THE impact of the Covid pandemic could leave Scotland with even fewer doctors than it had before, Scotland's GP leader has warned.

Dr Andrew Buist, chair of BMA Scotland's GP committee, said existing shortages in primary care could be exacerbated by exhausted GPs quitting the profession or taking early retirement when the crisis is over.

Speaking to the Herald as the trade union prepares to launch its six-point plan tomorrow outlining what it wants the next Scottish Government to prioritise, Dr Buist noted that the current state of the workforce is itself unclear after Holyrood statisticians were redeployed to monitor coronavirus figures.

A key issue for BMA Scotland is the delivery of 800 extra GPs by 2027, a pledge made by the Scottish Government in 2017.

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The trade union stresses that this must be a 'whole-time equivalent' increase, not headcount, in order to account for part-time working - something which has become increasingly common in general practice.

A report by Audit Scotland in August 2019 projected that on headcount alone the workforce was on track to grow by just 19 GPs, to 4,417, by 2027 due to a combination of more doctors leaving than joining, changing workforce patterns and Brexit.

Dr Buist said: “The trouble is we don’t know where we are with it [800 GPs target].

"We did a workforce survey in January 2020 and about 800 of the 900 practices responded. That data has never been analysed - HeraldScotland: Covid struck very shortly after the data was collected and the analysts were stripped out to produce the data statistics that we get on Covid.

"We’ve asked the Government to prioritise getting that data out, giving us an analysis, and then repeating it, because we really should be doing this measurement once a year. I can only speculate as to where we are.

"We were short of doctors before Covid. I know of a number of people who stayed on to help with the pandemic, but many of them have said when it’s all over, that’s it, they’re going.

“We could find that we’ve actually been left with less doctors than we had before Covid.”

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The six-point plan also calls for a renewed focus on delivering key objectives set out in the 2018 Scottish GP contract, specifically around the creation of multi-disciplinary teams in practices in order to free up GP time to focus on more complex cases.

Embedding physiotherapists, mental health nurses, and pharmacists in every surgery was a core plank of the new contract's vision of GPs as "expert medical generalists" overseeing a team of healthcare professionals.

It was also seen as a way of cutting down waiting times for patients, while removing a recruitment burden from GP practices as it was up to health boards to employ these staff and allocate them into primary care.

HeraldScotland:

To date, the goal has fallen short - largely due to existing shortfalls in hospitals - with GPs voicing their "deep disappointment" at the situation at the profession's annual Scottish conference in December.

A new deadline has been set for 2023.

Dr Buist said it is "doable".

“They need to do proper workforce planning to ensure there are adequate nurses, physios and pharmacists coming through," he said.

"In some areas, they need to improve the local management to get these services in place. Some areas have done considerably better than others.

"There is a shortage of workforce in the community just now and there is quite a bit of robbing Peter to pay Paul. People are moving around [between areas] to get better conditions, higher rates of pay.

"Our workforce planning has not been good enough up until now.”

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Improving IT infrastructure is another priority, to go hand-in-hand with "a blend of remote consultations and longer face-to-face consults" which BMA Scotland sees as the future of general practice.

Dr Buist, a GP in Blairgowrie in Perthshire, says this should be a benefit, not a barrier, to patients.

“We’re going to have to live with Covid for the foreseeable future and even once everybody has been vaccinated, things are going to be different," he said.

"We’re not going to get back to the way things were before. I feel for patients and I hear stories – relatives who’ve had difficulty getting to see the doctor - and I’m thinking ‘that’s not how it should be’.

“At the moment I have a 60:40 ratio – 60 per cent telephone and 40% face to face. By taking out the consultations that can be done by telephone, you can spend more time on the meatier ones where the patient might have three problems that they need to discuss and an examination that needs to take place.

"Fifteen minutes would be a start, but that still might not be long enough."