In conjunction with the Business Committee, I have given leave to Áine Murphy to raise the matter of access to rural GP services in Fermanagh.

I ask Members to either vacate the Chamber or take your seats, please. I call Áine Murphy, who has up to 15 minutes.

Go raibh maith agat, a Leas-Cheann Comhairle

[Translation: Thank you, Mr Deputy Speaker]

, and go raibh maith agat

[Translation: thank you]

to the Minister for coming to the Chamber to take part in the debate. I raise an issue that has become one of the most important in my community in recent years and months. As we are all acutely aware, GP access in Fermanagh has become very difficult. Many practices in the North are at breaking point. However, the state of GP practice capacity, especially in rural Fermanagh, is at crisis point.

My GP practice, Lisnaskea medical centre, has approximately 14,000 patients, which makes it one of the largest practices in the North. The issues faced by the practice are well rehearsed and resulted in a contract hand-back in 2022. The lack of GP provision, coupled with increased patient lists, has resulted in demand outstripping supply in relation to GP appointments. The lack of appointments has led to patients and staff becoming increasingly frustrated. Patient and staff frustrations have only continued to grow, and a meaningful intervention to assist them with the difficulties that they experience is required without delay. The patients and staff of Lisnaskea medical centre deserve better than that, and so do patients in any rural practice.

Patients deserve a service that means that they can get a GP appointment when they need one. Staff deserve an adequate plan to stabilise GP services and, most importantly, to protect them into the long term. Primary care needs to be supported, and direct intervention is required. The over-reliance on locum doctors and temporary staff must change. A plan to properly address the specific issues that rural practices face, such as the recruitment and retention of staff, as well as multidisciplinary team (MDT) roll-outs, can act as a foundation to relieve some pressure in the primary care sector.

Cheann Comhairle

[Translation: Mr Speaker]

, if you would indulge me, as I am aware that this is not Question Time, I should like to ask the Minister for an update on the long-awaited new build for the Lisnaskea health centre, because I have submitted questions over the past few months and years on that. Is the Minister willing to meet me to discuss specific issues around GP provision in south Fermanagh?

I gave that indulgence to talk to the Health Minister, but he is a very approachable person. You can talk to him fairly normally most of the time.

I call Deborah Erskine, who has up to seven minutes.

Thank you, Mr Deputy Speaker. I thank the Member for Fermanagh and South Tyrone, Áine Murphy, my constituency colleague, for securing the Adjournment debate, which is vital for our rural area.

Pressures in our GP services are nothing new. For at least a decade, we have been warned of the consequences of underfunding in primary care. In the west, we have unique challenges in attracting the GP workforce. Our constituency is one of the most beautiful in the UK. We are proud of our area, yet it is a rural area and there are challenges to overcome. We need to do more to promote our constituency as a place to live and work. We also need to support the GP workforce that has remained in the area. Recruitment and retention are two sides of the same coin. In the past, I have asked Health Ministers whether they were minded to implement measures that might incentivise GPs to live and work in rural areas. It has been done elsewhere. The Member for South Down was on the Health Committee when we discussed initiatives like that. It could be a measure to address some of the issues in rural areas across Northern Ireland.

In the summer, we heard that there were difficulties in accessing locums to keep services going. There is no disputing that, as local representatives, we hear week in and week out of the challenges that people have in accessing GP surgery appointments. Recent findings from the NI Audit Office reveal concerning trends. Almost one in three local GP practices has sought crisis support in the past four years. That is an alarming statistic that underscores the urgent need for action. We cannot afford to overlook the challenges facing the primary care workforce.

Consider that in the context of Lisnaskea health centre, which my colleague referenced. Recently, as the Minister will be aware, posters were put up outside it. What was achieved by doing that? Frankly, all that it did was demoralise and hurt the staff who work there. They are trying to do their best in difficult circumstances and, as was referenced, in a building that is crumbling around them. I also ask the Minister to give us an update on the medical centre, because it will be a welcome addition to our constituency and to health provision in my area. My hope is that we can develop multidisciplinary teams and aid service provision in one of the most service-starved parts of our constituency.

MLAs in our area face a situation in which we have a GP workforce that is retiring, with little sign of anyone coming forward to take on the mantle in GP practices. I pay tribute to practices in our area and thank them for the work that they do alongside the excellent community pharmacy provision. My practice at Brookeborough and Tempo Primary Care Services was one of 13 practices that had to hand back its contract in 2022-23. The Western Trust stepped in to provide a service for 8,000 patients who were on the books, but the trust's stepping in is an unsustainable situation. In the spring, we heard that the Minister had come to an agreement with GPs on new contractual arrangements. Has that made a difference to GPs coming to Fermanagh and South Tyrone and entering practice in areas?

