GP Contract Update

Tomorrow, GPs from across Scotland will gather to discuss all the key issues that are on our agenda as a profession at the annual SLMC conference.

This year, as Dr Teresa Cannavina, chair of the conference explained in her recent blog, things will be very different as we run the whole thing digitally for the first time ever.

Of course, that just reflects yet again what a year like no other 2020 has been. Indeed, I am sure we will reflect on much of that in what will be extremely important discussions around how Covid has impacted on our work.

While Covid does present the issue that is uppermost in our minds, a key area of debate is also likely to be around our current GMS contract for GPs in Scotland.

In place since 2018, it set a bold and ambitious course for GPs in Scotland, designed to restore hope to a profession, and begin to address the GP workforce retention and recruitment problems we faced.

Delivery of the contract first phase was set out over 3 years – so by rights, we should be now reflecting on the final stages of implementation and the difference the contract has made.

But even last year I warned that delivery was patchy across Scotland and was running behind schedule.

It is important we do not lose sight of what has been achieved and there are many examples of excellent redesign of services in some areas. The whole process has also helped GP subs and LMCs build new and stronger relationships locally, a real sign of progress which is benefiting primary care provision across the country.

But it is also clear that there is still some way to go before all that was promised as part of the 2018 contract will be in place.

There are many reasons for this – from issues with staffing, premises and management support and of course, so much has been put on hold this year due to Covid.

Rather than dwell on this, ahead of the conference on Friday I wanted to inform you of the agreement we have now reached with the Scottish Government on the way forward when the initial period of the 2018 contract comes to an end.

The details are in the following letter, but to pick out some key elements:

  • The SG confirms its ongoing commitment to investment in general practice and funding the GP and multi-disciplinary team workforce. There is also a joint commitment that the principles and aims contained within the Contract Offer remain the right ones – collaborative multi-disciplinary teams working alongside GPs in their role as Expert Medical Generalists to manage patients in their own community.
  • The letter makes clear that enhanced multi-disciplinary teams remain a key commitment in the Contract Offer, which is why they will be made a permanent part of the support that GPs receive from NHS Boards and Partnerships – by putting them on a contractual footing. This is key as it means the identified services will no longer be the responsibility of GPs – but will instead transfer to NHS boards and local integration partnerships.
  • If partnerships or boards are still unable to provide these services – GPs will maintain the service under new transitional arrangements, but with additional funding.
  • We have jointly agreed to transitionary approaches for each of the multi-disciplinary team services committed to in the Contract Offer – which includes: Vaccination Services, Pharmacotherapy, Community Treatment and Care Services, Urgent care Service and Additional Professional Roles (e.g. Mental Health Workers, Physiotherapists, Community Link Workers). Full details of these are in the agreed letter.
  • The letter also recognises that there will be some practices in remote and rural communities where there are no alternatives to ongoing practice delivery identified through a satisfactory options appraisal. The Government and BMA SGPC will negotiate a separate arrangement including funding for these practices.

The letter makes clear that these temporary measures are absolutely not seen as long-term solutions. Indeed, we have agreed new timescales with clearer endpoints starting with vaccinations in 2021 that will see regulatory and contract changes made to finally remove these services from the core contract and transfer responsibility to HSCPs.

I will say more about this of course, at the conference tomorrow – however I believe it is important to outline this in advance to allow a full and informed debate.

For many, many reasons, the speech I deliver at the conference wasn’t the one I had in mind when we welcomed in 2020. But we must deal with the situation we now find ourselves. The solutions we have agreed on work for now and importantly signal our shared and clear commitment to the direction of travel set out and our ongoing ambition to transform general practice in Scotland for the better.

Dr Andrew Buist, chair of SGPC

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Photo credited to Gordon Terris/Herald and Times Group

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