Why are GP practices now unable to do everything they once did?
General Practice across the country has been struggling for years. However, it has now reached a critical situation with less money, fewer doctors and less staff to meet the growing needs of the Scottish population. So how did we get here?
In 2017, the Scottish Government recognised this and promised to introduce a new contract, starting in 2018, to be fully implemented within 3 years. At that time, the then Health Secretary Shona Robison MSP said, “We equally recognised the fundamental challenges faced by general practice, not least growing workload and increasing risk”.
Unfortunately, for the first time in the history of the NHS in Scotland, large parts of this contract have not been implemented. Even worse, when Health Boards have been unable to spend the money to employ additional pharmacists and other professionals to support General Practice, the money had to be returned to Scottish Government rather than being spent supporting your local practice.
Integrated Joint Boards and Health Boards can choose to support practices with transitional payments.
Other Health Board areas have used this funding rather than it being reclaimed by Scottish Government. NHS Western Isles has failed to do this so this funding for patient care was lost. In 2022/23 this amounted to £565,000.
In 2023/24 the same decision making deprived General Practice in the Western Isles of £236,000 which is the highest amount for the whole of Scotland.
There have been many further challenges both locally and nationally since then.
- Many people are unaware that the funding for practices comes through a national formula and doesn’t reflect how many times patients are seen. Practices are paid the same whether you are seen once or many times in a year. In 2017, the Scottish Government recognised that this did not work and promised to move towards a new funding model. This still hasn’t happened, and the funding uplifts have been well below inflation.
- On average patients used to contact their practice 3 or 4 times a year this has now increased to 6 or 7. There are many reasons for this and include an older population, more people with illness (often multiple illness) and many more treatment options. The large growth of hospital waiting lists has also had an impact, with GP appointments being taken up by patients needing treatment while waiting to be seen in a hospital.
- We all know how much energy costs have risen over the last couple of years, there has been insufficient funding to cover this, reducing the money for services practices can provide.
- Part of the funding which comes to practices every year is for paying non-GP staff such as receptionists, nursing staff, practice managers. This has always matched the pay of staff working elsewhere in the NHS. However, for the first-time last year, the Scottish Government decided to break this link, leaving practices having to fund the shortfall or risk losing staff.
- The number of GPs in Scotland is falling. As part of the 2017 contract the Scottish Government promised that numbers would rise by 800, however since 2013 the total number of trained GPs has dropped by almost 200 full time equivalent GPs. During this time the number of practices has fallen almost a tenth and the average list sizes have increased by almost a fifth. The total patient population has increased by 7%. Four in ten practices in Scotland report at least one GP vacancy.
- In the last 20 years the number of hospital consultants has doubled compared to GPs, despite much more treatment being moved out to practices. The share of the NHS budget spent on General Practice is falling.
- In many areas, practice buildings are too small and are outdated. Unfortunately, Scottish Government has now cancelled all funding for new builds, leaving many GPs and other staff working out of buildings that are no longer fit for purpose. There is no longer a safe option for GPs to buy or build new premises themselves.
- With less staff and more work, better IT would help improve efficiency. General practice IT is cumbersome, slow and unreliable which often affects the care of our patients due to inefficiency, increasing inefficiency. We are the only country in Britain still using paper prescriptions – this alone costs a huge amount of clinical, administrative and patient time.
- Support for learning time was withdrawn by NHS24 and Scottish Government so there is less time for practices to look at ways of improving.
Incredibly, despite all the above your practice remains absolutely committed to provide the best service that it can with the resources it receives.
However, if you’re not satisfied with the service you receive, look beyond the practice and instead hold those with the power to improve matters to account. Scottish Government needs to do more to directly support General Practice, the bedrock of the NHS. Please contact your MSP. Their contact details can be found at Members of the Scottish Parliament (MSPs) | Scottish Parliament Website
Western Isles Local Medical Committee
July 2024
