A message from the Associate Director for General Practice and Primary Care

Colleagues,

Sincere thanks:

I reflect with sincere thanks and gratitude to our GP community on the incredible support over the last 10 years as we sought to increase the profile of GP for our medical undergraduates in a way that has impact on them. Our students greatly value the experiences they have had.

The support from the GP Community during the year-on-year incremental GP expansion (from 5 to 25% of the curriculum; 15.5 days toward 92 days in GP per student over the 5 years of their degree), through the new C25 curriculum roll-out, has been a reassurance to us that we have been moving in the right direction.

Challenges en route:

This journey has not been without challenges, by example:

1. A general fall in active teaching Practices – once close to 200, now down to circa. 150 (but this lower number thankfully now counteracted by greater involvement of those who have continued teaching)
2. Increasing clinical pressure demands across all sectors, competing for our attention
3. Launching the new Curriculum during a Pandemic with so much uncertainty for Practices when the focus of all was the maintenance of service continuity
4. Increased medical student numbers in Northern Ireland
5. Primary Care uncertainties in NI: the succession of Practice closures and the stark realities of unsustainable funding levels as set out in the recent NI Audit Office report

We have noted and responded to each of these challenges while endeavouring to stay true to the vision while working hard to keep partners and stakeholders happy and onboard.

However, at each annual increment over these 10 years, we found that we were always under in respect of offers of availability and had to work extremely hard with Teaching Practices to close the gaps; that is until this year! The 2024 availability offers spiked; for the 24-25 academic year when C25 reaches into the final year the response has been remarkable. Expectations exceeded+++. Thank you.

This table shows the difference between places needed and places offered for 24-25.

Unintended consequences:

Some Teaching Practices will have been surprised that their allocation for the academic year 24-25 has been less than in previous years. This reflects the spike in offers of placement availability as set out above. We owe you an explanation.

For placement allocations over the last 7 years, and with a view to the needs of future incremental expansions, we have taken the considered view (and revisited the rationale each year) that we should operate under the principles of:

1. Maximising Participation: with the rising proportion of GP Curricular time we took the view that we needed to grow the teaching base. This view was strengthened by the fact that we have always been under in respect of offers
2. Fair Allocation: allocation of places in proportion to each Practice’s offer. All allocations were done on an excel sheet which tracked and displayed proportionate placement allocation.  

As a result of the increased offers, some Practices have experienced a drop in allocations. Some of the increased offers of availability are perhaps a reflection of our collective emergence, for Teaching Practices, from the challenges that have characterised and challenged us over the last 5 years, as set out earlier.

Future planning:

While over the last 5 years, in respect of so many uncertainties, we were advised by GPs and Practice Managers not to ask too early in the academic year for placement availability for the following year, we now anticipate a growing desire for earlier certainty for forward resource planning.

Over the next 4 months we will be working with stakeholders to review the availability and allocations process to ensure ongoing fairness to all partners. Future options for consideration will include earlier allocations and the opportunity for some to enter into a 3-year commitment. Other proposals will be welcomed.

Northern Ireland GP Clinical Placement Alliance (NIGPCPA)

You will know that we have worked closely with colleagues in the Ulster University Medical School since their establishment through the development and activities of the NIGPCPA. This close collaboration will expand and extend in coming months as we appoint GP Locality Leads and a GP Sub-Dean who will act as an interface between Teaching Practices and the Medical Schools.

Once again my thanks to you for your support and commitment to the development of GP in the QUB undergraduate development; it is an important partnership. I am convinced that it is influencing the hearts and minds of future career choices; I can only hope that there will be a strategy for the future of Primary Care in Northern Ireland that will be a place in which this next generation of doctors will be inclined to work.

Nigel Hart

GP and Associate Director for General Practice and Primary Care, QUB