GP Contracts

Oral Answers to Questions — Health – in the Northern Ireland Assembly at 2:00 pm on 15 March 2022.

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Photo of Claire Sugden Claire Sugden Independent 2:00, 15 March 2022

3. Ms Sugden asked the Minister of Health whether he plans to review GP contracts with the Health and Social Care Board (HSCB) to provide primary care services. (AQO 3276/17-22)

Photo of Robin Swann Robin Swann UUP

GPs are often the first point of contact for many people seeking diagnosis, treatment and support. They play an important role in promoting health and well-being, supporting people to manage long-term conditions and coordinating patient care across specialities and sectors. They have also played a significant role in our response to the pandemic. That has included operating primary care COVID centres, undertaking an extended flu vaccination programme and playing a key role in the roll-out of the COVID-19 vaccine programme.

The general medical services (GMS) contract sets out the core elements of what GPs must provide to their patients. It is an agreed contract that covers all four nations of the United Kingdom. There is scope, however, for optional and enhanced services to be negotiated annually in Northern Ireland between the Department of Health and the Northern Ireland General Practitioners Committee (GPC), and that allows us to identify local priorities for increased focus each year. Under the quality and outcomes framework (QOF), GP remuneration is tied to the provision of quality care against a range of clinically based indicators. At the outset of the pandemic, the Health and Social Care Board negotiated with the Northern Ireland General Practitioners Committee and my Department to stand down the QOF elements of the GMS contract in order to enable GPs to respond to the escalation of COVID by establishing COVID centres without suffering financial detriment.

My Department recently commenced engagement with the GPC on the GMS contract for 2022-23. The negotiations are at an early stage. It is important to note, however, that GPs have continued to have a responsibility to provide core services to their registered patients and that the pandemic has not, in any way, negated that requirement. The service has been working hard to make best use of available resources for everyone seeking to access the care that they need.

Photo of Claire Sugden Claire Sugden Independent

I thank the Minister for his response. That was really helpful. A misunderstanding exists about how GPs are managed, in that they are, essentially, private organisations that deliver an NHS contract. Minister, I am sure that you appreciate that accessing GP services across Northern Ireland is an issue about which we, as MLAs, are regularly contacted. The fact that the issue is so widespread leads me to believe that it is systemic.

I will ask you a hard question, given that this is probably your last Question Time: is the shortage of GPs due to your Department's poor workforce planning over 10 years?

Photo of Robin Swann Robin Swann UUP 2:15, 15 March 2022

I thank the Member for indicating that this will probably be my last Health Question Time in this mandate. I will miss it greatly.

I do not put the blame for workforce planning and training at the feet of my Department. Having one-year non-recurrent budgets has made those challenges even more difficult. I fully recognise the need for additional GPs to be trained. As such, my Department, with the Health and Social Care Board and other stakeholders, has commenced work on reviewing the number of available training places for GPs in Northern Ireland. My Department has continued to invest in our GP workforce. It has increased the number of GP trainees by over 70% from 2015 levels. There are presently 111 new training places available for GPs each year. Work is under way to review the number of GP training places to ensure that we have the right number of GPs to meet our needs. That is part of a wider piece of work that my Department is taking forward to explore options for meeting our GP workforce needs in the most cost-effective way. It is important to note, however, that the increasing demand for primary care services cannot be met solely by increasing the number of GPs. It is also about other elements, including the wider roll-out of primary care multidisciplinary teams (MDTs) and the introduction of advanced nurse practitioners and additional general practice nurses. All that will make a difference to the way in which services are delivered in primary care and contribute to improved patient outcomes.

Photo of Colm Gildernew Colm Gildernew Sinn Féin

Minister, people continue to struggle to get appointments to see their GP. That is causing extreme anxiety for patients and is putting additional pressure on services and GPs, especially in areas such as Trillick and Dromore. There are particular issues and knock-on impacts in the Fermanagh and South Tyrone and West Tyrone constituencies. Minister, when will the people of Fermanagh and South Tyrone and West Tyrone see extra health staff being deployed on the ground to support GPs in the roll-out of their work?

Photo of Robin Swann Robin Swann UUP

I thank the Member. I nearly set him up by referencing MDTs; he has been pushing my officials on that issue at the Health Committee. I hope to be in a position within the next week to state where that roll-out will be.

The Member mentioned GP services in the south-west. There have been significant GP workforce issues in the Western Trust area, particularly in the southern part. The Health and Social Care Board has been engaging with practices across the south-west area. My Department will continue to work closely with the Health and Social Care Board and GP representatives to consider how best to respond to the challenges that face general practices in Northern Ireland and to ensure that we have a GP workforce in Northern Ireland that is supported, motivated and sustainable, and that continues to provide quality care to patients.

We want to encourage even more highly capable medical students to choose a career in general practice. We recognise that positive experiences during clinical placements can have a major influence on such decisions. The commencement of the graduate entry programme at the Ulster University medical school in Magee is a significant development in that regard. The curriculum of the graduate entry programme places a significant emphasis on primary care placements, with a high concentration on clinical placements in rural settings in the west. That will help to ensure that there is a supply of local students who wish to pursue a career in general practice in those areas. Other elements include the wider roll-out, as I said, of multidisciplinary teams, as well as the introduction of advanced nurse practitioners and additional general practice nurses, all of whom are making a difference.

Photo of Pam Cameron Pam Cameron DUP

What discussions have the Minister and his Department had with pharmacists to ascertain what role Community Pharmacy will play in assisting GP services and moving forward the transformation of healthcare? Will Community Pharmacy be included in the Encompass roll-out next year?

Photo of Robin Swann Robin Swann UUP

I thank the Member. I note her work as chair of the all-party group on community pharmacy and the engagement that she continues to have. I met the senior board and office bearers of Community Pharmacy last week to discuss how we look to the next three-year programme of work that it can do in partnership with us in the Department of Health and across the wider health sector. The Member is aware of Encompass, and I think that the Health Committee will receive an update in the near future on where that will be rolled out. The initial target is for it to be rolled out across all health and social care settings before we look at when it will be feasible and cost-effective to roll it out to the wider health family, which includes Community Pharmacy. The Member will also be aware that, in the meantime, we are looking at e-prescriptions, which can be easily transferred across all health sectors, especially into Community Pharmacy.

Photo of Colin McGrath Colin McGrath Social Democratic and Labour Party

Knowing that the Minister loves Question Time so much, I submitted a question for urgent oral answer. That was accepted, and I will ask it later.

On the theme of difficult questions, at the beginning of February, we submitted a question for priority written answer, which was to be answered within five days. It asked what percentage of the departmental budget is spent on general practice. Is that a difficult question to answer? Might you have that information to hand now?

Photo of Robin Swann Robin Swann UUP

I do not have that to hand now, but I will follow up on that for the Member.