New GPs are badly needed as several Northern Ireland surgeries are in crisis due to staff shortages
By Eimear Flanagan
BBC News NI
Almost 20% of Northern Ireland’s GP training places are yet to be filled, just days before the new academic year is due to begin.
The Department of Health is funding 121 training places but only 99 junior doctors have taken up the offer.
A department spokeswoman said: “It is regrettable that not all the funded GP training places have been filled yet for the 2023-24 year.”
They said “significant efforts” were being made to recruit more trainees.
However, the British Medical Association (BMA) said the figures were “concerning for the future of the general practice” and called on the department to take urgent action.
“New GPs are coming through but this number is not keeping up with the number of older GPs we are losing to retirement and burnout,” said Dr Frances O’Hagan, deputy chair of BMA’s Northern Ireland GP committee.
“We simply do not have the workforce to deal with growing patient numbers and workload demand.”
Getting to know patients
A total of 285 students graduated with a degree in medicine this year from Queen’s University Belfast but only some of them will choose to specialise as a GP.
One of the hopefuls is Tim Neill, a 23-year-old medical graduate from Poyntzpass in County Down.
“The whole way through I’ve been pretty keen on following on into general practice despite the things that have been in the news as of late,” he told BBC News NI.
Image source, Dr Tim Neill
Dr Tim Neill is the first member of his family to enter the medical profession
“There’s the old adage that a GP cares from the cradle to the grave,” said Dr Neill.
“It is true that you get to know patients and their families the whole way through life.”
He has just started his first foundation year as a junior doctor and part of his ward duties include writing discharge letters to send patients home from hospital.
“Discharge letters always end with the phrase that they are ‘discharged back to the care of their GP’ and it is attractive to be that coordinating person who gets to know a family,” he said.
Dr Neill spent his final year at Queen’s University as president of its GP Society and part of its mission is to promote general practice as an exciting and varied career.
‘The job goes beyond normal hours’
His personal ambition has not changed despite witnessing the pressure on doctors during several work placements in various surgeries over the past few years.
“The workload the GPs are seeing coming through has just exponentially increased and as students we get a grasp of that,” he said.
“It’s important to recognise that even though a GP surgery is only open between the hours of maybe 8am and 6pm the job goes far beyond that.
“GPs that I have been with this year are coming in in the evening; they’re coming in early in the morning; they’re coming in on holidays; and they’re coming in at the weekend just to write up paperwork; to look through blood results; to look through letters; to write referrals.
“All these things are spilling over into time that, as with any human being, we need to rest and we need holidays and we need time to get away from the workplace as well.”
Image source, Tim Neill
As a medical student Tim Neill completed work placements before and after the Covid outbreak
Pressure on GPs surgeries and the health service in general has been unrelenting the system tries to deal with the backlog of postponed appointments that built up during Covid-19 pandemic lockdowns.
Over the past year 16 surgeries across Northern Ireland have asked to hand back their health service contracts, with many doctors complaining that it had become impossible to staff and manage the service.
In March 2022 the then Health Minister Robin Swann responded to the shortages by temporarily increasing the number of GP training places from 111 to an “all-time high” of 121.
The same number was made available this year but the Northern Ireland Medical and Dental Training Agency (NIMDTA) has filled only 82% so far.
It is hoping to increase this year’s intake by recruiting more trainees with a February 2024 start date.
“Significant efforts are being made by NIMDTA, including a proactive communications campaign targeting doctors who have completed the Northern Ireland Medical Foundation Programme within the past three years, particularly those currently working locally as locums or abroad on short term contracts, who are now thinking of settling on a GP career,” said the Department of Health spokeswoman.
Image source, Tim Neill
Dr Tim Neill graduated from Queen’s University Belfast this month
As well as the difficulties of getting young doctors to commit to GP partnerships, Northern Ireland is struggling to retain homegrown medical graduates, some of whom emigrate after their health service training.
Dr Neill said he understood the appeal of that, because pay and conditions for junior doctors are often better abroad than at home, but he added that it was not all about money.
“The work-life balance is the thing that my friends and my colleagues are talking about. That is by far and beyond the greatest factor to pull people away from Northern Ireland,” he explained.
“But it depends on the person. I am openly a bit of a home bird so I probably will stay here but the idea of taking some experience abroad, even for a short period of time, is definitely still attractive.”
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It takes a decade to qualify fully – after five years of medical school Dr Neill and his fellow trainees face a further five years of GP training.
He believes the GP shortage is partly a lack of workforce planning but said that the workload was deterring junior doctors from taking up full-time posts or entering GP partnerships.
Even he admits to being a little daunted by the prospect of dealing with a surgery’s finances, including building costs, rates and “vastly increased” electricity bills, on top of caring for patients.
But despite the problems, Dr Neill insisted that he still wanted to work as an health service GP and believed there was “a very steady level of interest in general practice” among his fellow students.
He pointed to an increase in the Queen’s University GP Society’s membership number, which rose from 256 last year to more than 300 this year.
“There is a positivity to be seen in all of this because, despite everything that’s going on, patients in Northern Ireland do receive an exceptional quality of care from their primary care team,” said Dr Neill.
“There are difficulties at the minute that we have to work through and the powers that be have recognised that and it’s just a case of finding the right answer and the right balance.”
