As GPs on the frontline of the pandemic response, we have worked round the clock to care for those across our local communities who need us.
Even before Covid and while facing serious GP retention and recruitment problems, our priority was always doing the very best we can for our patients each and every time.
That is the main reason I think many of you shared my massive frustration and indeed anger at this week’s report on primary care produced by the Parliament’s Health and Sport Committee.
The careless and frankly inaccurate depiction of GPs only being available from 9-5 will have left many feeling dispirited and undervalued. And the timing could not be worse, given GPs will be exhausted from nearly a year of dealing with Covid and making such a huge contribution to the national vaccination programme.
In many ways, this is a real shame – as within the report there are also some well-made points, around the need for better IT systems and the expansion of multi-disciplinary teams which, as GPs, we know will clearly be valuable for our patient care.
Sadly, these constructive points will not be what many take from report – as instead the headline grabbing gibe around opening hours for GPs surgeries will be what most focus on.
So, let’s address that head on. GPs core hours are from 8am-6pm – when surgeries are open, and GPs are available. As I saw one GP tweet – the news that we only open from 9am-5pm will come as a surprise to our families, who wave us off to work before 8am and welcome us back after 6pm. Indeed, a great number of GPs regularly have to stay on beyond 6pm in order to complete paperwork, referrals and phone calls.
The use of 9am-5pm may simply be a shorthand, but it’s an inaccurate and lazy cliché that should be consigned to history. Equally importantly the committee would do well to remember that out of hours GP services run across Scotland throughout the day and night for patients who need emergency care – and these services are of course staffed by GPs, many of whom also work in-hours.
It is right we reserve out of hours services for conditions that cannot wait to be treated until in-hours services are available. If we move to the model this report suggests, we will reduce the service during in-hours – so people will be required to come for a routine check on a Saturday evening because we’ve moved the clinician’s availability to then. I am not sure that is what patients want. People may question why this plan would result in the reduction of the in-hours service, but that is simply because with the numbers of GPs we have, and are likely to have in the near future, these suggestions would be impossible without GPs going back to working gruelling 70 hour weeks. In turn this would drive doctors out of the profession, discourage recruitment and leave those remaining demoralised, exhausted and at risk of not delivering the care their patients need.
All of this should be considered in the context of a profession already being pushed to its very limit – even before the pandemic struck. We don’t have enough GPs, and the demands placed on them – by exponentially increasing demand, lack of funding, poor premises and now working on the frontline of Covid, are leaving many overworked, tired and facing burnout.
In these circumstances of course we welcome serious contributions to how we can make things better. What we don’t need are recommendations that seem to imply we just need to work the remaining GPs we have harder to cure all ills.
Indeed, the report actually questions the current plans to recruit an extra 800 GPs, instead suggesting recruitment of members of the multi-disciplinary should be the focus. But this is a false choice because primary care needs both more GPs and expansion of the MDT if it is to deliver effectively for patients into the future. If you take the logic further, primary care needs more members of teams to work across areas like physiotherapy and pharmacy to ease the pressure on GPs and make it an attractive career choice yet again. By investing in and recruiting across the workforce, you deliver mutual benefits that will in turn create a workforce fit for the delivery of modern healthcare. We simply must get away from the limited thinking of suggesting you either invest in wider primary care teams or in recruiting GPs, instead focusing on delivering a well-staffed workforce so sorely needed to deliver 21st century healthcare, including the extra 800 GPs already and rightly committed to.
One thing I do find hard to understand in the report is the lack of recognition that the GP contract, as agreed in 2018 has already set in process a radical change in delivery of primary care, based on expansion of multi-disciplinary teams providing more care to patients – ensuring they can see the right people at the right time and that GPs can spend more time with the patients who need us the most. Yet the report does not seem to reflect the importance or significance of this process.
There are further points in the report which go back to previous issues the committee have seemed to unfairly blame on GPs, around prescribing for example, issues that we robustly challenged the committee on back in July last year.
Sadly this report was a missed opportunity by the committee and instead of being able to really get our teeth into the important points on opportunities for new use of technology to improve access and increase efficiency, this report has instead required me to outline flaws around a tired and inaccurate debate on opening hours, which just doesn’t reflect the reality of life as a GP in Scotland. Every single day, we are desperately striving to do the very best we can for our patients. I hope we can move on from some of the less helpful elements of this report and focus instead on supporting our GPs better in the vital work they are doing to tackle the pandemic and beyond.
Dr Andrew Buist is Chair of BMA Scotland’s GP committee