In a packed function room of a Belfast hotel, there were audible gasps when a Co Meath doctor addressed Northern GPs last weekend.
The first time a representative from the Irish Medical Organisation (IMO) was invited to speak to his British Medical Association (BMA) NI counterparts, the event was “probably the spiciest conference in all my time”, according to one attendee.
The keynote address by the IMO’s Dr Maitiú Ó Faoláin centred on the dramatic improvements in patient outcomes and GP retention in the Republic over the past five years, and how this could be the key to solving the crisis in the North’s health service.
A decade ago, “we were those soldiers despairing in the ditch and had burned-out GPs retiring early and newly qualified GPs emigrating at the first opportunity”, said Dr Ó Faoláin, an Ashbourne GP.
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“It was grim, and our funding was completely decimated; we were on the brink of collapse, exactly how it is now in Northern Ireland. It has completely reversed … so I was trying to bring a message of hope.”
The contents of the presentation were a revelation for BMA NI chairman Dr Alan Stout.
“I think everyone’s jaw was dropping,” he said.
“This was the positivity in the midst of all the waves of negativity and problems … It was just so mindblowing and so stimulating in terms of what can be done.”
The BMA leader posted a tweet a day after the event, calling for an “all-Ireland GP service” based on the Republic’s medical card system. “Let’s start the debate,” Stout wrote.
Unionist politicians reacted with fury, branding the suggestion “madness” and “divisive”. Stormont health minister, the UUP’s Mike Nesbitt, told an Assembly watchdog committee on Thursday that a hybrid GP model similar to the South, where over half the population pay to see a GP, will not happen “on his watch”.
For Stout, a GP based in east Belfast, an area of the city once a bastion of unionism, healthcare transcends politics.
“I actually presented on this to all the practices in east Belfast yesterday afternoon; there was no dissent,” he said on Thursday.
“This has nothing do with politics or the constitutional set-up. It’s about better health outcomes.”
The National Health Service’s founding principle of offering free care at the point of delivery has become “an illusion” for patients in Northern Ireland because “they can’t get access” amid spiralling waiting lists, Stout added.
Latest figures show patients with suspected cancerous moles face five-month delays to see a dermatologist following a referral from their GP in the North; the wait for red flag breast cancer patients is up to ten weeks compared to two to four weeks in the South. The target on either side of the Border is 14 days.
Frustration at the lack of access to GPs in the North has also led to increasing numbers of patients living in Border areas to travel South to pay for private GP appointments, according to Ó Faoláin.
Key to “things being flipped” in the Republic was increased public funding for patients entitled to free GP medical care, he added. Those with chronic diseases were proactively managed by GP surgeries instead of hospitals and the results were “transformative”.
Frances O’Hagan, a GP in Armagh for 30 years and chairwoman of the BMA’s GP committee, said what was happening in the Republic was an eye-opener. She attended last Saturday’s conference.
“The thing that got all the gasps around the room was the outcome of the patients who got to see their doctor for free. The State funds general practice to aggressively manage those patients to nail things like hypertension to reduce the risk of stroke and heart attacks.”
Working in a Border surgery, she is concerned about retaining new GPs at a time when growing numbers of practices are either closing or at risk of closure.
Two of her three trainees are medical graduates from the South. “I severely doubt that either of them will stay in the North,” she said, while younger Northern GPs living in Border areas are choosing to work in the Republic.
Stout suggests that Stormont’s Department of Health “could simply lift” the Republic’s medical card contract for Northern Ireland GPs, with the ambition to extend a medical card contract to the entire population.
“It’s this helplessness that we have here,” he said. “You get the same line over and over again – ‘we’ve no money, it’s Westminster’s fault’,” he said.
“Whereas we can do things differently, the South is an example of that.”
