Contracts, covid and the new Cabinet Secretary: an update for GPs in Scotland

Last week I was confirmed as Chair of the BMA’s Scottish GP Committee for a further three-year term. It is a huge honour to continue in this role and is a responsibility I take very seriously. It also provides a key moment for me to reflect on my first three years in the job – and look forward to times ahead.

There is no doubt the last 18 months have been tough on everyone dealing with the Covid19 pandemic and general practice has been on the front line throughout: maintaining access to care in-hours, out-of-hours, providing most of the workforce for Covid Assessment Centres and playing our part in the major vaccination programmes. Many of us are seriously fatigued by what we have experienced (as our recent survey showed) and yet we still have quite a way to go to reach anything close to recovery, which I now think will take many years. And some things will never be the same.

As well as the pandemic, the other big issue that has dominated my first term has been the implementation of the 2018 GMS contract. The aims of the contract were clear – to reduce inappropriate GP workload through the development of expanded multi-disciplinary teams to provide patient services, to reduce practice risk and stabilise practice income and the bottom line, to make general practice more attractive as a career and build the GP workforce. Progress has been made in all areas although never quite as fast as we would have liked, but against widespread workforce shortages and the challenges of the pandemic, I think overall we have done ok. Having said that, I absolutely recognise the frustration you are feeling that things haven’t been better – or quicker and that delivery remains well off where we expected it to be. As we move forward, I want to reassure you that my team and I are determined to keep pushing for better – to make sure delivery matches our agreements with Scottish Government and improves working conditions for GPs across Scotland.

The pandemic has ironically helped in some transformational areas, most notably vaccinations where the scale of the Covid vaccine programme has enabled the NHS to significantly develop their vaccination workforce and infrastructure. And as promised there will be regulatory change in October to remove vaccinations from the GP contract and transfer responsibility to the Health Boards while retaining the funding in general practice.

Similarly, regulation will be established by April to ensure that practices and patients receive a pharmacotherapy service and a Community Treatment and Care (CTAC) service from their local Health Board. Progress in these areas is patchier across the country as our recent survey of practices demonstrates. My thanks to the 340 practices who responded, the key findings were as follows.

The Provision of a core (level 1) pharmacotherapy service, which means pharmacy support that includes acute and repeat prescribing medication management activities, actioning Immediate Discharge Letters, and monitoring high-risk medicines, has not progressed as far as we would like. While most practices are receiving some kind of service, with just 7% of responding practices saying they have no pharmacotherapy support, only 12% report that they are currently receiving the full service which the contract promised. Practices most frequently told us they have about half or less of the service they expect to receive.

There is also a lot of variation in delivery of CTAC services. While a majority (62% of responding practices) report that CTAC services in their area are providing phlebotomy service, just 10% report that their local CTAC service is undertaking chronic disease monitoring and related data collection. Even within the more developed aspects of CTAC services, there is much variation between boards with extensive phlebotomy provision reported in Lanarkshire, Tayside, and Ayrshire & Arran contrasting with very little provision in the Borders, Dumfries & Galloway and the Highlands.

I think these figures demonstrate what we have heard through our regular discussions and indeed our own experience as working GPs. Things are moving, but not at the pace we expect – and there is still some considerable way to go.

That is why it was so important that last week we also published the refreshed Memorandum of Understanding that describes the process for transfer of services from general practice to Health Board responsibility. It was a robust negotiation, but we got there in the end; maintaining the contract agreements and the principles we previously agreed with Scottish Government in December 2020. Having this set out with clarity for both sides, the MoU will now help guide us through the crucial coming months as we up the pace of delivery and ahead of us gathering to discuss progress at the SLMC conference at the end of the year.

Of course, political will and backing is a vital part of the jigsaw and I am looking forward to meeting for the first time soon with Humza Yousaf, the new Cabinet Secretary for Health. I do hope we can develop as good a working relationship as I had with his predecessor Jeane Freeman, who I met with regularly and who recognised the importance of general practice within the NHS, where she described GPs as the ‘foundation of the NHS’. I’ve called being Cabinet Secretary for Health the second toughest job in the Scottish Parliament. Mr Yousaf has come in at a critical time and not having had experience of health before, it is important that we quickly help him understand that the future of our health care service, indeed the Scottish Government’s own strategy begins and ends with patient care in the community, where the general practice is without doubt the keystone to making everything work effectively and delivering the very best, joined up care for patients.

One thing I do share with the new Cabinet Secretary is a sizable inbox, with many pressing issues on our respective desks. We need to work together to address them – and on your behalf I’ll be raising our key asks tirelessly over the next three years. Keep checking in with this blog and I’ll update you on progress.  Thanks again for your support and backing since I took over as Chair.

Dr Andrew Buist is Chair of BMA Scotland’s GP Committee

Picture credit: Gordon Terris, Herald and Times Group

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