By Dr Andrew Buist

IT was good to see broad support from most MSPs in Parliament last week for the fantastic job GP teams are doing throughout this pandemic. The reality is demand for appointments is outstripping capacity, but that is not new; it was happening before Covid-19, it’s just worse now. Pre-pandemic GP teams had half a million contacts per week: 16 times the number of people who attend A&E. Demand in this phase of the pandemic is increased; some practices are reporting 50-100% more daily contacts. So it is inevitable that appointments won’t be immediately available, and while Scottish Government latest guidance says triage is no longer necessary for infection control, our only way of coping with excess demand is to triage (or prioritise) patients who need us most.

We entered the pandemic with a capacity imbalance that has been further exposed. There are simply not enough GPs for the type of care our NHS says we should have, and our patients want. The average full-time GP in central Scotland will have 1,500-1,600 patients: as the population has aged and consultation rates have risen, it is no longer a manageable number. That is why we agreed in 2018 the first entirely-Scottish GP contract which sought to increase the number of GPs, increase investment in primary care, and expand the primary care multi-disciplinary teams (pharmacists, nurses, mental health). The pandemic struck before we had time to fully deliver on these commitments.

What should we do? First, don’t treat general practice as a political football. In the short term we need politicians, media and public to support general practice, recognising how well small GP teams continue to do in the pandemic. Knocking us when we are doing our best will damage morale, and risks harming workforce retention, only making things worse. We need to continue the hybrid model of patient access with telephone and face-to-face appointments and we need to be trusted to do our jobs and prioritise our capacity to those who need us most. And I would urge you to consider whether you absolutely need to see, or speak to, your GP: would a community pharmacist be able to assist? Is it something you can see a practice nurse about? Patients can self-refer themselves to local NHS physios.

We need to step up the pace of delivering the multidisciplinary teams to support GP practices to meet patient needs in the community. We need to fully realise the 2017 commitment to increase GP numbers by 800 as I fear GP numbers may not have increased since the commitment was made. We also need a significant investment in the community health infrastructure, as too many GP teams are operating out of cramped buildings that are no longer fit for purpose. This has been a significant restricting factor for infection control in managing patients in the pandemic. If we are to have a truly primary care led NHS in Scotland, then we must ensure the community gets a fair share of the NHS premises investment budget.

Dr Andrew Buist is chair of the BMA Scotland GP Committee