Covid19, winter and general practice

I am writing this as we approach what is likely to be a difficult winter.

In recent conversations with the Cabinet Secretary for Health and Sport, I have emphasised the importance of supporting the wellbeing of GPs and maintaining a functional general practice service this winter, as we are the frontline of our health service. General practice must be properly supported, and GPs and their teams’ welfare given proper attention, so we can provide a significant degree of protection to the rest of the NHS.

I am clear that that the way the system operates this winter and beyond must avoid destabilising general practice with excessive and in some cases inappropriate demands. Suspected cases of Covid should continue to be channelled through the Covid assessment pathway to keep general practice and A&E relatively clear for non-Covid work. I have stressed that the workforce in Covid Assessment Centres must be drawn from across the NHS and that general practice cannot be expected to cover this alone with individual GPs working excessive hours. We know that patient demand is now exceeding pre-Covid levels in many practices, while our capacity and workforce are reduced by the pandemic. Social distancing and infection control measures mean that things just take longer. If a practice team has sickness absences or has staff that are required to isolate, our services are of course impacted. So, SGPC are working with the Scottish Government to review the arrangements for stepping down practice services where needed and ensuring we have early warning systems in place for practices in difficulty. 

As Covid took hold this year, as a profession we adjusted access arrangements to reduce the chance of cross-infection while continuing to offer face to face (F2F) appointments when this was appropriate and necessary. This was necessary and pressing and indeed happened almost overnight. On reflection, the expansive rollout of new technology to facilitate digital consultations has been useful in the challenging circumstances we have faced and will likely continue to play a role post-Covid, but F2F appointments are an essential part of what we do as GPs, and we will all want to ensure that they continue to be available to patients when clinically necessary. Throughout the pandemic SGPC have made the case that simply defaulting to an entirely digital first approach will be not be beneficial to either GPs or patients in the long term

I have stressed with policy makers and politicians, that with the NHS operating at reduced capacity, we must ensure that the service is there for those patients that need us most. To assist with this, I have asked for robust national messaging to help the public understand that we are entering a critical period and while general practice and indeed the whole NHS is open for business, it is far from business as normal and services should be used only when it is clearly  necessary.

The flu vaccination programme is more important than ever this year with Covid cases increasing again. SGPC were anxious that general practice continued to play its part in the vaccination programmes, as part of an all hands-on deck approach that reflects the pandemic situation – but without compromising our other essential services. This is why in most areas the delivery will be led by Health Boards with general practice supporting with a time commitment similar to last year. 

We are also currently in discussion with Scottish Government regarding the 2018 GMS contract and how we address the progress that has been made and remains outstanding for April 2021. I hope to be in a position to inform you of the outcome of these discussions before the SLMC conference in December.

One further issue raised by the pandemic is the lack of data available to explain just how busy general practice is – to policy makers, the public and indeed to help us understand the challenges we face as a profession. We will be working with the Scottish Government to explore how this data can be collected and used to support general practice.

I thank you for your hard work and dedication during this exceptionally difficult period. I recognise that these challenges are likely to continue for some time but if we pull together as a profession and look after ourselves and our colleagues, I am confident that we will get through this. Please be assured that on your behalf SGPC are doing all we can to make the voice of general practice heard.

Yours sincerely,

Dr Andrew Buist, chair of SGPC

Photo credited to Gordon Terris/Herald and Times Group

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