A leading GP has warned that many more medical practices across Northern Ireland will join the "constant stream" of surgeries handing their contracts back.
Dr Alan Stout was speaking after Kilkeel Medical Practice became the latest GP service to announce it will be handing back its contract to the Department of Health later this year.
GPs in the Co Down practice said they had been unable to recruit new doctors to fill several vacancies.
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In a statement on Facebook, doctors at Kilkeel Medical Practice said it was a "difficult decision", adding that the workload had become unsustainable after it was unable to hire enough doctors.
They said: "The GP partners of Kilkeel Medical Practice can confirm with regret that they have decided to hand back to the Department of Health the contract to deliver GP services in Kilkeel Primary Care Centre.
"This will take effect on the 1st November 2023. Until that time Kilkeel Medical Practice will be operational as normal and continuing providing their services."
The doctors added: "This difficult decision has been taken as the practice has been unable to recruit GPs to fill several vacancies for some time now.
"The practice has been operating with half the workforce of three years ago and as a result the management of the ever increasing workload has become unsustainable
"The Department of Health will now begin the process of advertising and recruiting a new GP contractor.
"We want to assure our patients that we will continue to deliver GP services as normal until the contract is handed back. Patients do not need to do anything and should continue to contact the practice as normal. The Department of Health will shortly write out to all patients."
In the past 12 months, 15 GP practices across Northern Ireland have made the decision to hand back their contracts.
Earlier this month, Kells and Connor Medical Practice in Ballymena also gave notice of its imminent closure but was saved after Dalriada Urgent Care, which also provides GP Out of Hours services for the Northern Trust area, agreed to take over the role.
Dr Stout, head of the BMA’s GP committee in Northern Ireland, has warned that many GP services here are now "hanging by such a thread" and he expects more to join the "constant stream" of practices handing their contracts back.
He told Belfast Live: "What this is showing is the stress and strain that's out there and also that practices are just not sustainable at the moment for a number of reasons.
"That's partly down to staffing and the inability to replace doctors but there are also big funding issues at the moment too.
"Obviously Kilkeel is the most recent case and will cause significant problems in itself. We do know of several others that are potentially imminent as well which are going to cause major problems.
"We are effectively small businesses and like so many others we are seeing these massive increased bills and all that goes with them. That's putting particular pressure on a lot of practices and forcing them to close.
"These are people who have worked their entire life in the health service and run practices that are embedded in local populations, who know all their patients and employ a lot of staff.
"You cannot underestimate how big a decision it is for a practice to hand back a contract and effectively close that practice."
Dr Stout added: "We're doing everything that we possibly can to try and sustain some sort of service until we can get into some position to build for the future.
"The NHS as a whole fails if primary care fails so we need urgent help and attention to primary care to support it, which will then give us some sort of a platform to move into the future when we eventually get an Executive, a Health Minister and a Budget."
In a statement, the Department of Health said it will now begin a process to develop alternative arrangements for services in Kilkeel and acknowledged the "ongoing and significant pressures" facing GP services.
A DoH spokesperson added: "A number of different options are available to ensure patients are not left without a GP service. The preferred option is to secure a GP contractor – or grouping of GPs – to take over the practice through a formal recruitment process.
"In some circumstances, Health and Social Care Trusts can take over a GP contract as an interim solution.
"We want to reassure patients that the existing Kilkeel Medical Practice will continue to retain the contract to deliver GP services for the next six months.
"Patients at the practice do not need to take any action. They should continue to contact the practice as normal. We will be writing out to all practice patients to keep them informed as this process begins."
They added: "The Department acknowledges the ongoing and significant pressures on GP practices, stemming from the fact that demand for their services is outstripping capacity to provide it.
"Notwithstanding budgetary pressures, the Department is committed to building the GP workforce. We have made significant progress in relation to the number of GPs we train each year.
"The number of GP training places in Northern Ireland has been increased by 70% from 2015 levels in recent years. The review of places is ongoing and the Department will consider recommendations from the review of training places in the future.
"The Department has also recently streamlined the processes for GPs who qualified in a number of countries to take up roles in Northern Ireland."
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