Derry GPs joining Collective Action for 'patient safety'
'Health outcomes for patients are much , much better if GPs are adequately funded' - Dr Donna Mace
GPs across the North have embarked on ‘Collective Action’ in response to what the British Medical Association (BMA) - their professional body - described as the “imposed” 2025-26 General Medical Services (GMS) contract.
The contract is an agreement between Health and Social Care (HSC) and GPs outlining the terms and conditions under which GPs provide core medical services to their patients.
Local GP Dr Donna Mace, explained the aim of the ‘Collective Action’ was to address concerns about the impact on patient care resulting from the funding of the GMS contract.
Speaking to The Derry News about the ‘Collective Action’ which commenced this week, Dr Mace said GP morale was currently the worst she had ever seen.
A member of the NI General Practice Committee and the Western Local Medical Committee assistant secretary, Dr Mace said: “I have been a GP for 20 years and a partner in Aberfoyle Medical Practice for 17 years and GP morale is really low at the minute.
“We feel we are being constantly battered in the news. If there are any problems in emergency departments or hospitals in general, GPs are immediately blamed and yet we are actually doing the vast majority of the work. People don’t realise that.
“If we were the lazy GPs some people seem to think we are, do you not think we would be reprimanded?
“GPs do 95% of the workload and we get 5.4% of the [North’s] health budget and we are struggling with that 5.4%. We are seeing practices closing.”
Historically GP practices received 10% of the Health budget but that has been steadily decreasing, according to Dr Mace.
“We see GP’s in other areas of the UK receiving better funding which is driving GPs here to retire or leave. GPs can go to the Republic of Ireland and enjoy better working conditions, better pay, a better quality of life. It is a worsening crisis”.
“In addition, we are seeing the population increasing. We are also seeing the number of co-morbidities, chronic health and waiting lists increasing and, if a patient is on the waiting list for a hip replacement, they are going to go to their GP for their pain.
“If their mobility is getting worse or they are falling or frail, their GP is their first port of call, so GPs are having more and more and more contacts.
“Patients can’t get into the hospital so they are going to go to their GPs more and more.
“People say, ‘My GP sent me to the ED’. What people need to understand is this is because we cannot get patients admitted to hospital.
“When I started as a GP, I could ring a bed manager, the junior doctor, and say, ‘I have a patient with abdominal pain. It sounds to me like an appendix. Would you see this patient?’ and the patient would be admitted to hospital. Now I am immediately told, ‘No. They have to go to ED’. That is the policy. It has arisen from the situation where GPs were being told there were no beds.
“There is an ongoing social crisis. There are lots of patients waiting in hospital. They can’t be discharged into the community because the social service is the bit that needs the support. This results in bed blocking, which means they can’t get people through ED into hospital beds.”
She added: “GPs used to be the care navigators and now we are not so we are feeling very belittled. We are losing our role in society. We are getting constantly slated.”
Dr Mace reiterated the GP “Collective Action” was about “safe working”.
“Our hope would be that it is not going to impact patient care,” she added.
“When we talk about safe working, we are referring to studies done, particularly in Europe, where GPs have a safe working of 25 patients in one day, a mixture of face-to face and telephone contacts, which incidentally a high percentage of our patients say they prefer.
“I can tell you, when I am on call, I could get 25 plus patients in an afternoon, so that is not safe. Think about 25 patients in a four or five hour session. How long is that with a patient? You are literally skimming the surface. It is not safe for patients.
“And, if you are skimming the surface, that patient is going to keep coming back because you haven’t properly dealt with everything or you are going to miss something.
“That is what is happening to GPs. They are constantly worried they have missed something because they don’t have enough time with a patient. We get stressed and anxious. We are really worried about the safety of our patients. So, we have recognised, if we stick to that 25 figure, we have more time for our patients. We are less likely to miss things and it is safer for our patients.”
According to Dr Mace, in countries where GPs seeing 25 patients per day is in operation, patient complaints are reduced because they feel they have been heard.
“Patients have had time with the GP and the GP is not rushed and they have had that quality time,” said Dr Mace.
“And then you are also likely to see GPs saying, ‘Actually, that wasn’t a bad day’s work. I feel like I have done a good job for my patients and I am not leaving at the end of the day stressed, worried or anxious or totally physically exhausted’. The hope would be that this would encourage more GPs to come here. This is what is happening in England where GPs are sticking to 25 patients per day.”
Dr Mace said Health Minister Mike Nesbitt needed to support General Practice if he was serious about “shifting left to neighbourhood schemes”.
“GPs want to be able to provide the best care we can. We have all the information and we have the best records. We are the best place to do that but we are at breaking point. We are pulled apart at the seams. We are fatigued. morale is really low,” she said.
“For context, GPs see 200,000 patients a week in Northern Ireland. EDs see 750,000 in a whole year. According to Health Department figures, GPs have 95% of patient contact, with just 5.4% of the budget. GPs see 10 ½ million patients a year in comparison to ED’s 750,000 but people don’t realise this.
“They go into the waiting areas of EDs. They see it queued out and they complain and say, ‘we can’t get through in the morning at 8.30am to see a GP and then the appointments are gone’. What they don’t register is the appointments are gone because GPs are saturated as well.
“If GPs are adequately funded, the outcomes, the primary prevention and the secondary prevention and the health outcomes for patients are much much better.”