Bannview Medical Practice

Question for Urgent Oral Answer — Health – in the Northern Ireland Assembly at 3:15 pm on 17th January 2017.

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Photo of Robin Newton Robin Newton Speaker 3:15 pm, 17th January 2017

Mrs Jo-Anne Dobson has given notice of a question for urgent oral answer to the Minister of Health. I remind Members that, if they wish to ask a supplementary question, they should continually rise in their place. The Member who tabled the question will be called automatically to ask a supplementary.

Photo of Jo-Anne Dobson Jo-Anne Dobson UUP

Will the Minister of Health outline the measures she is taking following the withdrawal of the GP contractor confirmed to accept the contract to run the Bannview Medical Practice?

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

The Health and Social Care Board (HSCB) widely advertised the GP contract for Bannview practice, met a number of practices and held an information evening with practices in the surrounding areas. It also provided information and support that would be available to a new contractor taking on the Bannview practice. Despite all of its efforts, no applications were received by the closing date of 2 December 2016. The HSCB continued its efforts to secure a contractor for the Bannview practice, and, having identified an interested GP, it held a number of very positive meetings with the prospective contractor. Consequently, on 5 January 2017, a new GP contractor confirmed to the Health and Social Care Board that they would take on the Bannview Medical Practice from early March 2017. Yesterday, unfortunately, that contractor officially withdrew their intention to take on the practice. This is an extremely disappointing development, and I met the HSCB today to ensure that patients will continue to receive safe and high-quality healthcare and that all possible options for a permanent solution are being considered.

The HSCB has confirmed to me that it is actively seeking to secure a permanent GP contractor to take over the Bannview practice. It is also exploring other options, including the Southern Trust taking on the contract for Bannview. The board will continue to manage the practice and ensure that GP services are provided to patients whilst it works to secure a new contractor to take over the practice. No decision has been made to close the practice. I fully appreciate that patients are concerned about the current situation, but I reassure them that every effort is being made to secure a permanent solution for the practice and that the board will write to all patients to advise them of the current arrangements.

In 'Health and Wellbeing 2026', I set out the importance of primary care, and I have confirmed my intention to invest significantly in it. The future model of primary care must be focused on keeping people healthy and well, and it must be based on multidisciplinary teams embedded around general practice. I have already announced plans to have named district nurses, health visitors and social workers for every GP practice as well as plans to support the development of new roles such as physician associates and advanced nurse practitioners. Our continued investment in practice-based pharmacists will see over 100 in place in the near future. I also intend to invest in technology to help to transform the way in which general practice works and to improve services to patients. To that end, I have confirmed the further roll-out of the askmyGP system. 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.

There has been significant investment in GP-led services over recent years. This year, 2016-17, saw the investment of up to £7 million in GP services following contract negotiations, building on an investment of up to £5 million made last year. Those commitments, which will help to ease the workload of GP pressures and attract more doctors into general practice, will build on the already significant investment in general practice over recent years and reflect some of the recommendations of the GP-led working group. I have accepted all of that group’s recommendations as signalling the direction of travel needed to ensure that everyone here continues to have access to high-quality, sustainable GP-led services.

Photo of Robin Newton Robin Newton Speaker 3:30 pm, 17th January 2017

If the Minister needs more than the two minutes to answer a question, she should just ask.

Photo of Jo-Anne Dobson Jo-Anne Dobson UUP

Minister, this is a desperate situation that has caused real anger in Portadown and has the potential to impact on the health of all patients of the health centre, creating a domino effect across practices. Portadown must be prevented from becoming Humpty Dumpty. What is your response to the anger of the patients in Portadown? Was the contract signed as a stalling tactic because of the patient rally that had been organised?

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

I say to all patients that they will continue to receive safe clinical services and that the board will monitor that. We have medical and nursing cover in place. We have arrangements with the Dalriada practice for out of hours and independent prescribers, all working collectively as part of a team to make sure that patients have access to first-class GP services, which they are rightly entitled to. It is important that we do not scaremonger but are responsible about this. I will ensure that the board, as I have asked it to do, writes to every member of the surgery to make sure that they are fully abreast of the situation.

I assure you that I do not make public announcements on the back of a potential public rally or anything like it; I made the announcement about the Bannview practice because a contractor had, in fact, confirmed that he was going to take on the practice. Since then, he has realised that he is not able to fulfil the obligations of the contract. That is why we have found ourselves in this situation. As of lunchtime yesterday, the contractor has officially confirmed to the board that he is no longer able to enter into the contract with the Department.

