THOUGH I cannot recall the 1966 GP Charter mentioned by Dr Brian Keighley in his Agenda contribution ("Action needed now to put our GP service right before it is too late", The Herald, June 1), I have been working long enough as a GP to remember the 1990 and 2004 contracts; I am just not sure I can wait until the proposed new GP contract in 2017.
General practice has never to my mind been in such a perilous state as it finds itself in today. Little did I think I would be one of the one-third of Scottish GPs contemplating retirement from the job I loved within the next five years.
Primary care is the bedrock of the NHS where 90 per cent of all patient contacts in NHS Scotland occurs. Good access to primary care is essential for a cost-effective, high quality NHS.
I believe there are two main reasons for the situation we find ourselves in today: workforce planning and funding.
Since 2006 the headcount of trained GPs has increased by 140, or 3.3 per cent At the same time the consultant workforce increased by 1,312 whole-time equivalents, or 35 per cent. Since 2008 the figures are even starker with 29 additional GPs and 679 extra consultants in post. Scotland does have a higher number of GPs per head population than England but that is to be expected considering our rurality; the issue is does that statistic apply to Glasgow City or Forth Valley?
Primary and secondary care are inter-dependent and there are good reasons for an expansion in a consultant-delivered NHS but I doubt many of my consultant colleagues would argue that we have got the balance right.
The Royal College of General Practitioners has been calling for investment in general practice to rise to 11 per cent to cope with increasingly complex multi-morbidity. In 2006/7 this figure stood at 8.5 per cent but has now fallen to below 7 per cent of the £12 billion health budget. The annual gap of £180 million is needed now to shore up the current service. The £45m Primary Care Development Fund announced last November has not yet been allocated.
If we really care about public health, reducing health inequalities, mental illness and improved care of the elderly then we need to urgently establish a review group to look at how we can develop and train not only the GP workforce but the practice and community nurses, the pharmacists, mental health workers and carers that will be providing primary care in the future.
I believe that though well intentioned, the Scottish Government and the British Medical Association are wrong to think we can wait till 2017 for a new GP contract. Unless the issues of developing the wider workforce and funding are addressed with some urgency then we will see many more closures of GP practices across Scotland.
With public, professional and political will I am confident I could grow to love the job again ... and even put off retirement.
Dr Erik Jespersen,
Lorn Medical Centre, Soroba Road, Oban.
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