DOCTORS' leaders have accused the Scottish Government of having a "dearth of policies" to shape the future of the NHS and ensure it can cope with looming issues such as the growing elderly population.

Dr Dean Marshall, chairman of the BMA's Scottish General Practitioners Committee, claimed ministers have no clear strategy for primary care services in the "mid to long term".

He also said GPs were reaching "saturation point" with increasing demand in seeing patients who would have once attended hospital clinics for routine check-ups.

Marshall said they did not support the direction the NHS was taking in England, where plans to radically reform the health service include giving GPs and other clinicians more responsibility for spending and encouraging greater competition with the private sector.

But he said: "The problem we have suffered with for quite a few years is a dearth of policies and no clear strategy for primary care in Scotland. So where they have got lots and lots of different things that we don't like in England, we really don't have any.

"What we really need is Government to take a mid to long-term view about what kind of service they want us to be providing.

"The population is getting older, people are living longer with complex medical problems, and they are in the main best managed in general practice. But that will involve significant increased workload and we need to resource that, whether it be more doctors or funding to practices to provide other staff to do that."

Marshall said a reluctance to deal with the problem now could result in "stumbling along to our usual crisis-led NHS".

He said: "The risk then is what always happens to the NHS. We wait, everyone knows what the problem is, no-one grasps the mettle to resolve it, then it appears and we do something knee-jerk which doesn't solve it."

Marshall, who will step down as chairman of the BMA's Scottish GP Committee in August this year, was speaking ahead of the annual Scottish local medical committee conference which will take place on Thursday.

Among the issues which will be debated at the conference include the performance of NHS 24 and whether nutritional education should be introduced in schools to tackle the obesity epidemic.

Other motions also raise concerns over the increasing amount of work at GP surgeries.

Marshall said: "What's happened is that services have either been decommissioned or moved out from hospitals to primary care.

"For example, most diabetics are cared for in primary care now and don't go near a hospital; that has been a huge shift and there are no examples of any resources coming from secondary care to primary care [to pay for this].

"The other thing that has happened is the monitoring of long-term conditions has moved, so where people used to go to hospital outpatients to get a blood test or to have a review, a significant amount of that is done in primary care. Again there is never any shift of resources."

He added: "Now there is a general consensus among GPs that we are at saturation point, we are as about efficient as we can be.

"The Government wants to increase efficiency, but you can only go so far with a finite set of resources and then our concern is that quality starts to suffer."

Dr Jean Turner, chief executive of campaign group the Scotland Patients Association, said: "When you reduce beds and when you reduce the services at hospitals, there comes a point when you do get beyond saturation point.

"Over the past 20 years, more has been done by GPs and more and more is being pushed into the community. It does need extra resources; when you are thinking of looking after more people in the community you don't want to give them sub-standard care."

A spokeswoman for the Scottish Government said they were "very much aware" of the immediate and medium-term challenges facing healthcare in Scotland.

She said: "The Cabinet Secretary [Nicola Sturgeon] has set out clearly how the NHS in Scotland will need to respond if we are to deliver our vision that everyone is able to live longer, healthier lives at home or in a homely setting. That will include decisive action to integrate health and social care. She has also made clear that GPs will be central to delivering that vision."

The spokeswoman said the issue was also being addressed by pursuing the introduction of a more specifically Scottish contract for GPs, which is currently negotiated on a UK-wide basis.

She added: "Clearly, limited resources will be one of the key challenges to overcome. That is why we are pursuing a more Scottish contract for GPs, so that we can ensure that all the resources at our collective disposal are directed at meeting Scotland's health challenges."