A LEADING doctor has warned that the “wheels are about to fall off the GP wagon” in Fermanagh and predicts that health services in rural areas of the county “will collapse” within 18 months.
Dr. Brendan O’Hare, a senior partner at Western Rural Healthcare, has delivered a frank assessment of the crisis facing GPs in this area in which he
* criticises the health trusts for “inefficient and ineffective” record of delivery in this area
* claims nine GPs will leave their posts in Fermanagh in the next year and a half 
* calls on political leadership and senior health officials to “fully understand” the crisis 
* says the only way to save services in South Fermanagh is to amalgamate and move to Lisnaskea 
Dr. O’Hare, based at Castlederg Surgery, has worked in General Practice in the West for 28 years. He recently met with Sinn Fein’s Sean Lynch and Michaela Boyle. 
In a report submitted to politicians and seen by The Impartial Reporter, Dr. O’Hare hit out at the health trusts: “Trusts have no experience in this area. Their record of delivery is inefficient and frankly ineffective.”
“To be blunt, they simply do not have, and never will have, the expertise, interest and focus to understand primary care, never mind deliver it. They would potentially even raid any allocated budget and spend it elsewhere.
“An independent primary care trust with a budget may offer some potential, given the right leadership, but only as a free standing organisation,” suggested Dr. O’Hare.
He claims that of the 32 GPs working in Fermanagh, nine will leave, or have left, in the next 12 to 18 months. 
“Many of the posts that will become vacant are in small one to two doctor GP practices. The pool of GPs we will be trying to recruit from is overwhelming young and female. 90 per cent of all doctors currently training in General Practice are female. Many of them are having children. The current model of employment leaves doctors isolated and unsupported when working alone or with few colleagues. We simply will not attract applications if we do not change things fairly radically.”
Dr. O’Hare recently returned to full time General Practice to amalgamate his practice with a practice in Ederney and two practices in Newtownstewart “where they had been unable to recruit after a retirement.” His practice is also providing interim support to a single handed practice in Rosslea, 51 miles away from his base, where the GP is leaving. 
“Recruitment has failed and no local arrangements have been agreed to date. This will be done at considerable personal cost in terms of workload to the six GPs in our group of nine doctors who are prepared to provide cover. It will also impact negatively on the quality of service we can provide to the 14,700 patients we currently look after, particularly if we are forced to extend cover if local arrangements are not agreed soon,” he said. 
“It is critically important that a serious discussion occurs about how we develop a sustainable solution to the challenges we face,.”
Dr. O’Hare believes “an acceptable compromise” is what he calls “the hub and spoke model.”
“As an example, South East Fermanagh, where the real Western crisis will unfold, lends itself to this approach. 
“There is a health Centre in Lisnaskea. There are small practices in Rosslea, Newtownbutler, Derrylin, Maguiresbridge and Brookeborough, all within 10 miles or less. Five to six GPs are likely to leave in the next 14 to 18 months and services in this area will collapse. 
“An amalgamated group based at the Lisnaskea hub could provide morning or evening outreach surgeries to the spokes for acute problems and home visits but focus activities like smears, minor surgery, immunisation, nursing and chronic disease management at the hub. 
“This arrangement facilitates colleague support and mentorship, flexible and family friendly hours, resilience and leave without the need for locums. It is attractive to the pool we are trying to recruit from: young, part-time, fertile females. I personally see no alternative,” he said.
He believes political leadership and senior department personnel within health “need to fully understand that this is not posturing.” 
“The wheels are about to fall off the GP wagon in the rural west. 
“Resource allocation to meet the crisis is essential. The fact that it is about to happen in the first minister’s back yard can only be an advantage. It will happen on her watch,” warned Dr. O’Hare.