What is most important is that patients continue to receive safe clinical services, and the board, as I said, will monitor that. Ultimately, we need a permanent solution. This is, obviously, a temporary arrangement to make sure that we support the patients on the ground.

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

It is a temporary arrangement. We are working towards making sure that we have a permanent solution. We have to be creative about how we do that. Long gone are the days when the only solution to GP services was when GPs became independent contractors — individual businesspeople in their own right. The make-up of the GP workforce is now more female, and more people want a bit more flexibility. Not every GP wants to be a contractor; some want to be salaried, so we need to move towards that. We are engaged with the Southern Trust on how it can get involved and play its role. I believe that what we have in place now is making sure that we provide safe patient services.

I accept absolutely that people are worried about the future of their GP practice. That is understandable. I also accept that the surrounding GPs, who are under tremendous pressure, as we already know, are feeling the impact of it all. What we need here is a permanent solution, and I assure all the patients that this is what we are working towards. What we have in place now is a temporary solution, but I assure you, following a meeting that I had with the board earlier today, that there is GP cover, medical cover and nursing cover in place for the next six weeks. They will continue to make sure that we have rotas filled and cover that until we have a permanent solution.

There are a number of options for a permanent solution. The fact is that only one GP expressed an interest in the advertisement to come forward. That is a wider issue in relation to the recruitment of GPs. We have to look at other ways of having GPs in place. Looking towards salaried GPs is one option that we need to explore an awful lot more.

Photo of Carla Lockhart Carla Lockhart DUP

I thank the Minister for her answers thus far. I have to say, Minister, that this has been a very worrying time for the people of Portadown, particularly those who are sick and very vulnerable at this time. We have sick children, and I know a lady of 102 who is very ill at this time, and this is causing undue distress for her and her family.

I believe that there was irresponsible politicking around stating that a contractor had been found when we all knew that there was difficulty and that it was not at an advanced stage. I call on you, Minister, to give assurances to the people of Portadown today that they will be looked after and that the level of care that they require will be provided by the contractors that you have put in place in this short-term period.

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

Let us be very clear again that patients will continue to receive very safe clinical care. Medical staff, nursing staff and prescribers are in place. They are all involved in making sure that patients receive first-class care. That is the guarantee that the board has given, and the board will continue to monitor that situation. Let us be very clear on the message that we are sending to the public. I am involved in responsible politicking, I assure you, and I would not make an announcement in relation to securing a contract if I did not believe that that was the case. When the board confirmed with me, the contractor had confirmed that he was willing to take up the position.

We find ourselves in a difficult situation, but we have to chart our way through it. The best way to do that is to find a permanent solution. I have offered up how I believe we can do that. We are engaged with the Southern Trust around its potential involvement. That is looking towards salaried GPs. This practice had four GPs — two main contractors and two salaried GPs. One contractor left, and the other felt under pressure when the two salaried GPs went off on maternity leave. They did not receive the proper locum cover; they could not attract it. A combination of factors led us to this. We need to make sure that the public are assured that they have first-class GP services, and the board is making sure that that is in place. They will continue to monitor it, but we need a longer-term solution here and we are actively working to find that.

Photo of Mark Durkan Mark Durkan Social Democratic and Labour Party

I thank the Minister for her answers thus far. Without a doubt, the situation at Bannview is very serious, and we all hope that a solution can be achieved. However, sadly, it is symptomatic of a wider crisis engulfing general practice. The Minister announced, I think on 23 December, measures that she would implement to assist general practice, and that was very welcome. However, now, in the absence of an Executive and a Budget, what short-term measures can she implement to assist general practitioners to deliver care to patients in need?

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

You are right: on 23 December, I announced that I would take forward the recommendations of the GP-led working group, which charted out key issues that needed to be dealt with in the short, medium and longer term. I have said that I am wedded to making sure that we take those things forward. There is a range of issues. Without listing them all, it is about looking at multidisciplinary teams: who else can we put in to support the GP? As I said and recognise, GPs are under tremendous pressure, so we have to make sure that we do everything we can to support them. The best way that we can do that is to further enhance things like, for example, askmyGP. In the short term, we have committed to askmyGP being rolled out to an additional 30 surgeries. We have increased the number of pharmacists placed within GP services. Those are all things that will help to take the pressure off GPs in the immediate term.

