PATIENTS face having to see nurses and other health workers instead of a GP as a shortage of family doctors hits Scotland.
Dr Alan McDevitt, a leading doctor who is working with the Scottish Government on the future of community healthcare, has warned a staffing crisis and the soaring elderly population means there have to be changes to the services GPs provide.
GP partnerships in major towns are already collapsing because vacancies cannot be filled. NHS Forth Valley had to take over a surgery with 4,500 patients in Falkirk this week because the doctors running the practice could not fill an empty post and, it is understood, the workload was too much for those left behind.
The future of a practice in Grangemouth is said to be in jeopardy and there are reports of surgeries in Edinburgh, Fife and Tayside closing their lists to new patients because it would be unsafe for staff to handle the extra workload.
In a survey conducted by the British Medical Association Scotland and published today, 17 per cent of participating practices were short of at least one doctor.
Dr McDevitt, chair of the British Medical Association's Scottish GP Committee, said: "The workload is unsustainable, you cannot recruit doctors, you cannot get locums, people just cannot keep this up.
"I think people took a while to think about the scale of the changes that might need to happen to fix things, but there is a strong sense if we do not fix things, general practice will break."
The GP shortage has come at a time when they need to take on more work to prevent elderly people being admitted to hospital. Wards are already struggling to cope with the number of patients who require beds as the frail elderly population increases.
Dr McDevitt and other members of the BMA have been touring the country with members of the Scottish Government health department to discuss the situation.
To solve the problem, he said, the line which differentiates which patients see a GP and which patients are referred to other NHS staff might have to move.
He said: "We think GPs should be the senior clinical leaders in a team of people looking after you in the community including receptionists, nurses, healthcare assistants and pharmacists. All of them will make their contribution to people's healthcare as part of a much better team in future."
He admitted this might mean "hard choices" for GPs who are concerned they might lose their whole population expertise because they will have to "spend so much time on the complex elderly".
"I have the same anxiety about people not being able to see GPs for the things they used to be able to see a GP for," he said. "I want to be available to patients."
He suggested if the GP shortage was addressed longer term then the way patients were referred could change again. He also stressed the new set-up would have to be safe and it would take resources to expand the roles of the various healthcare staff involved.
The BMA GP vacancy survey was completed by 463 practices out of 988 in Scotland. As well as staffing gaps, three-quarters described difficulty finding locum cover when it was required.
Dr Andrew Buist, deputy chair of the BMA's Scottish GP committee, said: "An ever increasing workload, combined with falling resources, has led to a reduction in the number of doctors choosing to train as GPs, while senior GPs are choosing to retire early or work abroad for a better work-life balance. This will inevitably affect the care we can provide to our patients.
"A high vacancy rate translates into a decline in the number of available appointments - reducing access to general practice at a time when we are trying to treat more people in their communities."
NHS Forth Valley said they are working closely with the struggling GP practices to maintain safe, effective and sustainable services which meet the needs of local communities.
A Scottish Government spokeswoman said: "The difficulty in recruiting GPs is not an issue unique to Scotland, however this Government's investment in primary care has seen the number of GPs increase by 6.9 per cent. There are now more GPs per head of population in Scotland than England. We're working with health boards and the medical profession to develop short-term recruitment initiatives as we look to develop more attractive medical career pathways."
She added that a primary care development fund would ensure GPs and other health professionals could help the health service evolve to meet the changing needs of Scotland.
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