IN a “cry for help” and an “act of desperation” General Practitioners (GPs) across Fermanagh have agreed to sign an undated resignation from the health service.


The drastic step was agreed upon by the overwhelming majority of local GPs attending a ‘GP in Crisis’ meeting in Enniskillen last Tuesday.
“Disillusioned” by the historic lack of investment in the profession, GPs believe the situation in Fermanagh has not only reached a “critical” stage, it is “almost terminal”.


“We are watching the family GP service in Fermanagh crumble,” Dr. Brendan O’Hare told The Impartial Reporter this week, “We are literally withering. The tone of the meeting last week was just total disillusion. And yes, undated resignations is a drastic step. But it is that or nothing -- it is a cry for help and it has been done in an act of desperation. If things continue the way they are going now, we won’t have a GP service.”


Last week’s meeting in Enniskillen, organised by the British Medical Association Northern Ireland’s General Practitioners Committee (NIGPC) was attended by more than half of Fermanagh’s GPs.


In a radical step, 92 per cent of them agreed that they were willing to sign an undated resignation from the health service in order to prevent its complete collapse.


The decision to ask GPs to consider undated resignations follows a motion taken at a meeting of the Local Medical Committee (LMC) in March where doctors voted in favour of seeking support for such a mass action if the Department of Health failed to negotiate a rescue package for primary care within six months. 


NIGPC is calling on Health Minister Michelle O’Neill to ensure the survival of general practice throughout Northern Ireland by investing 10 per cent of the Healthcare budget on a “safe, sustainable GP service for patients; training more GPs so practices at risk of closure can stay open and meet the needs of patients, and; reducing bureaucracy and improve IT systems so more time can be spent providing care to patients”.


The issue also received air time during this month’s full council meeting.


Speaking at Tuesday night’s meeting, Independent councillor Josephine Deehan said the situation facing GPs was “unacceptable.”
“This is a matter which I believe should be raised at the next meeting with the Western Health and Social Care Trust,” she said.


Brian McCaffrey, Sinn Fein, described problems with GP services in his area of Rosslea as “an ever worsening situation” and said doctors were “performing an impossible task.”


“The number of GPs is getting smaller and smaller,” he said.
“There needs to be efforts made, possibly on a cross Border basis, to draft in GPs.”


Dr. O’Hare, originally from Enniskillen, runs a GP surgery in Castlederg. It recently amalgamated with Ederney and Newtownstewart in order to ensure patient care was not compromised when GP posts were vacated. During the Summer, his practice also delivered critical services to the Rosslea area, following the retirement of Dr. Donal Collins.


“It was a measure of how stretched the system is in Fermanagh when no other GP practice in this area was capable of supporting that surgery in Rosslea,” he said, “And the situation is only getting worse.
“We covered Rosslea at a personal cost to ourselves. It was done to keep the service afloat. But as you can imagine, operating a practice from 51 miles away wasn’t easy -- that is how far away Castlederg is from Rosslea.”


According to Tom Black, chairman of Northern Ireland’s General Practitioners Committee, whilst the GP crisis is being felt right across Northern Ireland, the experience in Fermanagh “is more advanced”.
In less than two years, 12 GPs have vacated their posts.


“It is difficult to say how cover is going to be provided here,” Dr. O’Hare said.
“We know it is really at a critical, almost terminal level now. People think this is a bluff, we are not winding this up.
“As long ago as 15 years ago warnings were being made that this crisis was coming. You only had to look at the demographics of the GP ages. But the Department hasn’t until last year made any attempt to increase training places. 


“Thanks to all of this, General Practice is not seen as a desirable career. And even if the uptake on training places was good, we would have to wait a minimum of three years to see any benefits because of the length of time it takes for training to be completed.”


According to Dr. O’Hare, there is a general scepticism amongst the GP profession towards the Department of Health’s commitment to resolve the crisis.


“We have had four reports now, including the Hayes report, the Compton report and the latest, the Bengoa report,” said Dr. O’Hare.
“The other three reports are gathering dust somewhere -- they never went anywhere.


“And the latest appeared in all the usual trumpeting and fanfare -- recommending that resources be moved here and there. But it is our bitter experience that none of this actually ever happens.
“It is stymied somewhere along the line.


“We would love to believe the Minister will deliver on her commitments, but we have had our fingers burnt so many times. So it has become a case of: ‘we will believe it when we see it’.”


According to Dr. O’Hare, all those present at the crisis meeting last week had reservations about agreeing to the undated resignation.
“It’s certainly not a step which has been taken lightly. 


“Ultimately we could end up with something much more like the Republic of Ireland where you would pay for the kind of service you are getting now.”


Lisnaskea General Practitioner, Dr. John Porteous, is now covering the vacancy in Rosslea.
According to him, morale amongst his colleagues throughout the profession, is at an “all time low”.


“We have repeatedly said that if money was invested in general practice, we could ease the pressure in secondary care. We see a lot more actual patients than a hospital casualty would in a day. And yet the money is always targeted towards a hospital environment instead.”
By Dr. O’Hare’s calculations, his practice processes three times as many patients in a day as Altnagelvin casualty would.


“One GP at the meeting last week said he hadn’t planned to retire early at all,” he said, “But he hasn’t had a day off in seven months because he can’t get any locum cover. So he has decided to retire earlier -- he is at the end of his tether.”


Dr. O’Hare says his expectations are low as to what the immediate future holds for his profession.
“My fervent hope is that the minister and our colleagues in the Department of Health will for a change, and I do mean for a change, actually deliver something,” he said.


“It appears they see no value in our service. But I can guarantee you that if we collapsed, they would soon see the value in what we do.”