The longer-term solution is looking at training more GPs, and I have already announced that I will do it. There is an absolute shortage, and the point that I made earlier is a really key one: traditionally, in the past, the GP workforce would have been male and of an older generation. There is an ageing population there. Now, a lot more females are employed. There are actually more females than males employed as GPs. They do not all — not just the females, even the males — want to be independent contractors. Let us look at more flexible ways of allowing GPs to work. For example, can trusts be involved in contracting GPs to work for them and provide services for their communities? That is absolutely in line with my vision for health and social care. That is what we need to move towards.

It is a combination of factors. In the immediate term, we just need to keep working. The board and the trusts need to keep working with GPs to make sure that, for any areas that are identified as being under pressure — there are a number of them — we are forward planning, realising what is coming down the line, particularly in relation to retirements, and making sure that we have succession planning in place and plans to make sure that they can pick up the slack where other GPs perhaps retire, for example.

Photo of Doug Beattie Doug Beattie UUP

Minister, thank you for your answers so far. You did not create the problem in general practice; it has been a long-term problem through underinvestment. This is about 5,200 people in Bannview practice who are extremely scared at this time. On 5 January, you said that a contract had been secured. You went on to say:

"I can today confirm that a new contract provider will be in place from early March."

It raises this question: before you rushed out that statement, did you test that contractor to make sure that they had the wherewithal to take on the Bannview practice, or was this about getting something out quickly to put a sticking plaster on a problem and save face?

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

That is unhelpful. We should not scaremonger. Patients are worried, and we should all accept that. The best thing that you could do as an elected representative is to assure those patients that everything is being done to make sure that they have a service.

[Interruption.]

You can ask me a question and accept my answer or not; it is entirely up to you. The message that I want to send to patients is that absolutely everything is being done to make sure that there are clinician teams, medical teams, nursing staff and pharmacists all in place to provide the service in the meantime whilst we find a permanent contract.

It would not be in my interest to stand up and make a statement confirming that I had a contractor if I did not believe that I had a contractor. At that time, when I issued the statement, it was, first, to provide the clarity about the situation that you had all been asking for and, secondly, to make sure that those patients were informed and knew exactly that something would be more permanent. At that moment in time, that is exactly what the contractor said that he could do. Unfortunately, for his own reasons, he has decided that he cannot fulfil the contract. We are now in a situation where, again, a contractor is absent. You are absolutely right: it is not of my making, but it is absolutely my determination to fix it.

Photo of Sydney Anderson Sydney Anderson DUP

I thank the Minister for coming along today in relation to the issue. Bannview Medical Practice in Portadown is in crisis. It is a serious situation. When you come along and put out statements that a contactor has been secured and suchlike, people stop believing anything. They tell me that they are being told lie upon lie. They ask whether this was another lie that was used to stop the protest that was being set up last Friday evening or whenever it was, which they rightly called off, believing that they would get a contractor in place. They feel really let down. There has to be a solution to this.

Minister, do you not agree that now, more than ever, is the time for you to focus all your time and energy on securing the best medical practice in Portadown Health Centre? Stop your politicking and make use of this time, instead of running around putting politics before Portadown Health Centre.

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

I am elected, so I believe that I am in politics. Let us be very clear about one thing: I believe in people power. If the people wanted to go to the streets, I absolutely support that. I would be with them on many occasions and have been over the years, so that is not a problem. Let us not pretend that there was some sort of attempt to dampen down the protest that may or may not have happened. I would not have had a problem with the protest happening: if people are that concerned, they can make their voices heard. That is not a problem.

Do not scaremonger. I am telling you that absolutely everything is being done. I am telling you that, as I stand before you today, clinician teams, medical teams, nurses, doctors and pharmacists are in the practice trying to provide the best possible service and the board continues to monitor it. I cannot say it any other way. It is a temporary solution. I want a permanent solution. I will use every bit of my best efforts to make sure that I find that permanent solution. I have done so continually and will continue to do so for as long as I hold office.

Photo of Paula Bradshaw Paula Bradshaw Alliance

Thank you, Minister, for coming today and answering Mrs Dobson's question. Given that you do not have your budget now, I am not as confident as I was a few months ago that you will be able to deliver on the reform process that you set out in your pathway that was influenced by Professor Bengoa.

This problem will get worse before it gets better, and it is very lamentable that we are now going into an election when we should be delivering on transformation.

I was listening to the radio this morning, and a patient from Bannview was talking about the lack of information. I welcome the fact that you said that the Health and Social Care Board would be letting patients know. What are you doing in the interim to prevent those patients who are frail and elderly, as Ms Lockhart outlined, from going to emergency departments? At the minute, there is a lack of information, and, as we know, emergency departments are already under tremendous pressure, especially in that area.

