GENERAL practice is, and always should be, one of the pillars of the NHS – indeed, it is likely to become even more important in years to come as the focus of healthcare shifts from hospitals to the community. And yet the evidence is many GPs do not have the resources and staff they need to work effectively for their patients. It is a crisis at the heart of the health service.
A number of factors have come together to create the problem, but one of the most serious is the way GP practices are structured. Most are run as partnerships which means the Government pays GPs’ salaries and provides money for most of the services and the partners are responsible for repairs and the upkeep of the surgery. This means that particularly in areas where budgets are tighter (surgeries in areas of high deprivation for example) some buildings can fall into disrepair - hardly an ideal condition for a place where people go for healing and support.
To make matters worse, since the 1980s many surgeries have been run under a precursor of the Private Finance Initiative in which they leased their buildings from private companies. The theory was that the surgeries would be spared capital costs but 30 years on, the leases are coming to an end, leaving some surgeries facing huge repair and maintenance bills. The bills are so great in many cases that the concern is that some GPs may go bankrupt and close down.
Not only is this situation exacerbating the already serious funding problems for surgeries, it is also acting as a serious disincentive for young doctors – who wants to join a GP surgery when it could mean taking on a six-figure liability to repair or maintain the building?
The bottom line is that solving the problem will mean more resources for surgeries. But the Scottish Government should also look again at the idea of weighting funding so that practices in Scotland’s poorest communities receive more. Young GPs picking up the tab for decisions made 30 years ago is a serious problem, but it is only one part of a bigger issue: a lack of honesty about the resources that GP surgeries actually need.
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