As we approach the Scottish LMC conference – where GPs will gather from across Scotland to discuss key issues – I wish that I could be more positive with you, but these are very difficult times for general practice with patient demand more often than not outstripping our capacity. GP vacancies are increasing, general practice has clearly lost its sparkle such that I have this week put it to Humza Yousaf the Cabinet Secretary for Health that there are clear signs we are now at a tipping point in terms of where we go next – and the future of the profession.
Last week the leadership of BMA Scotland’s GP committee held 3 evening open meetings for GPs across Scotland with over 500 attending to be appraised of where we are with our contract, the workforce and funding situation. It was clear that morale is low just now – in some places extremely low, the situation is bad, and the only positives are the strength of unity, that we care about our service and concern that we need to do something urgently to save the situation. Sadly, for many practices the situation is desperate, and I am expecting there to be increasing numbers of list closures and contract resignations over the next few months. That will be disastrous for Scotland, leaving patients to either be reassigned to another practice and maybe as a result tipping that practice over, or for the practice to be run by the health board as a 2C salaried service with less patient continuity at a far greater cost to the NHS. The Government tell me they are in a financial fix. I hear that, but general practice seems to be an easy target in health as we approach this most difficult of winters with the removal of PCIF reserves and reduction in agreed sustainability funding just when we needed more support not less.
The Government say they support the GP independent contractor model, and of course they should when you compare our efficiency, but we simply cannot continue to absorb more and more of the NHS workload without it breaking us. It seems to me the Government are hoping this crisis will all blow over and that we can just pick up where we left off in a few years. I don’t think that will be the case. Unless there is urgent intervention the landscape will have changed for the worse and there will be no way back. What we need is an immediate direct injection of funding to practices to expand capacity, with a sustained effort from SG to reduce demand on practices by public information and instruction to health boards to cease inappropriate diversion of activity to practices. I have heard calls for the profession to consider industrial action including in last week’s meetings and that is something that I know will be discussed at the SLMC conference next week. There are complexities to that debate as we are independent contractors, and I know it’s not something anyone would take lightly. We will be guided by the profession of course, but the fact it is even being mentioned shows how tough things are.
In amongst all this we are aware that practices have now received a letter from the Practitioner Service Division (PSD) indicating that the Scottish Government’s unacceptable pay uplift which leaves GPs the only group of doctors not to receive the DDRB’s recommended pay award was agreed with SGPC. This is categorically not the case and we have insisted upon an urgent clarification from PSD making this clear.
The pensions situation over annual and lifetime allowances is disastrous for healthcare retention of staff, most of the blame does lie with actions taken in London. I really had hoped that Jeremy Hunt who clearly recognised the problem when he was Chairman of the Westminster Health Select Committee would bring that understanding into the Treasury as Chancellor, but so far it seems not.
Last week we launched our Workload guidance on the BMA website, and I would encourage all practices to consider this individually in the context of their own situation. One of the recommendations that has attracted much comment and some scepticism is our advice that a safe level of working for a GP is up to 25 routine patient contacts per day with that number falling as patients require more complex care. This is recommended as a safe level for quality patient care and for clinician wellbeing. Some GPs have said this is impossible in the context of the demand they are facing, I understand that, but this is about resetting the norm – how far away are you from a safe level of working? We are caught in a situation that has been forcing us to work this way, now collectively we should start to push back on unreasonable workload demands, and I would encourage you to help your patients understand what you are doing, and I hope we can win over their support. Fundamentally the question the public needs to ask is whether they are content that their care is being compromised because clinicians are being over-stretched, are tired and working beyond what is an evidence-based safe limit? We would suggest some may want to contact their MSP to say they are not happy with this and demand that their general practice is given a fairer share of the NHS budget in order to provide a high-quality safe service.
Finally, we have just concluded a Wellbeing survey of GPs with over 1000 responses. It provides further evidence that GPs in Scotland are struggling with the workload and that it is negatively impacting on their wellbeing with a worryingly low number of respondents saying they would recommend a career in general practice. I’ll say more about that at the conference. The present situation is clearly not easy, but we must have hope that it is not too late, and that the situation can be redeemed by our politicians in the Scottish Parliament. We are making that case, through the media and all avenues available to us. Your support in that is vital – it is only by speaking as one, as a profession united that we will persuade our politicians to take the action that we all know is needed. I look forward to seeing those who will be there and continuing the discussion – at the SLMC conference next week.
Dr Andrew Buist is Chair of BMA Scotland’s GP committee