GPs: Multidisciplinary Team Support

Oral Answers to Questions — Health – in the Northern Ireland Assembly at 2:00 pm on 26th April 2021.

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Photo of John O'Dowd John O'Dowd Sinn Féin 2:00 pm, 26th April 2021

3. Mr O'Dowd asked the Minister of Health for an update on the roll-out of multidisciplinary teams to support GPs. (AQO 1921/17-22)

Photo of Robin Swann Robin Swann UUP

I thank the Member for his question. The primary care multidisciplinary team (MDT) model introduces new physiotherapy, social work and mental health roles into GP practices to work alongside an enhanced level of nursing staff and the existing practice team. It aims to move from a system of treating illness to holistically supporting good physical and mental health and social well-being.

Like many transformation projects, the expansion of the programme has been affected by the COVID-19 pandemic. However, the MDT model is in development in five areas across Northern Ireland: Londonderry, west Belfast, Causeway, Newry and district, and north Down and Ards. It is fully implemented in the Down GP federation.

Across all the areas, the programme supports 300 members of staff. My Department and the Health and Social Care Board are engaged in a process to develop the road map, as I indicated. That involves engaging with all those in general practice and the trusts to agree realistic and achievable proposals, which will then be aligned with the overall strategic priorities or current and emerging pressures.

That road map, as I said, is due to be completed before the summer, and will enable robust planning on the cost and timescale for the roll-out. However, further roll-out of the model is dependent on the availability of a suitably qualified and experienced workforce, readiness of accommodation and appropriate funding.

Photo of John O'Dowd John O'Dowd Sinn Féin

I thank the Minister for his answer. Does he agree that if we are to turn around the oil tanker that is the health service, we have to concentrate on primary as much as acute care, and perhaps more on primary? I understand that only five of the 17 multidisciplinary teams have been established. If we were to establish them, surely that would take significant pressure off GPs and acute services.

The Minister may be interested to know that, recently on social media in my area, patients were asking one another how often they had to phone their GPs to get through. The dubious winner was hitting redial 400 times to get through. Many of those patients will be seeing their GP simply to be directed to another service. It would appear to me that MDTs would be the answer to much of that problem.

Photo of Robin Swann Robin Swann UUP

I fully agree with the Member about the benefit that MDTs will bring because it is about that multidisciplinary team aspect. When they were initiated, or even first talked about here, there was much reluctance about somebody going to a GP thinking that they had to see the GP, but they saw the benefits when they could see a physiotherapist, a nurse practitioner or even a pharmacist face to face rather than having to wait to engage with a GP.

Our GP colleagues see the benefits as well. Experience to date has shown that many of those working in MDTs were recruited from existing roles within health and social care trusts. Recruitment to our MDT roles must be progressed through a measured approach so that we are not robbing Peter to pay Paul and shifting the same staff around the service.

The Member made the analogy of the health service being an oil tanker that needs turned around. We need to start turning it around very fast. The health service has been able to reposition itself pretty quickly over the past 14 months, but we need to make sure that the support is there to turn it around, get it parked and get it to a place where it supports the entirety of Northern Ireland, including through investment in primary care, in secondary care and across the workforce of the health and social care family.

Photo of Pam Cameron Pam Cameron DUP 2:15 pm, 26th April 2021

Minister, we realise that the roll-out of the multidisciplinary teams is vital. As Mr O'Dowd has just said, it is very important to note that the pressure that GPs are under is much greater. That is primarily due to the switching off of healthcare appointments during the pandemic. Many of these calls and queries are from patients who have not been dealt with in secondary care. Given the disparity in access to GPs across Northern Ireland, what work is being done to ensure that GP access does not continue to be a barrier to early diagnosis of life-threatening conditions? Basically, Minister, what I am asking you is when we will see face-to-face GP appointments being made readily available to the public.

Photo of Robin Swann Robin Swann UUP

I thank the Deputy Chair of the Committee for her points. I do not agree with the use of the term "switching off". We had to take drastic steps during serious waves of the COVID pandemic that put serious pressure on the entirety of our health workforce.

I want to be clear that our general practices are open. They have been open throughout the pandemic. I pay tribute to GPs' hard work, commitment and innovation as they continue to provide a critical service for us all. GPs have continued to see patients. Indeed, the number of consultations is now close to pre-pandemic levels. The most recent figures, for the week ending 16 April, show 83 consultations per thousand, compared with 87 consultations per thousand in November 2019. Despite the need for social distancing and infection control, GPs have been able to maintain face-to-face consultations at a level. Of those recent consultations, 37% were face to face, compared with 50% in November 2019.

As has been clear from the outset of the pandemic, our GPs are working tirelessly for the good of everyone in the community. They have not only delivered a range of additional services, including COVID centres and vaccinations, but have remained focused on continuing to deliver core, vital services. We owe all of them a huge debt of gratitude for the work that they have done. I acknowledge that that level of service is not consistent across all GP practices. A small number have not stepped up to the mark and the expectation of even their own colleagues.

Photo of Cara Hunter Cara Hunter Social Democratic and Labour Party

My question refers to the point made by the Members who have spoken. Understandably, people have deep frustration and concern about not getting face-to-face appointments. We are all hearing it from our constituents. Off the back of that, what conversations are you having with patients and GPs about face-to-face appointments resuming as soon as possible?

Photo of Robin Swann Robin Swann UUP

As I have said before and referenced in the answer to the previous question, we have seen an increase in face-to-face consultations and how we are now, compared to where we were in November 2019. The situation in regard to face-to-face GP consultations is improving. However, we need to be clear that many patients' experience of trying to access GP appointments is comparable to what it was pre-COVID. It was not a good level of service then either, because we saw a decrease in the number of GP practices and GPs across Northern Ireland.

I pay tribute to and support my GP colleagues in the healthcare family, who have stepped up and gone above and beyond to work in COVID and vaccination centres and who have supported their patients throughout this time. Like me, they will want to get back to as normal a health service as we have seen in the past. That will be replicated in the Royal College of GPs and British Medical Association. The Member has heard those representations at the Committee. She knows the input that health professionals and organisations are putting into returning our health services as much as possible to face-to-face consultations while realising that those services are still under pressure.

Photo of Rosemary Barton Rosemary Barton UUP

I thank the Minister for his answers so far. Hopefully, the all-in-one stops will improve the accessibility of care for all patients. Will you, Minister, give your assessment of the impact of the MDT model so far?

Photo of Robin Swann Robin Swann UUP

I thank the Member for her point. As I indicated in my original answer, the impact of the MDT programme has been to provide more care closer to people's homes and to improve access to early support and diagnoses by proactively managing patient need in the local GP practice setting through a multidisciplinary early intervention team. In my answer to the original question, I talked about the professionals that patients can actually access.

During 2019-2020, across the five sites, a total of 41,459 first-contact physio appointments were made, 86% of which were managed in primary care and only 12% of which received onward referrals. Continuing the roll-out of primary care MDTs will support the transformation of service provision in the context of a rapidly changing landscape of treatment options, workforce gaps and opportunities for change. Given the innovative nature of that approach, learning and evaluation are key elements of the MDT programme. The effectiveness of MDTs is being reviewed on an ongoing basis through an independent evaluation. Although year 1 of that evaluation has been heavily impacted by COVID, work is ongoing to address those challenges.