Domhnall MacAuley: Northern Ireland general practice

Domhnall MacauleyLast night Clare Gerada, chair of the RCGP, spoke in Northern Ireland about the Future of General Practice. This morning she meets our new Minister of Health. She described her vision and what she would like to achieve. She was, perhaps, trying to encourage the wrong audience – those present already believe in her values.  But, this morning when she meets our Minister she has an opportunity to influence our future.  A voice from London may hold more sway – general practice has a problem being heard. I suggested that she might mention the following:

1) The “department” view.  The departmental and health services management view of general practice seems to be that we are money motivated lesser doctors; QoF is a bonus rather than an incentive to good care and; that we need to be controlled. This view seems to colour every discussion and is very destructive. Clare could, perhaps, emphasise that the majority of GPs are conscientious committed doctors whose main motivation is to give good evidence based care to their patients.

2) The primary care team. It will soon be history. Health visitors are no longer practice attached. District nurses are accessed via an anonymous impersonal telephone system, physiotherapy which used to be available in our practice, is similarly accessed and provided elsewhere. Some practices still organise primary care team meetings to link with board employed staff, but it is increasingly difficult. The rest of the world is moving forward- our system is retreating to the days of isolated GPs in a parallel service.

3) Academic leadership. Our local medical school does not have a professor of general practice as the post has not been filled since the previous chair retired. An entire cohort of doctors have now qualified without a role model, where general practice does not have equal standing in the academic hierarchy, and they will start their career thinking general practice is a lesser discipline. The medical school seems focused on new buildings and lofty research aspirations but they forget that it is a regional university providing local doctors. Today’s students are tomorrow’s general practitioners and most stay in Northern Ireland.

The attendance at the meeting was disappointing; some old friends of my generation; doctors in training and young principals but few from the main mid career bulk of general practitioners. Clare Gerada has a high political profile and the College is very active in countering the health service reforms in England. This is of little relevance to Northern Ireland general practice. Our needs are different and more basic but it is great to have Clare’s support.

Domhnall MacAuley is primary care editor, BMJ