FOR Highland GPs, the vaccines debacle is the tip of a much more troublesome iceberg.
Back in 2018, a landmark new GP contract - the first ever negotiated specifically for Scotland between the Scottish Government and BMA Scotland, independent of the rest of the UK - was voted through by a 71.5% majority.
Support was far from unanimous, however: more GPs actually abstained than voted, and it was universally rejected by rural practices "betrayed" by a revised funding formula which boosted the coffers of Central Belt practices while their rural peers saw no uplift.
It also promised to reduce workload by transferring responsibility for vaccinations from GP practices to health boards, something many overloaded urban GPs welcomed - but which their rural counterparts feared would lead to reductions in uptake for everything from childhood inoculations to winter flu jabs in areas where a GP-run service would be more convenient and easier to staff.
READ MORE: Is general practice about to face its biggest shake-up in NHS history?
The slow rollout of the Spring boosters in Highland has, they say, just proved their point.
Dr Andrew Buist, chair of BMA Scotland's GP Committee, insists that flexibility has always been built into the contract and that it is too simplistic to say that the contract "doesn't work for rural areas".
He said: “If boards like Highland assess that they will struggle to deliver services like vaccination due to issues such as rurality, they can use the options appraisal process. This allows small remote practices that are identified as hard to reach to continue doing traditional GP practice activities such as vaccination – with extra funding to support them.
"This flexibility is built into the contract and is precisely because it is clear that remote and rural areas need to be allowed to make sure solutions are suitable for their own specific circumstances. We have seen board led delivery of vaccination programmes can work over recent times – but of course this may take time to bed in."
Something else bothers Highland GPs about the decision to sideline them from vaccinations, though.
Back in 2018, critics suggested the funding formula had been cynically skewed in favour of the Central Belt to ensure there would be enough GPs enticed by the promise of a boost in income to overlook what some perceived to be a looming threat to their independent contractor status.
READ MORE: Highland GPs 'betrayed' by funding formula which hands £10k windfalls to urban colleagues
Phase Two of the contract - which is still to be approved - envisages a consultant-style income scale for GPs, which is easier to create if no practices are providing "extra" services like vaccination. Opponents have dubbed it a "salaried service by stealth" which will rob GPs of their autonomy; BMA Scotland insists it is committed to retaining the independent contractor model.
The Highlands vaccine row may turn out to be just the first skirmish in a much bigger battle to come.
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