Northern Ireland GP services at ‘critical juncture’ as practices fall 13% while patient numbers rise

(L-R) RCGPNI Chair Dr Ursula Mason, Northern Ireland Health Minister Robbie Butler, and Dr Emma Murtagh (Vice Chair Policy, RCGPNI)

Tuesday 22 September 2026

Northern Ireland’s GP service is at a “critical juncture”, with the number of practices falling by almost 13% since 2014 while the registered patient population has risen to 2.07 million, a major new policy paper has warned.

The Royal College of General Practitioners Northern Ireland (RCGPNI) says the combination of rising demand, workforce shortages and financial pressures is threatening the long-term sustainability of general practice and patients’ ability to receive consistent care.

Its new report, Safeguarding the future of general practice in Northern Ireland, says the average number of patients being cared for by each practice has increased by 24% since 2014. The patient population has risen by 7.7%, from 1.92 million to 2.07 million, over the same period.

Growing pressure on GP services

The College says general practice accounts for more than 90% of patient contacts on a typical day across Northern Ireland’s health service, but received approximately 5.4% of total Health and Social Care expenditure in 2022/23.

It argues that funding has failed to keep pace with growing demand and increasingly complex care, leaving practices struggling with operating costs, recruitment and investment.

RCGPNI also points to a fall of around 10% in whole-time equivalent GP capacity since 2014, despite an increase in the overall headcount of doctors. It attributes the decline primarily to reduced GP partner sessions amid escalating workloads, increasingly complex care needs and rising levels of burnout and moral distress.

Fewer practices serving more patients

The report says around one in 20 GP practices handed back their contracts over a two-year period, while the College said 29 practices have handed back contracts since July 2022.

RCGPNI Chair Dr Ursula Mason speaking at today’s launch of RCGPNI’s new policy paper ‘Safeguarding the future of general practice in Northern Ireland’

RCGPNI Chair Dr Ursula Mason said:

“General practice is the foundation of our health service. General practice provides 90% of patient contacts within our health system and is essential to delivering care closer to home.

“If we are serious about transforming health and social care, then general practice must be at the centre of those plans. Yet the reality is that the future of general practice remains fragile and uncertain.”

She added:

“While the number of GP practices has continued to fall, the number of registered patients continues to rise. GPs are managing increasingly complex care needs, with fewer resources and under significant pressure.

“These challenges are affecting GPs throughout their careers. We are finding it harder to attract doctors into general practice, harder to retain experienced GPs because of excessive workload and burnout, and harder to provide the continuity of care that is proven to deliver the best outcomes for patients.”

Workforce and recruitment concerns

The Stakeholder Panel (L-R): Martina Moore (Director of Primary Care, DoH), Dr Margaret O'Brien (Head of GMS, Professional Lead for General Practice NI, SPPG)

Prof Deirdre Heenan (Professor of Social Policy, Ulster University), Dr Ursula Mason (Chair RCGPNI), Meadhbha Monaghan (Chief Executive of Patient Client Council), Dr Emma Murtagh (Vice Chair Policy, RCGPNI)

The College says Northern Ireland remains without a dedicated, funded GP workforce strategy and argues that the training pipeline is not keeping pace with projected need.

Its paper says a 2018 review identified a requirement for 169 GP training places annually by 2023, compared with a current intake of 121. It also reports that only around 55% of newly qualified GPs remain on the Northern Ireland Performers List after three years.

RCGPNI’s 2026 survey found 96% of responding GPs and 92% of Practice Managers said escalating workload was negatively affecting their practice. Meanwhile, 80% of GPs and 81% of Practice Managers agreed that increasing whole-time equivalent GP capacity would improve patient access.

The survey also found 40% of GPs felt unable to cope with stress at least weekly, while 63% reported insufficient time to build effective relationships with patients.

The College says workforce shortages are particularly severe in deprived, rural and border communities, where recruitment difficulties can combine with socioeconomic need, geographic isolation and higher levels of patients living with multiple health conditions.

Six actions proposed

RCGPNI is calling for six areas of action: prioritising continuity of care; increasing investment in general practice; building workforce capacity and improving GP recruitment and retention; safeguarding the GP partnership model; improving digital and physical infrastructure; and developing and delivering a comprehensive general practice strategy.

