Locum doctors are being paid up to £1,000 (€1,170) per day to provide cover to struggling GP practices in Northern Ireland, a watchdog report has found.
The inflated rates are “distorting” the market for other practices seeking temporary staff, it warned.
The Northern Ireland Audit Office (NIAO) report, published today, identified one in three “at risk” GP practices which sought crisis support in the last four years to cope with workforce and funding pressures.
A combination of long-term trends, including an ageing population, spiralling hospital waiting lists and the impact of Covid have led to “extreme pressures”.
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The Access to General Practice in Northern Ireland report found that just under half of all GP consultations were face-to-face in 2022-23 — similar to levels achieved in England at the height of the pandemic — with the majority undertaken via telephone or video.
By March last year, face-to-face appointments “represented around 70 per cent of activity in England”.
While the total number of GPs in the North increased by about 9 per cent between 2018 and 2023, auditors cautioned that the headcount data “masks” changing patterns of GP work which “indicate there has actually been an overall decrease in whole-time equivalents”.
Auditor General Dorinnia Carville called for urgent long-term planning to tackle the crisis.
“Measures taken to date have largely been short-term, which can be costly for public finances,” she said.
“At the same time, progress on delivering more meaningful transformation, such as the planned rollout of multidisciplinary teams to work alongside GPs, has been significantly delayed. Ultimately this results in patients not receiving the timely support and access to treatments that they need.”
The report examined 13 practices which had either handed back their contracts or gave notice to do so, with Health and Social Care Trusts taking over five of them.
“In cases where Trusts have taken on the role as contractor, this has had the effect of increasing costs, often substantially,” it noted.
“Whilst Trusts have access to a range of staff which can help stabilise practices, GP cover is often sourced from locums. However, the need to attract locums to challenging practices has resulted in high rates being paid — up to £1,000 per day.
“Stakeholders told us that whilst it may immediately stabilise the practice, it had the effect of distorting the locum market for other practices.”
The NIAO said Stormont’s Department of Health increased GP training places from 65 to 121 between 2014 and 2024.
Despite the rise, the report found many of these were taken up by international medical graduates who were “less likely to remain in Northern Ireland after this training, pointing to a need for proactivity to nurture their retention”.
Auditors also criticised the “limited progress” in the rollout of multidisciplinary teams (MDTs) within primary care settings.
Launched in 2018, MDTs involved establishing a range of clinical staff to work alongside GPs and expand the services available in primary and community settings to improve patient care.
The department’s target was to roll out the service within five years.
By March 2023, MDTs had been fully introduced in only one of the 17 GP federation areas across Northern Ireland and partly introduced in seven areas.
“Only around 161,000 (8 per cent) of registered patients currently have access to the full range of MDT roles.”
The report cited a lack of available, qualified staff as a “key constraint in the rollout” and estimated that an additional £91 million was required annually to sustain the operation of a full programme of MDTs.
Ms Carville said it was “important to note that there are no quick or easy solutions”.
“What is essential now is the development of sustainable long-term plans to address the significant challenges facing GP services in Northern Ireland.”
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