‘Northern Ireland is broken’: how a ‘toxic’ culture and better pay is enticing North’s doctors across the Border

When Peter Maguire works a shift at a hospital in Dublin, he earns as much in one day as he would in a week in Northern Ireland’s NHS.

The anaesthetist quit his consultant’s job in the North five years ago. A “toxic” NHS culture, Stormont’s collapse and Brexit led to his decision. He began working part-time in the Republic.

“Best thing I ever did,” he says of the move.

Maguire, who has 30 years’ experience, is one of a growing number of senior doctors from the North who are working in locum and full-time posts in the South.

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Oncologists, gynaecologists, radiologists and emergency department consultants are among those who have recently made the move, says a leading figure within the North’s main doctors’ union, the British Medical Association (BMA). Those taking up permanent positions can expect to more than double – and in some cases triple – their NHS salaries.

Some GPs, including those starting out in their careers, are also leaving. A workforce report published this week warned the profession was “struggling to the point of collapse” and demanded urgent action to prevent further departures.

[ Northern Ireland strike: Six striking workers explain why they are on the picket lines ]

“While the grass is not entirely greener in the Republic, if you speak to anyone there, it’s probably not as frantic. They’re not dealing with the fallout of the crumbling NHS,” says Belfast GP Michael McKenna.

“Lots of junior GPs are making the move but we’re also losing a lot of older consultants who are just fed up. The worrying thing is that half the GP trainees they’re putting through in the North don’t want to stay; they’re training here and going back down South.”

A GP starting out in the South would be earning “two-and-a-bit times” more than the same GP in the North, where the average salary is about £92,000 (€107,000), he says.

“We can’t get anywhere near those salaries,” says Alan Stout, co-chair of the BMA’s GP committee.

“It’s Enniskillen, it’s Armagh ... it’s those Border areas that doctors are leaving and [the money] makes it such an easy decision. It’s no coincidence that those are the areas where we’re struggling to recruit people”.

Consultants in Northern Ireland have a starting salary of £88,000, which tops out at £118,00 for a 40-hour week. This compares with a baseline salary of €217,325-€261,051 in the South for a 37-hour week

Ireland is now third to Australia and New Zealand as the most popular destinations for UK doctors planning to practise elsewhere, according to the General Medical Council (GMC), the UK regulator for doctors.

For Northern doctors, who earn less than their British counterparts, the lure of enhanced pay packages in better staffed hospital departments is “super attractive”, one senior medic said.

Consultants in Northern Ireland have a starting salary of £88,000 annually, which tops out at £118,00 for a 40-hour week. This compares with a baseline salary of €217,325 to €261,051 in the South for a 37-hour week under the Sláintecare contract introduced last year.

“Things are so much better and different in the South for consultants,” says Maguire, who was based at Newry’s Daisy Hill Hospital for 16 years.

“Only yesterday, I took the train down from Newry to Dublin and worked in St Luke’s in Rathgar. I did my shift and came home and never found the work so satisfying in my life. It’s what I trained to do, look after people.

“It’s far better paid and there’s far less bureaucracy.”

After tax, he was earning around £4,500 a month from his NHS consultant job.

“I’m not comfortable talking about money but I was asked to go up to Letterkenny to cover for holidays last June and took home €9,600 for a week.

“Let’s even park the money. When you can come home and say, ‘Wasn’t that a brilliant day’s work?’ I would never dream of returning to the NHS.”

While no firm data exists on the number of medics from Northern Ireland working in the South, information provided to The Irish Times by the GMC is an indicator of what appears to be happening on the ground.

The regulator confirmed a spike in requests for a document that enables UK-based doctors to practise in the South; figures show the number of Certificate of Good Standing (CGS) applications rose from 507 in 2022 to 804 last year.

The GMC cautions that the requests “do not necessarily mean the doctor has definitely left the country – rather, it may show an intention”. Of those who applied in 2023, 632 were still registered and licensed to practice in the UK.

Pay parity, staff shortages and the North’s deteriorating health service – it has consistently recorded the highest NHS waiting lists over the past decade – are undoubtedly factors for those moving.

[ Striking junior doctors warn more medics will leave North’s health service without pay rise ]

The impact of Brexit, Covid and a two-year political vacuum have also been felt, with junior doctors striking for the first time over pay last month.

Since Stormont’s restoration in February, Northern Ireland’s Health Minister Robin Swann has pledged to build the GP workforce and retain more experienced doctors.

But he has yet to stop the exodus.

Anne Carson is a consultant radiologist who left her NHS job after 25 years for locum work in Letterkenny and Portlaoise.

“I choose to go down South because as a senior radiologist walking into any NHS department in Northern Ireland, I would be flogged to death. That’s the bottom line.

“There has been a complete reversal; it used to be the Southerners came up to work in the North and now it’s very much the other way round because of terms and conditions and pay, and pressure of work.”

However, Carson says it’s “not all roses” for doctors in the South. “Southern consultants have their own issues and it can be very stressful for those in permanent jobs,” she says.

“But Northern Ireland is broken. It’s so broken I don’t know what the answer is.”

Asked if it was concerned about the movement south, the Department of Health confirmed that discussions were under way with consultants’ representatives on pay issues.

The Northern Ireland health service continues to “actively recruit clinicians regionally, nationally and internationally”, says a department spokesman.

“While a small number of medical staff may have chosen to take up work in the Republic of Ireland or other jurisdictions, it should also be acknowledged that our workforce across the health service continues to grow.”

David Farren, chairman of the BMA consultants’ committee in Northern Ireland, takes issue with the department’s view, saying vacancy figures for consultants “tell a very different story” – there were 182 unfilled posts in September last year, an increase of 80 per cent since March 2017.

“Every consultant I chat to in a health trust in Northern Ireland is now telling me they know someone who is leaving to work in the South,” says Farren, a consultant medical microbiologist at Antrim Area Hospital.

He has been inundated with calls from English colleagues asking “What it’s like to live in Ireland?”

Some colleagues in Antrim have recently left for Dublin – and he says he was about to quit himself, but decided not to move for family reasons.

“We’ve lost a couple of radiologists, a couple of obstetrics and gynaecology consultants and there’s a few people who have gone part-time, who are doing a few days a week in Antrim and a few in Dublin,” he says.

Farren says he could earn double what he makes a week for a 37-hour week in the North “with no on-call”. There are other benefits; he lives in Lisburn and has a 40-minute driving commute, but could be in Dublin in less than two hours on the train.

“I don’t have to drive, I can work on the train or read a book or even do a crossword. Simple things like that,” he says.

Northern doctors believe there could be more cross-Border health services, beyond cancer treatment and children’s heart surgery that is already provided, if the trend continues.

“It wouldn’t surprise me particularly if staff keep moving across the Border,” says Farren.

Alan Stout believes “one of the biggest drivers towards an all-island health service” would be if “a large majority” of Northern Ireland’s doctors end up working in the Republic.

“So if our doctors are in the South, we’re going to end up having to share services anyway,” he says.

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