WE have known for some time that there is a crisis in general practice, but we now know the crisis is deepening rather than improving. Many GPs in Scotland do not have the resources they need to work effectively for their patients. There is also a recruitment problem because many junior doctors are reluctant to take on what they see as the thankless task of being a GP. And now, to top it all, it looks like more and more GPs have had enough of the stress of trying to run their practices, leaving an increasing number to be run directly by health boards. Some practices are closing down altogether.
The figures show that the problem was bad enough two years ago but it is now significantly worse. In July 2015, 42 GP practices in Scotland were under direct health board control, but in the last two years that has risen by nearly 25 per cent to 52. It means that across the country one in 20 practices is under direct health board control because there are no GPs to run them.
The Glencairn Medical Practice in Ayrshire is typical of the problem. Most surgeries are run as partnerships under which the Government pays GPs’ salaries and provides money for a range of services set out in the General Medical Services (GMS) contract, while the surgeries themselves are owned and operated by the doctors. However, Glencairn Medical Practice is due to be taken over by the health board from August after the partners resigned the GMS contract, citing a list of familiar problems: lack of funding, a lack of staff and an impossible workload.
It also does not help matters that many practices have been run under a precursor of the Private Finance Initiative in which they lease their buildings from private companies. The problem is that the leases are now coming to an end, leaving some surgeries facing big maintenance bills, and that is acting as yet another disincentive for young doctors who might take on the responsibilities and run surgeries in the future.
Faced with all of these factors, and no prospect of relief in the near future, it is not surprising that many GPs are leaving, but the consequences for patients are serious. In some cases, the health board will take over, but in others the practices are going to the wall entirely, leaving patients to try to find a place with another practice. We are not at the point yet where patients cannot find a doctor, but there is now a serious risk that it could happen in the future.
The answer is to directly tackle the problems listed by the doctors at the Glencairn Medical Practice. A new GP contract for Scotland is currently being negotiated but if it is to solve the problem of retaining doctors to run practices (as well as attracting new ones) then it must make the job more bearable.
What this means in practice is reducing the day-to-day workload by moving certain services to other parts of the health service – pharmacies for instance. The contract must also look at reducing the business and admin elements of a doctor’s workload so they can concentrate on patients. The bottom line is that Scotland’s surgeries need more resources, more staff and more support and that without those essentials, even more GPs will decide enough is enough.
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