I come to another question, Minister. It concerns a common complaint that MLAs receive, and it is not unique to Fermanagh and South Tyrone. In 2022, the then Health Minister announced that £1·7 million was to be invested in telephone services. I have asked several times where that money has gone and for a breakdown of the surgeries that received money for those services, but, as yet, I have not had an answer. Perhaps we need more accountability around where money is directed in the system. I ask about that because practices have closed in Fermanagh and South Tyrone or have been amalgamated, and that places a burden on practices, with increased calls to the surgery. We need infrastructure in place to cope with the demand. As I mentioned, we need to see MDT development in the south-west federation area. When services transform and are reshaped in our area, access to services at the first port of call — our primary care settings — will be truly transformative.

That brings me on to a developing situation, which is not in Fermanagh but in south Tyrone. I refer to the Moy GP practice. MLAs in the Chamber will have received correspondence on the issue last week. We were informed that the district nursing team would be relocated to the South Tyrone Hospital in Dungannon without any planned warning having been given to the practice. GP practices such as the Moy practice rely on the district nursing team to support the most vulnerable members of the community. Those nurses are on-site in a more immediate way in our practices, so I would like to understand from the Minister whether that is part of a wider reshaping of district nursing teams across the trust areas or, indeed, whether it is unique to the Southern Trust area.

The problems will not be addressed overnight: I get that. The importance, however, of delivering real change cannot be overstated. I therefore impress on the Minister the need to address the specific concerns in the rural area of Fermanagh and South Tyrone. That should include innovative ways to address the difficulties with GP services in our constituency.

I thank my party colleague Áine Murphy for securing this afternoon's Adjournment debate.

Primary care in a wider sense is generally the first point of contact with the health service for those who become unwell, providing 95% of the care that people need throughout their lifetime. Let me therefore, first off, acknowledge the enormous contribution made by those working in primary care.

While primary care also includes our nurses, health visitors, physiotherapists, social workers, mental health practitioners and community pharmacists, our GPs have shouldered the burden of escalating demand, a declining workforce and real-terms funding cuts like never before.

As Deborah Erskine said, the recent NI Audit Office report on access to general practice found that almost one in three local practices sought crisis support in the past four years. The absence of a specific workforce strategy for general practice has resulted in the failure to train, recruit, retain and reward staff, which has consequently led to a deterioration of service provision and limited progress on the roll-out of MDTs in local primary care settings. That is the foundation of the health service. Significant levels of funding and transformation are therefore required. With more than one in 10 GPs in the North leaving the profession last year, the need for support to preserve and protect the existing general practice workforce must be addressed as a matter of urgency.

The sense of urgency feels even more pressing in Fermanagh, where we have all heard and experienced stories of failure to get GP appointments. While people experience difficulties during the day, it was brought to my attention that the whole of Fermanagh was left without out-of-hours GP cover for at least 36 hours one weekend in July, with some constituents being left with no alternative but to pay for a private GP appointment. I know that the Health Minister cannot fix our GP crisis overnight, but I wrote to him highlighting that cause for huge concern and asking that it not happen again. People cannot afford to pay for it. Inevitably, our health will deteriorate if the two-tier health service continues.

I thank Áine for securing the debate. As Deborah stated, the issue affects all of Fermanagh and South Tyrone, with several surgeries lost in the Dungannon area alone. It is a contracts issue, and I know from my time on the Health Committee that it has many factors. At rock bottom, however, the key problem is the lack of availability of general practitioners. Deborah mentioned their ageing profile and the fact that we are seeing so many retirements. Minister, I urge you to do everything that you can to address that issue. I worked previously with your colleague Robin Swann on the indemnity issue, and that has been resolved.

There are probably other outstanding issues, such as professional qualification recognition across the island, that may help us to attract GPs from elsewhere. There is also merit, I think, in prioritising the multidisciplinary teams, as was mentioned. Those other allied health professionals can bring so much to the equation. They often deal with issues better and more directly than GPs, as well as taking pressure off them. In places where there is particular pressure on GPs, I ask the Minister, as the multidisciplinary teams are rolled out, to consider prioritising areas that have reduced cover or are under threat of losing their cover, so that we do not see any further reduction.

Social prescribing also has huge merit. When it comes to transformation more generally, transforming the social element of primary care is important. We had a debate just yesterday on the European social fund and the value that our community and voluntary sector brings. A lot of that value is in health-related areas. We could look at something there. During COVID, a review was done of what was described as the "alternative workforce". Many of those people were in the community and voluntary sector. There may be areas there that we can look at.

The other area that we could look at is the fact that we now see many more young women coming into general practice. Often, they will require more flexibility or will not want to work five days a week as a general practitioner. Young GPs coming out of medical school often want to specialise. If we can find a way to develop contracts that encourage that, we may see more young students coming into general practice.

