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Fears for future of patient care as Crossmaglen GPs resign

June 29, 2015

People in Crossmaglen and the wider south Armagh area are facing an uncertain future regarding primary health care in their community following the recent departure of one doctor and the resignation of a further two, The Examiner has learned.

The recent announcement by the two doctors based in Rathkeeland House surgery – Dr. Patrick Fee and Dr. Neal Walker – that they have tendered their resignation to the Health and Social Care Board (HSC) and are currently working out their notice, has prompted fears for the future of primary care and emergency health cover in the town.

The impending departure of the doctors comes on the back of the recent resignation of Dr. Mark Sweeney, who quit the town’s Health Centre-based GP practice earlier this month.  With just two family GP practices in the town, both of which now face significant staffing issues, there are fears that the primary care of their patients, totalling in the region of 9,000, may be compromised.

This worry is compounded by the fact that the treatment room shared by the GP practices has been subjected to repeated closure in recent weeks owing to a shortage of nursing staff and the failure of the Trust to replace the full time nurse who retired last year.

The fact that huge swathes of south Armagh fall significantly outside recommended ambulance response times for any type of emergency is another defining factor of concern.  As is often the case in rural areas, local GPs are frequently called upon as the first responder to an emergency incident while waiting on an ambulance to arrive.

The growing crisis in primary care across Northern Ireland, with an overall shortage of newly qualified doctors and fewer medics choosing to become GPs, is being keenly felt in Crossmaglen.  Heavy workloads, transfers of work from hospital to community and retirements are among the reasons for the chronic shortage of practicing GPs, which is nearing crisis point.

A leading doctor has slammed the Department of Health for holding “review after review” but making few decisions to improve its service to patients.

Dr John D Woods, the Northern Ireland chairman of the British Medical Association (BMA), called for the department to “go back to the drawing board” and build a partnership with doctors instead.

In a keynote speech at the recent BMA annual conference in Liverpool, Dr Woods said Northern Ireland faces increasing pressure with cuts to funding, longer waiting lists and underfunded GP practices and called for the department to take the medical profession’s “common sense views” on board more in decision-making.

Doctors have previously raised concerns over a lack of action implementing the new blueprint for the Health Service ‘Transforming Your Care’, which aims to shift the majority of care from the hospital environment to the community or primary care environment.

Meanwhile the chairman of the BMA general practice, Dr Chaand Nagpaul, has warned that unless pressures of the job are first reduced, doctors will continue to leave and newcomers will not join the profession.

Speaking at the conference, Dr Nagpaul said: “The tragedy is nine out of 10 GPs feel they cannot do their jobs properly and give patients the quality of care they need.  There is a crisis in general practice, which has to be resolved.  If nothing is done patients will suffer, more practices will close while others will run on skeleton staff which will have a domino effect increasing workload on nearby practices which too will break under the strain.”

This scenario has become all too real for the practice of Dr. Patrick Fee who revealed he tendered his resignation solely “to prevent services in his practice being precipitated into a crisis”.

“Despite invoking the good offices of the Health Board and BMA in recent months, we continue to have difficulty accessing treatment room services for our patients,” he told The Examiner, adding that he had recently seen a reply from a senior Trust director advising one of his patients, in the aftermath of a serious emergency, that “Crossmaglen Treatment room is not a minor injury or an ED (Emergency Department).”

“In the face of reduced nursing services, absence of an appropriate place to manage injuries and acute emergencies,  a breakdown in communication with Trust officers, departing doctors and poor ambulance cover, I have advised the Board I will not remain in post while I am stripped of the resources that I need to do my job properly, simply to carry medico-legal liability in the event of a serious adverse event,” said Dr Fee.

“Every decision a doctor takes must put the welfare of patients first and we are in the bizarre position where the only way to show solidarity and care for our patients is by resignation.”

With around 25 per cent of practicing GPs over the age of 65, and fewer newly qualified medics entering the field, Dr. Fee points to the increasingly chronic shortage of doctors: “The number of doctors who are finishing their primary care training in Northern Ireland is getting smaller as the years go by.

“Last year less than a quarter of the required number of new doctors completed their training for primary care and recruitment and retention is a major problem” he revealed

With posts unfilled, work devolves onto the shoulders of other people, often placing medical staff in intolerable situations.”

