Andrew Buist SLMC ’19 speech

Conference – good morning. I doubt I am the first Chair of SGPC to deliver this speech and begin by saying this is a crucial time for our profession.

But – this year – there can be little doubt that this is the case.

When we met last year, it was to reflect on the first few months of implementing the new contract, a contract we negotiated, and you overwhelmingly supported.

Now, we are halfway into this transformational process. I know many of you, like me, are frustrated by progress. 

Transformation on this scale is not easy, but we were ambitious, and we remain ambitious

As it stands, I know that we are still seeking the stability we all crave for our profession, however I remain convinced the direction set by our contract is the right one for the future of general practice in Scotland and will in time provide long term stability to a service that will be the envy of most other countries.

At the beginning of negotiations, we found general practice facing a growing recruitment and retention problem that reflected systemic neglect for over a decade. That changed around 2016 and as we negotiated phase 1 it became increasingly clear that at last we had a Government that understood the pressure GPs were under, and the crucial role we play in maintaining the health of our nation.

But, while we were able to translate that understanding into a new contract that promised much of what we asked for, it is clear that this is still not consistently translating into the urgent changes we need to see on the ground.

Making this contract work was always going to be more difficult because it relies not just on recruiting new workforce and new funding, but even more importantly on new relationships and new ways of working between Integration Authorities, Health Boards, and Local Medical Committees – at the frontline of healthcare.

Around the country I hear of the frustrations of patchy progress being made that is reflected in your everyday working lives. I am grateful to the over 600 practices that returned our recent practice survey of contract services. The results show that while there is good progress with some services like level 1 pharmacotherapy, many other services are only partially implemented, while there is very little progress to date with CTACs and adult immunisations.

So, it is clear that there needs to be a considerable and concerted effort to increase the pace of transformation. And we want to make sure that areas where implementation is going well can help those places where progress is slower. That means understanding why some places are ahead of others and spreading that learning more widely.

And while every partnership area has a Primary Care Implementation Plan, we have been concerned that these plans are often constrained by what is possible within budgets allocated. In some cases, they simply aren’t ambitious enough to deliver fully on the contract and for both these reasons a number of these plans remain unsigned by LMCs. So I have asked SG (and they have agreed) to write to every HSCP advising that they must satisfy themselves that their plans will truly deliver on the commitments made and if not to revise their workforce and financial projections now. If extra funding is required, then we are clear it must be provided, anything else means we are simply designing to fail.

Because it is undeniably the case that if we continue as we are – with insufficient pace of progress across Scotland, and lack of ability to deliver on multi-disciplinary teams– then we will not achieve full contract implementation by April 2021.

Let me be clear, the fact that implementing the contract is hard cannot be used as an excuse not deliver on our agreement. Our expectation is that these services must be in place by 2021 because after that date they will no longer be core contract work.

As GPs – and as SGPC – our job is to help lead the change. But the delivery of more rapid progress is of course outside our remit. Instead those who hold the levers – HSCPs, Scottish Government and Health boards themselves, must make this a priority.

As a key example, health boards MUST deliver the staff needed for multi-disciplinary teams, in the timescales set out. Every board needs to put this at the top of their to-do list. And we need a clear, practical national workforce plan from the Scottish Government to make this a reality.

And Conference, from the outset I have been conscious that the challenges of transformation and stability are even greater in remote and rural areas.

I visited several rural practices in Caithness and Sutherland this summer. I was reminded that rural GPs are the original Expert Medical Generalist. And I heard their concerns loud and clear and I want to assure them – again – I recognise their diversity and way of working and do not intend to destabilise this, quite the reverse.

Solutions in these areas will be different to those required by GPs working in more urban areas.

And we absolutely remain committed to ensuring that flexible ways of working within contract implementation are found for rural areas – ways that work both for GPs and crucially for patients.

Conference, I want to use this opportunity to set out what our core negotiating principles are for Phase 2. The two phases are not dependent on each other, but together they provide our long-term vision for the future, a coherent plan that will improve our working lives and secure General Practice for years to come. So, while phase 1 is about risk and inappropriate workload reduction, phase 2 is about improving GP pay and building up the GP workforce.

And absolutely central to our approach will be to maintain, protect, and promote the independent contractor status of General practice.

And we aim to secure the additional funding required to address practice vacancies and to grow the GP workforce, and in doing so to reduce individual GP workload. Our stated goal is also to deliver additional funding to improve GP earnings – the earnings of all GPs in Scotland should be comparable to that of hospital consultants for core clinical work. And like consultants, GPs should also be able to earn additionally from enhanced services, private work and other sources of income.

We intend to incentivise and increase the number of GP partners and establish practical and financial incentives to allow the creation of new practices where and when they are needed.

And a key element of these negotiations will be to deliver a system that directly reimburses most practice expenses to protect against rising or unexpected costs whilst maintaining the ability to develop the practice.

And finally, we want to introduce more protected time within the working day for GPs for personal development and quality improvement as a core element of the GP contract.

And conference, I believe remote and rural practices are among those who stand to gain most from what we aim to achieve from the Phase 2 negotiations. Phase 2 will remove the need for income supplements that are an inevitable consequence of distributive formulas that can never work in rural areas, and by doing so we will ensure their long-term financial stability and equity with the core earnings of other GPs across Scotland.

To do all of this, we need much better data with which to assess the current position – which is why we are embarking on the most comprehensive data collection exercise ever undertaken for Scottish GPs. I hope very much that you will all engage so that we are sighted on your situation – it is a crucial piece of the jigsaw that we need to secure investment on your behalf.

Conference, I ask you to give us the opportunity to negotiate on your behalf the best possible phase 2 offer.  Empower us to bring back to the profession this time next year a new, comprehensive funding package on the basis I have set out – and then it will be down to you to decide whether it is acceptable. 

To help that, we are committed to providing every practice with detailed information on how the proposal would impact on your practices finances and, as a result, the best possible chance to make the right decision for the future.

Before I close, I would like to express my thanks to my team, for all their hard work and support; to my deputies, Andrew Cowie and Patricia Moultrie.

I also would also wish to express my thanks and recognise the huge amount of hard work and commitment that you, the LMCs and the GP subcommittees have made in working with your local health and social care systems to deliver on your Primary Care Improvement Plans.

Conference, it is on the basis of all I have set out in this speech that I make no apologies for saying once again that this is a pivotal moment for GPs in Scotland.

Our ‘new’ contract isn’t that new anymore. Phase 2 is approaching.

It is an ambitious path we are taking. We have asked a lot of ourselves and of our partners – but they signed up to this course too. They must step up and deliver.

Now is not the time to turn away from the direction we’ve chosen together.

Instead it’s time for all parties to renew their focus, renew their drive and see through the full implementation of the contract – for us as GPs of course – but consequently and most importantly to allow us to continue to do the absolute best we can for the people we care for.

Andrew Buist, Chair of the Scottish GP Committee

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