Northern Ireland

GPs and their uneasy relationship with NHS

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Image caption Hundreds of individual Northern Ireland GPs have signed undated resignation letters, meaning they could leave the health service

GPs in Northern Ireland have been saying for some time that the profession is entering a "perfect storm" over problems with recruitment, funding and workloads.

In December, hundreds of individual GPs signed undated resignation letters, meaning they could leave the health service.

The GPs are members of the British Medical Association (BMA), the professional association and trade union for doctors.

They met in Belfast on Wednesday to agree the next step in the process.

They have now voted to collect undated resignations from practices, something which NI GP Committee chair Tom Black says was done with "deep regret".

"General practice is on the brink in Northern Ireland and we feel we have no alternative to proceed with collecting undated resignations from our members," he said.

This is not the first time GPs in the BMA have threatened mass resignation as a look back at the health service shows.

Beveridge blueprint

The term general practitioner first appears in records in the early 19th century. The role evolved separately from physicians and surgeons, who specialised and held hospital appointments from which GPs were largely excluded.

Before the setting up of the NHS in Great Britain, people not covered by the National Insurance Act 1911 either had to join a medical aid society or pay to see a family doctor.

A famous report by William Beveridge in 1942 provided a blueprint for the welfare state that changed everything.

The BMA, while initially supportive of some aspects of a national health service, became strongly opposed by 1946.

They negotiated directly with British Health Secretary Nye Bevan to ensure general practitioners did not simply become salaried employees.

In Northern Ireland, health reform was done via Stormont and, according to historian Dr John Privilege from the Centre for the History of Medicine in Ireland, GPs in NI got a good deal.

Image caption GPs threatened mass resignations in both the 1950s and 1960s

"Doctors were given a seat at the negotiating table not only from the get go, they were also consulted on framing legislation and on the form their payment and compensation would take," he said.

"For example, they received compensation to the tune of £2m for the loss of potential revenue and the fact they could no longer buy and sell their own practices."

People in Northern Ireland were enthusiastic about the new service and figures show that 93% of the population enrolled with a GP.

But less than 10 years after it was set up, GPs across the UK were threatening to leave.

Mass resignation threats

John Simpson, a former chair of the Eastern Health Board in Northern Ireland, said: "I think that the threat of resignation in 1957 was a continuation of the fact that they still hadn't settled the institutions that became the national health service.

"That has been there ever since, it set the tone and we lived with a situation where we have not really got a settled relationship between general practice in the health service and what we as citizens expect."

The immediate threat from GPs was lifted when the Westminster government set up a Royal Commission on pay.

But it wasn't the last use of the mass resignation technique, which resurfaced in the 1960s.

GPs felt they had too many patients, too much form-filling and that they weren't properly supported.

The BMA came up with a charter and collected letters of resignation from nearly 80 percent of GPs.

A solution was thrashed out and formed the basis of a new contract.

The 1970s and 1980s were more settled decades. With the Blair government in place in the late 90s, the BMA again took ballots on mass resignation in 2001 and considered doing so in 2008.

Now Northern Ireland GPs say they're on the brink of resigning from the health service, citing pressures of overwork and under-resourcing.

For Dr Privilege, this is unexpected.

"The lines of communication between medical professionals and politicians in Northern Ireland, even under direct rule, were always good," he said.

Image caption Dr Tom Black said general practice was "being delivered under unsustainable conditions that we can no longer tolerate"

"Somewhere that link has been lost and you no longer have this communication between government and medical professionals."

For Mr Simpson, the current situation could be the beginning of a bigger conversation about the role of GPs.

"Around 95% of contact with the medical profession is with the general practitioner and the availability of GPs to do that is becoming limited.

"We've seen under Transforming Your care and the Bengoa proposals that primary care should be shaken up and do much more to prevent us loading people into hospitals."

Dr Black said he and his members have been left with no choice.

"The work of the Northern Ireland government may have stalled, but the need to provide safe and efficient healthcare to patients has not stalled," he said.

"General practice is being delivered under unsustainable conditions that we can no longer tolerate."

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