Catherine Seeley Sinn Féin 3:00 pm, 16th January 2017

I thank the Minister for her answers so far. The Minister has committed to investing in primary care. How does she feel that will alleviate pressure across our health system?

Photo of Michelle O'Neill Michelle O'Neill Sinn Féin

Investment in primary care is critical. The vision for transforming health and social care, 'Health and Wellbeing 2026: Delivering Together', set out clearly the importance of primary care. As part of that vision and direction of travel, I confirmed my intention to invest significantly in primary care. We have to change the future model of delivery. The future model of primary care must be focused on keeping people well and healthy; it must be based on multidisciplinary teams embedded in GP practices.

I have already announced plans to have named district nurses, health visitors and social workers for every GP practice; to support the development of new roles such as physician associates and advanced nurse practitioners; and to continue to invest in practice-based pharmacists. I also intend to invest in technology to help to transform how general practice works and improve services to patients. To that end, I have confirmed the further roll-out of the askmyGP system. I have also said that I will bring forward a public consultation on the role of GP federations. Further detail on our approach to building multidisciplinary teams will follow over the next short period.

Given my focus on support and investment for primary care, I have also increased to 111 the number of GP training places over the next two years. This year, 2016-17, also saw investment of up to £7 million in GP services following contract negotiations, building on investment of up to £5 million made last year.

Photo of Kellie Armstrong Kellie Armstrong Alliance

Minister, 20% of attendance at out-of-hours surgeries is for routine, repeat prescriptions. No matter what we do to inform the public that the service should not be used for that, it is still happening. The main reason for that is that no one can get near a GP surgery for love nor money. I heard you talk about supporting GPs, but what are you going to do to make absolutely certain that the public can access GP services?

Photo of Michelle O'Neill Michelle O'Neill Sinn Féin

I think that I have clearly set out what needs to happen. I set out the transformation vision, Delivering Together, which is the road map; that is what we have to do to transform the picture. There is no doubt that our GPs are under significant pressure. We all recognise that; we all see it every day, and we all engage with people who are trying to get an appointment but cannot. GPs need our support, and that is what I said I wanted to do. It is about building a multidisciplinary approach and about making sure that when you go to your GP, you can, perhaps, be seen by an occupational therapist or physiotherapist or anyone you might need in a multidisciplinary team.

If we do not get to that place, our hospitals will be continually under significant pressure and our waiting lists will continue to grow. I am as committed today to the transformation and the work that needs to happen on it as I was when I announced it in the Chamber a number of months ago. We have to deliver transformation; otherwise the health service will continue to be in crisis and waiting lists will continue to grow. Transformation is the long-term answer. If we invest, I believe, wisely in primary care and in bringing care into the community — that includes domiciliary care workers and everyone who works at the coal face and supports individuals — we will arrest the picture, and we will be able to change things. However, in the absence of transformation, we cannot keep doing things the way we are and expect people to have different outcomes.