It is called primary care for a reason: it is the first point of contact. It is where well-being can be attended to and where illness, deterioration, hospitalisation and a worsening of conditions can be prevented if we get proper GP care out into the community and support general practice to deliver the service that it does so well.

Hawk-eyed Members will have noticed that I am not from Fermanagh or South Tyrone, but I am happy to speak on behalf of the SDLP in the Adjournment debate on the important issue of getting rural healthcare services right for people. Fermanagh is a great example, so if we can get it right there, we will be able to get it right in any rural community across the North.

All that I want do is offer my reflections. Over the summer, as a member of the Health Committee and someone with an interest in health, I visited a number of the bigger GP practices in my constituency to catch up with them, find out how things were going, see what pressures they faced but also see what was working well for them. I know that I am echoing remarks that have been made, but we are really lucky in South Down to have the MDT teams. They are a game changer.

In one of the health centres that I visited, the doctors take between half an hour and an hour in the morning to triage all the calls that come in. Depending on what is needed, they then send the patient to the relevant profession, be that social work, physiotherapy, counselling or pharmacy. One of the GPs said to me, "If somebody rings me up and says that they have a sore elbow, there is very little that I, as a GP, can do". If that GP can send the patient straight to the physiotherapist, however, that person will get the exact care that they need, without having to spend 10 to 15 minutes in a GP slot, only to be told that they need physiotherapy: they can be directed straight on to the physiotherapy list.

The GPs in that practice spend a bit of time each morning populating the timetable for the rest of those professionals. That means that people get the exact care that they need, which is better care, and are not blocking appointments in the GP practice only to then be sent somewhere else. Those GPs said that that system works fantastically for them. In a rural community, you need to be able to go to a primary care facility and get the treatment that you need there, rather than be signposted somewhere else, which may be a hospital that is 25 or 30 miles, or even further, away. The experience of those MDTs was very positive, and they work well for people in a semi-rural community like the one that we have in South Down. I think that those teams would be of great assistance to existing services.

Another important point that the GPs in that practice raised was that they felt that they were getting work done. They felt that they were directing patients to the services that they needed and that they were therefore getting to see the patients that they actually needed to see. They felt a bit of satisfaction in their work because they were able to do the signposting to other services in their health facility and get people appointments much more quickly. That gave them a sense of reward in their jobs, which is what makes people want to go into work each day. By contrast, in health centres that are just trying to get through long lists that they never catch up with, the GPs never get enough of their work done and start to feel stressed. If they feel stressed and unhappy in their work, they will want to go somewhere else where they do not have those pressures. Then you end up with practices that collapse.

We all know that MDTs are a game changer, and we can see what they do. I hope that the Minister can give some feedback on how quickly we can get them rolled out even further so that we can provide those services where people need them.

Minister, you have up to 10 minutes.

Thank you very much, Mr Deputy Speaker. I thank Áine Murphy for securing the Adjournment debate, and I thank the Members who have contributed. This is an opportunity to recognise and pay tribute to the fantastic work that is carried out by our primary care services.

It is obvious that I am on my own in the Chamber, in a party political sense. Baron Elliott of Ballinamallard would have loved to have taken part in the debate, as he represents the area, but he was called away, and our health spokesperson, Alan Chambers, has been inconvenienced this afternoon. So, it should not be taken as a lack of interest from my party on the issue.

I will come to Members comments presently. Over the past three and a half months, I have had the opportunity to meet many staff working across primary care, including a number of representatives from the South West GP Federation. We are very fortunate to have such a dedicated workforce. I am very aware of the challenges that face general practice. Those are particularly felt in rural communities, because there is a feeling there of being left out of public services and investment more generally. I appreciate that some people in Fermanagh have concerns about whether they will continue to be able to access high-quality primary care in their area. Those concerns are, of course, not unique to Fermanagh, but they carry a particular weight in rural areas. I reassure you that my Department has worked and will continue to work very closely with GP representatives on how best to respond to those challenges.

As some of you will be aware, I want to make it my mission to tackle health inequalities in Northern Ireland. I have announced plans for a pilot scheme under the banner "Live Better" that is aimed at taking services right into the heart of the community and making a positive difference to people's life. I am very aware of the recent issues that were raised in the media about escalating tensions at the GP premises in Lisnaskea. Let me make this clear: that behaviour is absolutely unacceptable, and I condemn it utterly. I fully support our primary care staff and value the dedication that they show daily to those who need them.

You asked about the new health and care centre in Lisnaskea. That facility will support the delivery of integrated primary and community care services for the population of Lisnaskea and the surrounding area of east Fermanagh. I hope that I will not frustrate you too much when I say that the announcement is imminent.

