WITH nearly half of GPs retiring before they are 50 and a slump in medical graduates entering general practice, many practices face a precarious future.

The significant challenges facing the profession, especially in rural Scotland, are hammered home in a new fly-on-the wall BBC documentary, 'Family Doctors', set in one of Scotland busiest GP practices - Elgin health centre.

HeraldScotland: Dr Ron Stewart

With two of the six GP partners planning to retire, the shock announcement by a third - Dr John Nicol - that he wants to resign from the partnership and become a part-time salaried GP instead in order to take up a GP training post for North Scotland is enough to threaten the practice's survival.

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Speaking in the debut episode, which airs tomorrow, practice manager Eileen Rae said: "The worst case scenario is that John leaves the partnership and we don't have someone to replace him; that two GPs who have already said they will be retiring in the next two years follow that through and that leaves us with just three GPs. That's not enough to continue with the partnership. We could be looking at closing our doors."

The remaining partners face a dilemma to retain Dr Nicol on significantly reduced hours, or attempt to recruit a new full-time partner - but the average time needed to fill such a vacancy in Moray is two years.

Dr Ron Stewart, the practice's longest-serving GP, and one of those planning to retire aged 65 in 2020, added: "I think back to the halcyon days where we'd put a quick advert in the BMJ and get 30 to 40 responses. Now when someone leaves, we get no applicants."

Speaking to the Herald, Dr Stewart said he hoped the programme would help attract young medics by showing a "fair representation of what life in general practice is like", as well as helping patients to understand why primary care is changing.

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It comes as family doctors prepare for what may be the biggest shake-up to general practice in decades if the new Scottish GP contract is passed next week.

However, Dr Stewart - like the majority of rural GPs - is angry that the contract's new workload-based formula will cut his practice's share of GMS (General Medical Services) funding - in the case of Elgin Health Centre, by £110,000 a year. Although that shortfall will be made up through protection payments which both the BMA and Scottish Government insist will continue indefinitely, it still means that many rural practices will remain no better off while urban practices are gaining financially.

Dr Stewart said: "I find it disappointing when the formula was meant to reflect workload and population need that there has been no account taken of rural practice. That's the problem I have.

"If you are a young GP and you are looking to see where to go and work, it would be very difficult if not impossible for most practices in our situation - and most practices outside the Central Belt, Aberdeen and Dundee - to give any assurance that they're going to get any additional funding to try and help them address the problems of recruitment and retention.

"At best, even if incomes are guaranteed, the practices will be no better off - and there's still that concern that the might end up worse off. I'm not sure that's going to attract young GPs to go out and practice in these areas."

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Despite the problems, Dr Stewart adds that he would still choose to be a GP if he were graduating today.

He said: "It still offers that direct day to day contact with patients. The chance to sit down and hear their problems and try to help them through those. That's the bit that I enjoy."