The College wants the proportion of the HSC budget allocated to general practice increased beyond 5.4%, alongside a secure and predictable baseline budget and annual funding increases above inflation.

It also wants GP training numbers increased, a permanently funded indemnity scheme introduced, greater support to retain international medical graduates and a dedicated Practitioner Health Programme established for Northern Ireland.

More than 10 million GP appointments a year

The scale of existing demand is highlighted by figures in the report which say GP practices already provide around 200,000 appointments every week — more than 10 million a year — supported by a £380 million General Medical Services budget.

The paper contrasts this with plans for the expansion of Multi-Disciplinary Teams (MDTs). It says a full regional rollout would cost approximately £83 million annually and provide around one million additional MDT appointments each year.

RCGPNI supports the role of MDTs but argues they should complement rather than replace GPs, with the success of the model dependent upon a secure and sustainable core GP service.

Continuity of care at centre of warning

The political panel (L-R): Colin McGrath MLA, Diane Dodds MLA, Dr Ursula Mason (Chair RCGPNI), Nuala McAllister MLA, and Philip McGuigan MLA (Chair of NI Health Committee)

A central concern in the report is the ability of patients to build an ongoing relationship with a GP who knows their medical history — something the College argues can become more difficult when services are under sustained pressure.

More than 97% of patients responding to RCGPNI’s survey said it was important to see a GP who knows them when managing their health and wellbeing. More than 97% of GPs surveyed also agreed that fragmented care has a detrimental impact on patient health outcomes.

The College argues that increasing pressure to provide faster access should not come at the expense of continuity, particularly for people with long-term or complex conditions.

Future of GP partnership model

The report also raises concerns about the future of the GP partnership model, under which practices operate as independent contractors providing services on behalf of Health and Social Care. Around 95% of Northern Ireland practices operate in this way.

RCGPNI says eight practices are currently run as fully salaried services under Federation Community Interest Company contracts, while another eight are operated directly by HSC Trusts following contract hand-backs.

Despite concerns over financial risk and workload, the College’s survey found 64% of GP registrar respondents wanted to become a GP partner within five years. Around 87% of GPs and 90% of Practice Managers surveyed said increased funding would make partnership a more attractive option.

Investment in GP technology

The College is also seeking sustained investment in GP digital and physical infrastructure, warning that communication between general practice and other parts of the health service can be “slow, inconsistent, and fragmented”.

The report says Northern Ireland does not currently publish a routinely reported or validated measure of whole-time equivalent GP numbers, which RCGPNI argues makes effective workforce planning more difficult.

It also says investment in GP digital infrastructure has been constrained while the wider health service has undergone its major Encompass digital transformation, leaving challenges around integration, real-time data sharing and communication between services.

Call for long-term strategy

Health Minister Robbie Butler speaking at today’s launch of RCGPNI’s new policy paper ‘Safeguarding the future of general practice in Northern Ireland’

The policy paper was launched at Parliament Buildings, Stormont, on Tuesday (September 22) and comes as Northern Ireland’s health service seeks to move more care away from hospitals and into community settings. RCGPNI argues that ambition cannot be achieved without first stabilising and strengthening general practice.

Dr Mason said:

“With only 5.4% of total health spending being invested in general practice in Northern Ireland, we are lagging well behind the other devolved administrations. The continued erosion of funding has left many practices struggling to meet basic operating costs and invest in services for patients.

“The consequences are already being felt. Twenty-Nine GP practices have handed back their contracts since July 2022. Further instability will inevitably follow without urgent intervention.”

She concluded:

“General practice is not a cost pressure to be managed; it is the solution to many of the challenges facing our health service.

“Investing in general practice improves patient access, supports prevention, reduces pressure on hospitals and delivers better value for the health system as a whole.

“The decisions made now will shape the future of general practice for years to come. We urge the Minister and the Department of Health to act on these recommendations and provide the sustainable support that general practice, and our patients, urgently need.”

RCGPNI’s warning leaves a fundamental challenge for Northern Ireland’s plans to reform healthcare: if more treatment is to move out of hospitals and closer to people’s homes, the College says the GP service expected to help deliver that change must first have the workforce, funding and long-term stability to cope.