GPs ‘angry, disappointed and disrespected’ by imposed contract | UK News

GPs in Northern Ireland have said the ongoing stalemate with the Department of Health over an imposed financial contract has left them “angry, disappointed and disrespected”.

The move has triggered a work to rule, which includes doctors ignoring non-essential paperwork, limiting appointments to the recommended safe limit of 25 per day and the withdrawal of noncontractual services.

There are concerns the “stalemate” is damaging patient care, Dr Ciaran Mullan, the deputy chair of the British Medical Association (BMA) NI, has said.

Health Minister Mike Nesbitt said he didn’t believe there had been a breakdown in communication, but the money GPs wanted just wasn’t available in this financial year.

Ann Watt, the director of the public policy think tank Pivotal, described the minister’s stance as “unprecedented” and said it “could have a serious impact on patients”.

“It is a situation where the minister has been scathing in his language about GPs and he says that negotiations for this year are over – that’s something that’s never happened before and shows the real depth of feeling on his part,” she said.

Pre-Covid, GPs were recognised as the first point of contact for the public and the gateway to the NHS.

However, GPs now believe a decade of underfunding, increasing patient complexity, rising bureaucracy and recruitment problems have led to a beleaguered workforce.

In a statement the Department of Health (DoH) said: “The minister has been clear that the current state of play in relation to the GP contract is regrettable.”

In 2024, BMA NI, the union which represents and negotiates on behalf of doctors, asked for an additional £80m for their 25/26 contract. Instead, they received £1m.

In a very public fall out in May, the health minister told the assembly that due to budgetary constraints he was imposing a contract on GPs.

Nesbitt also said that “he wasn’t looking for a fight”.

But four months on, the BMA has said the mood music hasn’t improved and they feel the department door has been shut.

Dr Ciaran Mullan, a GP at the Riverside Practice in Strabane, said this is the first time a health minister has chosen to impose the GMS (General Medical Services) contract on GPs.

“We are very unhappy and angry and feel disrespected especially how it was delivered in the assembly – we’d spent a lot of time in our negotiations, and you would not hear any other profession being spoken to like that,” he said.

Making the announcement, Nesbitt mentioned the difficulty the public have accessing their GP as well as the projected £600m gap between available funding and the cost of maintaining existing services this year.

In a statement, DoH said the 2025/26 GMS contract had an additional £9.5m investment, including £5m additional investment in GP indemnity costs.

According to the department, the total investment in general practice in 2025/26 would be £414m.

• Health budget is £7.8bn
• General practice receives 5.4% of the health budget, which amounts to £388m (2023/2024)
• 24/25 general practice asked for an additional 1%, which amounts to an additional £80m – they received £1m
• General practice deals with 2,066,970 patients, which is a 4.5% rise in seven years
• In the past seven years, as the number of practices has decreased the average number of registered patients per practice has increased by about one-fifth from 5,500 to 6,586

Compared with the rest of the UK, investment in general practice in Northern Ireland is the lowest – in England, GP services receive about 9% of the total health budget while in England it is 6.6%.

According to the BMA, the issue of funding is compounded by a shortage of GP’s and increasing pressures have made attracting new recruits difficult.

Up until recently, Riverside Practice had seven GPs but due to problems recruiting it now operates with five.

“We are a practice with two GPs down, which means we have less availability to spend time with patients who have complex comorbidities (the presence of more than one condition) – we should be spending more time with our patients,” Dr Mullan said.

Dr Kate Corrigan, who is involved in attracting and retaining GPs to work in the area, said it can be a “hard sell”.

“We have a lot of trainees on the programme, but it is a matter of helping them while they are here and encouraging them to stay and to stay for their career instead of moving elsewhere,” she said.

In July, the minister announced a new neighbourhood plan, which commits to establishing a neighbourhood-centred health and social care system. A similar plan is being rolled out in England.

The minister said GPs will be at the centre of that plan, which will open all sorts of possibilities for reworking the contract with them.

“If you are asking GPs and pharmacies and community-based organisations to do more, then the obvious logical implication will be more flowing in terms of money out of our budget and into community and health care” the minister said.

The BMA said they they’ve not been consulted about their potential role.

The department confirmed work has “commenced” to develop this model and “it is at an early stage”.

“GPs have an important role to play in helping to develop and deliver this model,” it added.

GPs said they don’t know what will happen next and who will blink first to restart negotiations.

Ann Watt said adopting a more conciliatory tone during negotiations is always best but clearly that had not happened within the Department of Health.

“I think in all negotiations it is good to keep talking. It is always good to treat the other side with the upmost openness and respect and I think a continued conversation would have been better than this stalemate that we have now,” she said.