‘Practices in Scotland are returning their contracts on a regular basis’

In a series of articles on the state of general practice in the devolved nations, Jenny Gibson looks at the key issues currently faced by Scottish GPs…

The legacy of the pandemic is still keenly felt in general practice across the UK, and Scotland is no exception.

In early 2020, things were looking up. The BMA and Scottish Government had successfully negotiated a new GMS contract and the sector was optimistic about the expansion of multi-disciplinary teams. But three years on, GPs continue to cope with excess workload and financial strain linked with hospital backlogs and the effects of the lockdowns on their patients.

Chair of the BMA’s GP Committee in Scotland Dr Andrew Buist says: ‘Long waiting lists in secondary care pushes back into general practice. You make a referral and you’re told it’s maybe going to be a year, so the patient needs ongoing care. Sometimes they fall off waiting lists. They come back to you, and you have to write to the hospital again. That creates additional workload.’

He adds: ‘Populations are still recovering from the pandemic in many ways. Levels of mental health issues have risen. It’s not often the severe and enduring type, more the lower-grade anxiety and depression problems. It all lands in general practice.’

For GPs, there have been some positives in recent years such as the successful transfer of vaccinations out from almost all practices, and the ‘massive advantage’ of not having the QOF to navigate, as England does. There is also more good news in the form of enhanced shared parental leave for GPs following lobbying, as well as the prospect of more money to attract doctors to rural areas and significant investment in practice-based mental health advisers.

However, GP leaders report low morale in Scottish practice. RCGP Scotland council chair Dr Chris Williams says: ‘Looking across the profession, there are many GPs who have given their all and are tired.’

He adds: ‘Covid has really caused such a degree of rearrangement that it’s sometimes difficult to know to what extent our problems are due to workforce issues, and what problems we face due to wider societal problems. Certainly, workload is above the level that we can comfortably service…’

As with the rest of the UK, workforce and workload problems plague general practice in Scotland. According to Public Health Scotland figures, the number of patients has risen 6% since 2012 and over 65s have increased by a fifth in this period.

Meanwhile a third of practices have at least one GP vacancy they cannot fill. In January, the chair of BMA Scotland, Dr Iain Kennedy, warned that 2,000 new GPs were needed to solve the country’s workforce crisis. Audit Scotland recently reported that ambitions to increase the headcount of doctors are ‘not on track’.

Dr Williams says: ‘We don’t have enough GPs and there are not likely to be sufficient GPs in the immediate future. So, how do we plan for that? From a college perspective, how do we give quality care for everyone, in a system that is missing certain elements?’

Money is also an issue. In October, the Scottish Government made a £5m cut to a pre-agreed £30m funding pot, and a recent 4.5% GP pay rise across the devolved nations – described as ‘hugely disappointing’ by a former BMA Scotland chair – has caused ill feeling.  

So far, industrial action as seen in England has been avoided, but Dr Williams warns: ‘I don’t think that will necessarily continue’ and in December, LMCs indicated their support for potential collective action.

In the meantime, the risk of closures remains high. RCGP Scotland recently warned that one in three practices is at risk, while the Public Health Scotland survey highlighted a steady downward trend in the number of practices.

Dr Buist says: ‘We are seeing practices returning their contracts on a regular basis all around the country, in some very surprising places, places you would never have thought would be vulnerable to losing their contract or giving up their contract.

‘There’s one in a very affluent part of semi-rural Aberdeenshire that is giving up its contract in April just because it was an eight-doctor practice, dropped to three and couldn’t recover, so they resigned. Almost every week I’m hearing of another practice returning their contract.’

He concludes: ‘We’ve reached the tipping point for a lot of practices and sadly I think the number of practices returning their contracts is going to increase.’