For most of us that title will seem to be an obvious statement, so to back it up with some stats we conducted a survey of GPs in July, and nearly 900 of you responded. The results should be of concern to all involved in healthcare in Scotland. GPs are being asked to deal with too much workload, with 28% saying it is unmanageable. A similar proportion consider that their practice is in a precarious situation while another 60% fear for their practice sustainability if they were to lose a GP as they are concerned about not being able to recruit a replacement. And with 1 in 4 GPs responding to say they are planning to leave their practice in the next 2 years, it means the situation is only going to get worse.
This demanding situation is taking its toll on our well-being. While we GPs are generally a robust group of people; after all you don’t become a GP if coping with multiple demands and hard work is not something you can manage, but everyone has a limit, and 85% of you said you sometimes or regularly struggle to cope and that work is having a negative impact on your physical or mental well-being. That is seriously concerning as it is what leads to people leaving the profession prematurely and further exacerbating the growing crisis.
The Scottish Government is currently conducting its annual snapshot of the workforce in general practice, I hope your practice has been able to contribute. We’ll get the results in a few months, but I anticipate the news will not be good with the continuing flatlining of the GP numbers (actually the whole-time equivalent (WTE) was 3.4% down last year compared to 2019 pre-pandemic levels). For sure Government will point to the rising headcount of GPs but it is the WTE which provides the capacity that does the work and the access that patients need. A rising headcount with a falling WTE means that the workforce is increasingly working less than full time, a sign that GPs are protecting themselves by having more recovery time each week.
The SG workforce survey will also try to establish the number of GP vacancies that exist. However, even before these results are collected and published, we are concerned that many practices are struggling to recruit and that the number is rising. But even then, in reality the number of vacancies is falsely low as many practices have given up on recruitment attempts after failing to attract GP applicants. It also does not take account of the “missing GPs”- the additional GPs that practices require to meet the excess workload they currently face and for which no additional funding has been provided by the Scottish Government. The Scottish Government committed in 2017 to increase the GP workforce by 800 by 2027, now 6 years into that 10-year plan we should have approximately an additional 480 GPs working in practices, but we don’t. And the reason is that while we have increased our GP training numbers in Scotland, because we have a GP retention problem that needs urgently addressed, these new GPs are needed to replace the established GPs who are leaving prematurely.
In my view the 800 target was an arbitrary under-estimate of our needs, and that Scotland should be improving patient access to GPs by bringing patient list sizes down. The Scottish Government should be working to establish how many WTE GPs Scotland actually needs to deliver on its strategic aims of Right care right place with a sustainable affordable NHS to address the needs of our aging population and the inevitable increase in disease burden, and then working with BMA Scotland to deliver the plan set out in 2017 for income and expenses reform which has the potential to deliver on the required increased number of GPs and to target them to where patients need us most. Given the seriousness of the situation the Government must act now.
Dr Andrew Buist is Chair of BMA Scotland’s GP committee
Photo credit: Gordon Terris, Herald & Times Group
bmascotland.home.blog 