Photo of Michelle O'Neill Michelle O'Neill Sinn Féin 3:45 pm, 17th January 2017

I agree with you about keeping patients informed; they need to know exactly what is happening. A letter will be going out to them to inform them about the current situation.

You are right about the transformation journey. In Delivering Together, I set out the direction of travel for the next 10 years. All parties more or less signed up to that vision, and that is the transformation journey that we all recognise that we need to go on. It was also recognised very clearly across all staff, patients and the people with whom I engaged that people were starting to get excited about the transformation. They knew that it needed to happen and was long overdue. For the first time, people could start to see a way forward and the need to change radically how we do things. We were going to change the picture on the focus on primary care, including GPs and multidisciplinary teams. The fact that this will now be interrupted because of the scenario we find ourselves in is as disappointing to me as it is to you.

We are in this situation because people need to have confidence in these institutions. When you take tough decisions about transformation, education or any service, people need to have confidence in the integrity of these institutions and in the integrity of the Ministers of these institutions. Unfortunately, we are in this scenario because of the actions of the DUP and its continued arrogance. For me, that is the biggest issue in relation to the lack of a Budget.

I say this to all Health and Social Care staff who have been taken to the top of the hill on the transformation journey: I want to get back to my desk. I want to make these institutions work, but they can work only on the basis of equality because that is the only way in which people will have confidence in the decisions that I take as a Minister or, for that matter, any Minister takes.

[Interruption.]

Photo of Robin Newton Robin Newton Speaker

Members, the Minister must be heard when replying to questions.

Photo of Paula Bradley Paula Bradley DUP

I thank the Minister for her answers thus far. Minister, to say that we are extremely disappointed is an understatement. I do not think that anyone is scaremongering. It is rather disappointing that you continually blame everything on the DUP's arrogance. As one member of this party, I have supported you 100% as Chair of the Health Committee, as we all did on the Health Committee. We decided to take the politics out of health; I still want to take the politics out of health.

We are at the end of the road when it comes to the GP crisis, especially in Portadown. It is not only in Portadown, however. This week, my colleague Mr Humphrey and I are meeting a GP practice that spans north and west Belfast. This is becoming a Belfast issue as well. I still want to support the way forward. I still want to support the stuff that you talked about today in bringing about a better way of working in GP practices, multidisciplinary teams and social workers.

I hear what you are saying. What I want to know is this: when will we see it? We need to see it as soon as possible. I do not know how far down the line we are with Portadown and whether we will ever save it, but GP practices across Northern Ireland are crying out for help. Multidisciplinary teams, social workers and whoever else need to be put into those practices ASAP to save all our other practices in Northern Ireland.

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

I thank the Member for her contribution. I agree and am as disappointed as you are or anybody else is about this contract that we thought was secured but has now fallen through. Nobody is more disappointed than I am. I thought that patients could finally feel comforted by a permanent solution. We do not yet have a permanent solution, but I believe that one is there. We must make sure that people feel assured by the temporary arrangements; that is the responsible thing to do. We must make sure that people and patients feel assured that what is there now is clinically safe, there are services in the practice for patients, and the board will continue to monitor it.

We have to find the longer-term solution. I believe that we can push the boundaries and do things that have not been done before. The Southern Trust needs to step up. As the Member rightly said, we had a good relationship and engagement with the Health Committee, which I welcome. I absolutely believe in taking the politics out of health; it is the only way to deal with the issue. Going forward, I am as wedded to that transformation journey as I ever was. I have very much enjoyed my seven months as Health Minister. I believe that the transformation journey and the Delivering Together document, which most people were able to sign up to, is the most positive work that the health service has seen in quite a number of years. People were up for the change; they were up for the transformation. However, the reality is —

[Interruption.]

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

The reality is that in order for people to have confidence in the tough decisions that need to be taken for transformation and where we need to go, they needed to have confidence in the integrity of these institutions, that decisions are being taken for the right reasons, and to know that the Ministers taking decisions have integrity and equality at their core and that they do not disrespect the issues of —

[Interruption.]

Back-Bench Members can shout all they wish. The reason we are in this situation is DUP arrogance, pure and simple.

Photo of Steve Aiken Steve Aiken UUP

[Interruption.]

