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Evidence of case for NHS review

It is 10 years since the overhauled GP contract was introduced, removing a duty to provide out-of-hours care from GPs and, in its wake, the working life of family doctors improved.

Well paid and facing manageable workloads, being a GP became an attractive proposition.

Yet, for some, the experience appears to have been relatively short-lived. GPs meeting in Glasgow this week are due to debate deepening concerns about staff shortages and rising workloads.

This is no rogue motion from one disgruntled GP practice. Doctors from seven health board areas have highlighted the consequences of doctor shortages. They talk of increased workload stress on those who remain, threats to services for patients, problems filling places in out- of-hours clinics, and warn that primary care is under-resourced given the growing demand from an ageing population.

Are GPs leaving the profession or reducing their hours? Anecdotally, both seem to be the case, with some doctors going part-time or retiring early. If they are doing so because of high levels of stress, that is a serious matter. More research could help identify how widespread the problem is and its underlying causes.

Clearly, if trained doctors are throwing in the towel or are working at below capacity because of stress, that must be urgently addressed.

The question for the future must be: are enough GPs coming through the training process to meet Scotland's needs and is general practice attractive enough as a specialism to encourage young doctors to take it up?

The worry is that young doctors perceive it as being excessively stressful. The ageing of the population is putting more pressure on GPs. Not only are older people more likely to become ill; frequently they have multiple and complex problems.

At the same time, GPs and the primary care sector in general have been given the task of helping shift more of the burden of care for the elderly out of hospitals and into the community. It is not entirely surprising that some doctors are feeling harassed.

Hospitals are no nirvana by comparison, of course. There, too, services are under strain. In fact, it is precisely because of fears that hospitals are already struggling and will not be able to cope with more elderly patients in future that the drive is under way to ensure that as many frail patients as possible are cared for in future in the community.

If GP practices are already working excessive hours and facing recruitment shortfalls, however, it is hard to see how they will be able to cope with that increased workload.

The Herald's NHS: Time for Action campaign has called repeatedly for a review of capacity and staffing in the NHS and social care sector to ensure that enough doctors, nurses and resources are in place to cope with the growing demands created by the ageing population. It is increasingly clear that this challenge is not for the future, but is happening now.

Excessive workloads cannot be allowed to become the norm for family doctors or they might vote with their feet and reduce their hours or leave the profession altogether.

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Health

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