[Laughter.]

Boom. I am sorry. There is no issue that I am aware of that will delay it. It will happen. It is tied in with a couple of other announcements. They need to be tied down — the i's need to be dotted and the t's crossed — and then I will be ready to go. Imminent means imminent.

Will the Minister give way?

Of course I will give way to the very frustrated Member.

Thank you to the Minister for giving way. Are we liable to see diggers on the ground before the end of 2024?

I will get back to you.

[Laughter.]

There have been too many broken promises to make a promise in the Chamber. I want to get the time frames absolutely nailed down. I promise that, when I say "imminent", I do not mean weeks and months.

I acknowledge and appreciate the need to further stabilise and bolster capacity for services in primary care more generally. I fully understand the ongoing challenges that patients and GPs along with their teams face, not least the increasing demand and resultant increasing workloads. Colm Gildernew's point about the workforce was extremely well made. When we think about health and social care, we think about buildings, equipment and medicines, but they do not matter, or they do not count, because they cannot deliver without the workforce and the people.

Officials in my Department have worked hard to ensure that, where contracts have been handed back, no practice has closed — I commend them for that — and patients have continued to access GP services in their area. Stability of services across Northern Ireland will require new ways of thinking about how our services are organised. In Fermanagh, the Western Trust is playing a leading role in promoting stability through holding the contracts for GP practices that have got into difficulty. There are three such practices in Fermanagh, and my Department is supporting the Western Trust to move towards a more sustainable model for service provision in those practices through the appointment of salaried GPs. That will help to strengthen the service in those practices and reduce reliance on locums, which is a very expensive way of doing business.

We cannot continue with a situation where, in some instances, GPs face such sustained levels of pressure that they feel that the only course of action left open is to hand back their contact. I want to build resilience and capacity in that service. However, I am under no illusion that the new 2024-25 contract will resolve all the challenges that face GPs. The issues that are impacting general practice are complex and will require a sustained and long-term response.

In a standard week, our general medical services clinical teams carry out over 200,000 consultations, over half of which are face-to-face. I think that that maybe explains part of the pressure on access to services. I also share this with Members: according to our Business Services Organisation, we currently have 1,448 GPs, excluding locums. That is an increase over the past 10 years of just about a quarter: 22·7%. Per 100,000 registered population, we are just behind Scotland in the headcount of GPs. Scotland has 77·1 GPs per 100,000 registered population; we have 70·9 GPs, which compares really favourably, particularly with England, which has the lowest ratio at 56·4. That suggests that we should not have the problems that we are having to endure at the moment, so I am determined to work at that.

Jemma Dolan made the point that 95% of first contact is at a primary level. That is true, but it is also true that primary gets 5·4% of the total budget. I would like to see that go up really significantly. That is why I am promoting what Professor Bengoa called the "shift left". In an ideal world, if you need access to healthcare, you get it in your home, and if you cannot get it in your home, you get it as close to your home as possible in a GP surgery, a community centre or whatever. The second-worst outcome is having to go to an acute hospital. The worst outcome is having to go to an acute hospital and stay overnight. The problem with the budget is that, if you are in an acute hospital, that is where the big problems and the expensive processes to fix are. To shift the budget left will require health inequalities and health literacy to be tackled, and people to be more conscious about staying healthy and not getting sick.

Deborah Erskine talked about promoting the beautiful constituency of Fermanagh and South Tyrone. Áine Murphy asked whether I would meet her to talk about problems in south Fermanagh. I most certainly will, but maybe we should do it in the beautiful constituency of Strangford. Maybe we should go down to Harrisons on Strangford lough and have a little meeting there. Other restaurants are available.

What else can I say in response? I want to talk about multidisciplinary teams. Professor Bengoa reported eight years ago. Some people think that that report went on to a shelf. It did not; we have started actioning it and shifting left. We have daycare procedures in places such as Lagan Valley. We have elective overnight centres, such as the South West Acute Hospital, and I hope that we will develop the Causeway Hospital in the fullness of time. Things are happening. The professor is coming back — he is scheduled to be here on 9 October — to reboot that report. That is when I am going to say, "We need to finish this deal". Multidisciplinary teams clearly work. They are probably the biggest success story of recent years in transforming our health service. Seven of the 17 GP federations have MDTs. Fermanagh and South Tyrone is down to be one of the three in the next tranche, but I gently say this to the Members opposite and Mrs Erskine: you voted for the Budget. We did not vote for the Budget in this party, and one of the reasons was that we were not going to be able to roll out the MDTs as we would wish.

Let us speak again after the debate about south Fermanagh.

Thank you very much, Minister, and thank you, everybody, for your contributions to the debate.

Adjourned at 4.34 pm.