Gentlemen. I thank the Minister for her comments so far and for coming through. On a point of clarification, you mention Dalriada. Dalriada out-of-hours service is excellent; I have used it many times for my children. However, the Minister must be aware that it is under severe pressure, and it is based in Ballymena. How will it cover the people of Portadown?

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

There are arrangements in place in terms of a phone triage service. That can be provided no matter where you are. The board is confident that that arrangement works. It works for Dalriada; it is happy to provide the service. It is part of the interim solution to provide services for people. I cannot stress enough that we should not scaremonger; let us give patients the comfort that they need. If people are sick and need services, they deserve to be supported and get all the information possible. I make sure that that happens, and I will make sure that they receive letters to confirm exactly the case that we are in. I will make sure that, every day I am in office, we will work to provide a permanent solution. However, let us be very clear: a temporary, interim solution is in place. This is about patients and about making sure that they know that what can be provided for them is being provided. We are all responsible for that. I can give that assurance.

Photo of Roy Beggs Roy Beggs UUP

GP services are vital, particularly for the old and very young, but indeed for any of us who may have an ailment. It must be of great concern to all of us that the Health and Social Care Board, the Department and the Minister, are unable to ensure that there are alternative GP services available in Portadown. Given that no Budget is set for 2017-18 and that we face an election, will the Minister advise what action she can take to ensure that there are GP services for all citizens in Northern Ireland? My own constituents are patients of the Antrim coast medical practice where a similar situation is emerging, as the long-serving GP, Dr Glover, is retiring after many years of valiant service at the end of March.

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

The board is working with the practice and with local GPs to find a solution to the Glenarm situation. I believe that we can find a solution to covering the practice that is to be vacated. There are solutions. We are working in advance and making sure, as I said earlier, that we are planning for change that we know will happen, such as potential resignations that are coming down the line. We are making sure that all the things are in place. That work is ongoing; the board does not stop working. It will continue to work to make sure that we have something in place for Glenarm and for the wider Cushendall and east Antrim area.

In relation to the Budget, I am as disappointed as anybody that I cannot continue with my transformation journey. I can keep rehearsing it if you wish: we are in this scenario because of the arrogance of the DUP, its lack of integrity, and its failure to listen to the public on the latest RHI scandal. I do not want to be here, but, unfortunately, we are.

Photo of Rosemary Barton Rosemary Barton UUP

Minister, I hear what you say about Portadown. Unfortunately, that situation is about to be replicated in County Fermanagh, where over 30% of GPs are due to retire in the next two years. What steps are you taking at the moment and in future to mitigate the problem of surgeries not being filled?

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

Fermanagh is another issue on which I am in ongoing conversation with the board. The board is actively engaged with neighbouring GPs to try to provide services, and it is looking at the best configuration of those services. Nobody is sitting on their hands. That work is ongoing, and we are making sure that we are planning for the future. We know the challenges in Fermanagh; they are actively being worked on.

Photo of Robbie Butler Robbie Butler UUP

Thank you, Minister, for attending. The first tentacles of this news broke late last week, and we were getting little feeds of information. In the week in which you allege that DUP arrogance has brought these institutions to their knees, I have sat on the Health Committee, where your party did not feel fit to represent the constituents that you have concern for today. What confidence can you give the people of Northern Ireland, as part of an Executive, up until last week, that the two parties before us actually have the health of the people whom we represent at their core, and that this is not all politicking?

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

I take my responsibility very seriously. Since I have come into post, I have been out, I have been engaging and I have been talking to patients, carers and staff, anywhere that anybody wanted to chat, about their current issues and feelings about the health service. I very quickly picked up on the key issues that needed to be addressed. I have set out the transformation journey; I have set out the direction of travel; I have set out a plan on how we can transform the health and social care system. People have really got on board with that plan. There absolutely is goodwill for it, and people want it to work. Unfortunately, because of the scenario that we are in, we cannot deliver, or, at least, it is going to be interrupted. As I said in relation to the transformation journey that I have embarked on, it is as disappointing for me as it is for anybody else. However, the plan is there, the strategy is there and a lot of work was done in the first seven months. I had set out a number of key issues which we would deliver in year 1, and we are well on our way to delivering all of them. For me, that is the key. It has to be about that transformation. We have to deliver real and meaningful change. I have been up for it. I think that anybody who works in the health service can see that I was up for that transformation.

Photo of Robin Newton Robin Newton Speaker

Members, that concludes the item of business. I ask Members to take their ease while we change the top Table.

(Mr Deputy Speaker [Mr McGlone] in the Chair)