Scotland’s GP leaders have outlined a list of demands for the Government to meet in order to avoid industrial action, including GPs receiving 15% of the NHS budget and long-term contract reforms.
Last month, Scottish LMCs representatives voted in favour of balloting the profession on industrial action, as a result of ‘years of disinvestment in general practice’ with financial cuts opposed to uplifts to GP partners pay.
Now the BMA’s GP committee for Scotland said that following the vote they have shared a ‘position statement’ with Scottish Government, containing its asks to ‘rescue’ general practice and ‘avoid’ dispute.
It pointed out that a ‘gross neglect’ of GMS ‘over many years’ has led to a crisis in general practice, and added that the proportion of NHS funding allocated to general practice must return to its previous level of 11%, with the ‘ultimate goal’ of reaching 15% of overall NHS spending.
It said: ‘We acknowledge that achieving this objective will be highly challenging and will necessitate several years of effort. This trajectory, however, is essential to ensure the long-term sustainability of the NHS.’
The list also included:
- Move towards a reimbursement model for certain non-staff expenses
- Progress work to transfer premises risk to health boards
- Urgently recommence sustainability loans
- Review where new enhanced services in general practice could achieve better value for money and reduce waiting times and seek to negotiate these
The document also said that while SGPC is not seeking to negotiate a new contract ‘at this time’, these changes can and should be underpinned by reform of GMS regulations and the ‘initial groundwork’ in preparation for future negotiation ‘could begin to be laid now’.
‘Our future direction of travel should be for GMS to be a contract to deliver consistent levels of expert medical generalism across Scotland by core funding rewarding practices that are achieving desired levels of GP WTE numbers and GP provided care, with a more extensive and more flexible range of enhanced services that will allow general practice to flexibly meet the variable needs of different communities,’ it added.
The SGPC added that ‘it would appear’ that the Scottish Government ‘are listening’ and mentioned that health secretary Neil Gray announced an additional £13.6m to go directly into core GMS this financial year. The Scottish Budget last week also mentioned ‘an extra £2 billion for the NHS’.
The SGPC said: ‘As always, the devil is in the detail of such announcements. The vast majority of this money includes all pay awards made in 24/25, including our own original uplift to the global sum of 7.5% and the extra £13.6m announced.
‘What is genuinely new money amounts to £100m of which £10.5m has been allocated to GMS via a new enhanced service.
‘This has to be agreed with the profession and is something we are looking to work on quickly. Given the lack of capacity creation, any new enhanced service must be a sensible business case to create the required capacity otherwise we will not be able to support it.’
A Scottish Government spokesperson told Pulse: ‘We value a constructive working relationship with the Scottish GP Committee and we do not regard dispute as inevitable.
‘Sustainable reform of the NHS means we must look to shift more care to primary and community care with a relentless focus on better outcomes for people. This can only be done by working with GPs and the BMA.’
The demands in full
Short term
• Agree a service specification that is achievable with current levels of MDT resourcing, and provides assurances to practices around consistency of health board MDT provision. This must also include arrangements for practices where Boards fall short of the requirements of this specification. Furthermore, if a board determines that local needs are best addressed by allocating sufficient resources to a practice capable of delivering these services, and there is consensus with the local General Practitioner Subcommittee/Local Medical Committee, this course of action should be endorsed.
• Establish what data is needed to move towards a reimbursement model for certain non-staff expenses and seek to collect and analyse it as rapidly as possible before developing a suitable model of reimbursement.
• Progress work to transfer premises risk to Health Boards, starting with hard and soft facilities management costs in health board provided premises, while ensuring fairness across different types of premises.
• Urgently recommence sustainability loans and prioritise lease assignations where Practices request this.
• Review where new Enhanced Services in general practice could achieve better value for money and reduce waiting times and seek to negotiate these. The £10.5m earmarked for this work in the recent Scottish Budget gives us an opportunity to progress this, along with seeking a share of the £100m intended to reduce waiting lists.
Medium term
• Look to reform the Minimum Earnings Expectation to achieve some alignment with consultant earnings whilst also retaining the incentivised efficiency, flexibility and responsiveness of the independent contractor model.
Longer term
• Negotiate reform to GMS regulations so that GMS is focused around providing consistent levels of GP Expert Medical Generalist input and patient access across communities.
• Rebalance the distribution of NHS resources so that over time around 15% of NHS spending goes to a revitalised and expanded general practice, with a ratio of 1 WTE GP per 1,000 patients.
Source: GPC Scotland
It comes as new NHS Education for Scotland data showed that the number of whole-time equivalent GPs continued to decrease in the past year, from 3,478 in 2023 to 3,453 in 2024, a decrease of 0.7%.
The data also showed that:
- The number of whole-time equivalent GPs decreased for a third consecutive year, resulting in a decrease of 6% since 2013
- The number of GP sessions lost to sickness absence was around 5,500 (15%) higher than in 2022/23. The number of hours lost to sickness for non-doctor staff was around 50,000 (11%) higher than in 2022/23
- The number of practices in Scotland decreased by 9% from 997 to 911 practices since 2012, reflecting a trend towards fewer practices overall and instead having larger practices
- The number of patient registrations in Scotland increased by 2.1% over the past two years
If follows an announcement by the Scottish Government which unveiled a new recruitment and retention strategy for GPs, setting out 20 measures to improve retention.
Commenting on the data, RCGP Scotland chair Dr Chris Provan said that this indicates ‘a failure to stabilise the GP workforce’.
He said: ‘On the frontline in GP practices, it means challenging workload levels all year round, but particularly during winter. Action is needed now to ensure we have sufficient GPs to service our patients’ needs.
‘We know the Scottish Government is not on target to meet its commitment to recruit 800 new GPs by 2027, as evidenced by the publication of these figures.
‘However, we welcomed the Scottish Government’s new recruitment plan and its commitment to examining the optimal shape of the future GP workforce, taking into account evidence about population health, projected burden of disease, and the crucial role of GPs in supporting care closer to home. Decisive action to reverse these worrying workforce trends can’t come soon enough.’
