Many earn more than £100,000 a year and few have to work evenings or weekends; with such generous terms and conditions, those outside the medical profession can struggle to work out why doctors seem so reluctant to enter – and stay in – general practice.
But the facts speak for themselves: Scotland is facing a severe shortage of GPs. This is not new, of course; but the results of the latest survey of GPs is especially concerning since they reveal the particular nature of the perfect storm that is brewing in surgeries across the land.
Let’s look at some of the headline findings. The total number of full-time GPs in Scotland has slumped by 100 in the last two years, while vacancies have doubled since 2013, and half are still empty six months later.
All primary care boards except for Shetland are struggling to cover out-of-hours care, with 60 per cent of surgeries saying they are regularly unable to recruit locums for unplanned absences.
Instead of being spread across the profession, the vast majority of out-of-hours care is carried out by a small group of GPs, leaving little room for manoeuvre. Alarmingly, the picture looks set to get worse – more than a third of current GPs are over the age of 50.
And all this comes at a time when more and more is being expected of family doctors, the gatekeepers of the NHS, by patients and health boards alike.
An ageing population means more services are required, and for longer periods of time. At the same time, changing perceptions mean we now want and expect more and more care to take place in the community, in peoples’ homes, rather than impersonal in hospital wards. And with over-stretched emergency departments urging people to consult their GPs rather than turning up at hospitals, it’s easy to see how the pressure can build.
Professionally, GPs are weary. They get little time to spend with patients due to ever-increasing caseloads, leaving those they want to help frustrated. With all this in mind, it’s perhaps getting easier to understand why many doctors opt for other specialisms, while those who do become GPs often leave or retire early.
So what, if anything, can politicians do to turn things around? SNP Health Secretary Shona Robison has accepted there are difficulties and is right to admit a redesign of the service will be required to ensure services are sustainable.
So what might such a “redesign” look like? As opposition politicians are lining up to point out, it’s probably going to take more than a few extra GP training places.
Pilot projects such as the one running in the Lothians to bring back retired GPs as locums, could have merit. We also need to think more broadly about who provides care and expertise – GPs should be leading teams of specialist nurses, pharmacists and, as care moves increasingly into the community, social workers.
Crucially, we need to ensure we can retain family doctors, rewarding them not just financially, but with fulfilling careers. Achieving this at a time of austerity remains one of the toughest challenges currently facing our NHS; the fundamental importance of GPs to its existence means we cannot afford to fail.
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