Assembly Committee warns primary care is “in crisis” as major failings in GP access exposed

Northern Ireland’s primary care system is “in crisis” and requires “urgent intervention”, according to a major new report from the Northern Ireland Assembly’s Public Accounts Committee (PAC).

The Report on Access to General Practice in Northern Ireland outlines serious shortcomings in how patients access GP services and calls for radical reform of the system.

The PAC report, based on evidence from health organisations, the Department of Health (DoH), and an unprecedented public response, identifies systemic failures in GP access, workforce planning and the use of public money. It sets out 10 recommendations aimed at stabilising and reforming the sector.

Unprecedented Public Response Shows Deep Discontent

As part of its inquiry, the Committee launched a public call for evidence earlier this year, receiving more than 15,000 responses—the largest in the Assembly’s history.

More than half of respondents rated their experience of contacting their GP as “poor”. Many reported repeated unsuccessful attempts to get through to practices, leaving them stressed, anxious and, in some cases, forced to pay for private consultations.

The Committee noted that people were often left navigating a “confusing patchwork” of access methods, from early-morning phone queues to lengthy callback systems, with little consistency between practices.

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Department of Health Lacks Crucial Data, Committee Told

During the inquiry, DoH officials admitted it was “too difficult” to measure demand for GP services and confirmed that the Department does not hold figures on how many full-time equivalent GPs are working in Northern Ireland.

While there are around 2,000 doctors on the GP performers list, this includes trainees and does not reflect actual workforce capacity.

The absence of a workforce strategy for primary care was highlighted by the Committee as a key factor contributing to GP recruitment and retention challenges.

“Primary Care Is in Crisis” – PAC Chair

Daniel McCrossan, Chairperson of the PAC, warned that the system is failing patients.

He said:

“Being able to see your GP is a cornerstone of basic medical care – but too often accessing this service has felt impossible for many.

“What we have learned from our Inquiry is that the primary care sector is in crisis and requires urgent intervention and stabilisation. It beggars belief that some of the fundamental building blocks of primary care are not in place.”

Mr McCrossan said the Committee was told GP workload pressures were significantly heightened by hospital bottlenecks, with demand in Northern Ireland far higher than elsewhere.

“The scale of demand appears to be greater here than elsewhere: the BMA NI told us that on average, a patient sees a GP nine times a year, whereas in Ireland it is three times a year.”

He also raised concerns about cases where GP partners handed back their contracts only to be re-employed as locums at “significantly high cost”.

“This is an inappropriate practice and an unacceptable way of using public money.”

Call for a Comprehensive Primary Care Strategy

Diane Forsythe, Deputy Chair of the PAC, stressed the for improved cooperation between the Department and GPs.

She said:

“Improving access to primary care depends on strong and effective working relationships between the Department of Health and GPs – which just aren’t there at the moment. Everyone involved must work together to deliver better outcomes for those in need.”

The Committee is calling on the Department to produce an overall primary care strategy within 12 months, incorporating a workforce plan and setting out the future direction for GP services.

Ms Forsythe also highlighted a stark mismatch between complaints data: while the Patient and Client Council (PCC) reported a 70% rise in complaints about GP services between 2022 and 2023, the Department’s Strategic Planning and Performance Group (SPPG) claimed a downward trend over the same period.

Urgent Need for Modernisation: Committee Demands e-Prescribing

Digitisation was another major theme of the inquiry. The Committee concluded that the pace of technological development has far outstripped delivery within the health system.

Ms Forsythe said:

“We are recommending the introduction of e-prescribing as a matter of urgency and expect the Department to have completed a business case within six months.”

She added that while some improvements in primary care models have begun, progress remains “slow and small-scale”.

Key Recommendations

The report’s 10 recommendations include:

• A comprehensive primary care strategy within 12 months.

• A public education programme to help people navigate appropriate care pathways.

• A review of data on patient experience, including complaints handling.

• Accelerated delivery of e-prescribing.

• Stronger engagement between the Department, GPs, and the PCC.

TUV: “8am Phone Lottery Must End”

TUV Braid councillor Christopher Jamieson said the Committee’s findings merely confirm what the public has long understood.

He said:

“I don’t think anyone in Northern Ireland will be surprised that an Assembly Committee has finally admitted what patients have been telling us for years – primary care is in crisis.”

He added that patients are trapped in an “8am phone lottery”, left “constantly redialling” or pushed into overcrowded A&E departments.

Councillor Jamieson criticised the Department’s lack of workforce data and strategy, calling the situation “a scandalous misuse of public money”.

He continued:

“The 15,000 responses to the Committee’s survey – the biggest in the Assembly’s history – show the depth of public anger and anxiety. Behind every statistic is someone in pain, a worried parent or an elderly person left to struggle.”

He said radical change must go beyond another report that “gathers dust”.

“We need a grip on workforce planning, an end to cosy contractual arrangements that fleece the public purse and a relentless focus on getting patients through the GP’s door when they need it.”