This appears to be a factor in the recent repeated closure, at short notice, of the treatment room in Crossmaglen Health Centre.  The full-time  treatment room nursing post has remained unfilled since the former nurse retired last year.  Duties are being undertaken by the district nursing team alongside their own workload and, it is believed, this added pressure has led to two of the nursing team requiring sick leave.  It has also been claimed that subsequently agency nurses recruited to the post are considering withdrawing because of the sheer volume of work.

“Patients of our practice have been turned away at the door of the treatment room over-riding direct GP instructions,” said Dr Fee.

The Examiner contacted the Health and Social Care Board seeking a response for the concerns raised. Responding in relation to the Rathkeeland House Practice, a spokesperson said,

“The Health and Social Care Board is aware that due to one of the partners accepting a position in another GP surgery, the practice is currently seeking to recruit a GP partner or salaried GP.

This recruitment process is ongoing and the Board would not be in a position to comment further until the outcome of this process is known.”

Dr Patrick Fee refuted this statement stating that it does not recognise that a double resignation has occurred at Rathkeeland House and claiming that the statement is in fact out of date.

In relation to the post left vacant by Dr Mark Sweeney, a Health and Social Care Board spokesperson added,

“The Health and Social Care Board is aware that due to the resignation of a Partner at Dr Margaret Fee’s practice in Crossmaglen, the practice is currently seeking to recruit a GP Partner, salaried GP or long term locum.  This recruitment is ongoing and the Board would not be in a position to comment further until the outcome of this process is known.”

A spokesperson for the Southern Trust, which has responsibility for the staffing of the Health Centre Treatment Room, was unable to provide a response ahead of going to press.

Commenting on the situation, Crossmaglen Sinn Fein councillor Terry Hearty said the loss of doctors is “a very worrying development”.

“In many instances, people are up to an hour’s wait from an ambulance, even more where the road conditions are particularly bad, and the GP surgeries have been a lifeline for those people.  On top of that, it is having the knock-on effect of putting people off going to [Accident & Emergency] where they can find themselves waiting for hours on end to be seen.”

He said that the Trust must do more to ensure that people in the area have adequate services.

“I would question what efforts the Trust are making to attract good, experienced doctors to the area.  In this day and age we simply cannot allow a situation to develop whereby vulnerable people are left with nowhere to turn. It is simply unacceptable,” he said.

Meanwhile, Assembly Member Megan Fearon says Sinn Fein is seeking a meeting with all involved groups to discuss the situation.

“A lot of people are very worried about this but I would urge them not to panic,” she said.  “We are very much in problem-solving mode regarding this issue and we will do what it takes to ensure the people of Crossmaglen and the surrounding area are not left without vital services.

“I have already spoken to both surgeries and it is quite clear to me that the problem is one of an inordinate workload.  In addition to the actual workload of patients, doctors are now expected to run their practices like a business, which is taking away from what their primary focus should be – one of patient care.

“I have requested a meeting between myself, Conor Murphy MLA and Mickey Brady MP and the Chief Executive of the Trust to bring these concerns to her and to try and find a solution,” she added.

SDLP representatives Dominic Bradley MLA and Councillor Geraldine Donnelly have expressed their deep concern and called for urgent action by the Health and Social Care Board, the Southern Trust and the Department of Health.

Mr Bradley explained,

“This week we learn of the devastating news that we are to see a reduction in GP services in Crossmaglen and fear this is only the thin edge of the wedge.  We need to see an urgent round table discussion with all the stakeholders involved and this needs to happen as a matter or urgency.’

“South Armagh is a vast area and we are constantly seeing health care provision under threat.  The people of this area deserve a quality health service and at present that just isn’t happening.’

“This week’s development is not about finance, it’s about manpower or the lack of it.  The system is at breaking point and we need to see urgent action before it’s too late.’

“We cannot have rural communities in south Armagh cut off from essential health care services and we need to see intervention from the Minister to ensure this does not happen.”

Councillor Geraldine Donnelly said that GP services are often the first point of call for vast areas of south Armagh and to be left without that provision is a very concerning development.

“In south Armagh we are a rural, isolated community and we have seen the constant withdrawal and closure of essential services in education, health, transport and other front line services, we need to see government work together and protect essential services in this community,” she said.

“The GPs and Nursing Teams in Crossmaglen offer an outstanding service to the local community, they go beyond what you find in other communities. They step in to help where others are failing. The slow response times for ambulances and rapid response vehicles is a major issue for this community and yet in this area it’s often the GP who will respond to an emergency first.

“We need a fundamental review of health care in south Armagh, it needs more support not less.  This community deserves better.”

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