Abstract
GPICRT offers managerial support and GP clinical cover to practices facing closure or service disruptions due to emergencies or sustained pressure.
The main goal is to support practices, enabling them to continue offering GP services. This, in turn, stabilises the local network, addressing challenges in meeting patient demand. The impact extends to practices, patients, and the broader GP service in Northern Ireland.
The General Practice Improvement and Crisis Response (GPICRT) team has worked with each of the four Local Medical Committees and SPPG.
GPICRT, formed in 2018 due to escalating GP concerns, increased workloads, and funding gaps, initially comprised a Clinical Lead and Practice Manager. By 2023, responding to heightened demand, the team expanded to 2 Clinical Leads, 19 Salaried GPs, and 2 Project Support Managers. Despite covering all of Northern Ireland, recruiting GPs for remote areas remains a challenge. The team devised protocols for remote GP cover in those rural areas and established a referral process through SPPG offices.
In cases of difficulty, GPICRT engages in an initial meeting with practices, forming a collaborative Practice Recovery Plan covering short and long-term strategies, including GP clinical cover and managerial support. The team works with practices on improvement plans, conducting regular reviews until stability is achieved.
For knowledge sharing, GPICRT actively presents at GP conferences, focusing on referral themes and successful initiatives to enhance practice resilience and aid future planning.
In the initial three years (2018-2021), GPICRT received 52 referrals, with a notable surge to 39 referrals during the 2022/2023 period alone. To meet the growing demand, GP clinical sessions in crisis-stricken practices across Northern Ireland significantly increased:
- 01/04/18-31/03/2019: 18 sessions
- 01/04/19-31/03/2020: 533 sessions
- 01/04/20-31/03/2021: 996 sessions
- 01/04/21-31/03/2022: 1140 sessions
- 01/04/22-31/03/2023: 1330 sessions
GPICRT has engaged with 88 practices, with 39 currently under the service. Of the 52 practices signed off following successful Practice Recovery Plans, 88.5% (n=46) have stabilised and are providing GP services, while 11.5% (n=6) handed back their GMS contract to SPPG.
Critical to the service is ensuring workforce capacity. Salaried GPs, allocated to at-risk practices, require an incentivised and beneficial job plan to attract and recruit into the team. This approach allows the service to deploy GP clinical resources where needed most, providing time for CPD, peer support, and educational opportunities.
While the GPICRT model may not be the ultimate solution for a crisis in the general practice system, it offers vital support to keep practices operational until long-term strategies are developed and implemented by responsible health organisations.
Securing additional funding and a commitment from the Department of Health for ongoing support is essential. These resources would be utilised to recruit additional roles like Advanced Nurse Practitioners, Paramedics, Pharmacists, Care Navigators, and clinical coders. This approach enables the provision of a customized support package to practices.