GPs in no mood to take medicine from ministers

Published on Monday 2 June 2008 10:44

Doctors are up in arms at plans to make them open their surgeries out of hours, and the stage is set for a long and bitter battle, as Health Reporter Gareth Rose finds out.

IT is shaping up to be one of the bitterest clashes between the Scottish Government and those providing essential services since the firefighters' strike put the public's lives in the hands of the Army's archaic Green Goddesses.

Once again the problem centres around money and once again public servants who regularly save lives are being accused of being inflexible and even greedy. The Scottish Government wants GPs to open out of hours and has offered them more cash in return, but GPs are resisting.

The growing impasse has even reached the point where family doctors voted on strike action – the move was, thankfully, defeated – after complaining about the "continuous erosion" of their pay and conditions.

The government shouldn't underestimate GPs' strength of feeling on the issue though. They believe they are being railroaded into unjustified changes to their working pattern, through a mixture of "spin" and strong-arm tactics. Neither side appears willing to budge, both utterly convinced they are in the right.

The situation is coming to a head in the Lothians with the GPs' reluctance to work unsocial hours threatening to leave the Scottish Government's plans in tatters.

The upshot for the vast majority of patients is that they will have to continue travelling to the ERI and other hospitals for their out-of-hours medical treatment.

Scottish ministers – like their Westminster counterparts – want to see more surgeries opening before 8am and after 6pm on weekdays, and on Saturday mornings. Such moves, they believe, would be more convenient for patients and ease the pressure on accident and emergency wards and NHS 24 – the current alternatives at evenings and weekends.

Ministers say surgeries can earn about 16,000 each if they comply. An average practice with 5400 patients would open an extra two-and-a-half to three hours a week, the equivalent of one early start, one late finish, or one Saturday morning.

The BMA accuses the government of "spin", arguing only half of the 16,000 would be extra money, with the rest already owed to practices for the other services they provide.

It believes that the added staff and running costs will erode the rest of the money over the course of a year.

It is also highly suspicious that the demand for an out-of-hours service exists in the way the Scottish Government claims.

One solution might have been to have piloted the scheme in an individual health board area. The number of patients turning up at various times, and extra costs run up by surgeries, could have been measured, and the evidence spoken for itself.

Now it seems we're too far down the road for that and the language from both sides is getting more confrontational.

Dr Marshall, a GP in Dalkeith, is adamant his surgery will not open on Saturday mornings. He is not alone – so far just three out of a potential 125 surgeries in the Lothians have agreed to the Saturday option.

"It sounds like a lot of money, but it does not mean we will get 16,000. That's spin," he said. "When they mention those figures that is not what we will earn. The government is deliberately making it sound like a lot of money.

The spin war against the government is an even harder one for doctors to win than it was for firefighters. With an average wage of around 100,000-a-year, they cannot plead poverty, and arguments against working evenings and weekends are unlikely to wash on a population which includes many people who regularly have to.

However, unlike the fire service which was always hugely oversubscribed by people wanting to be firefighters, the role of family doctor has had a recruitment problem and low morale among staff, which was why contracts were originally renegotiated to make the profession more alluring to young medical students who might be more tempted by the glamour of hospital work.

It is perhaps also why the Scottish Government has attempted to take a conciliatory approach in their efforts to introduce flexible hours – it simply cannot afford a war with GPs that will drive medics away from the industry.

In a country with an ageing population and increasingly busy accident and emergency departments, the role of the family doctor is as vital as ever.

Health Secretary Nicola Sturgeon recently said: "I believe that our offer to GPs is a good one – for GPs and for patients." GPs are not buying into her thinking though, and a lot of work is still to be done to prevent this key policy being left, embarrassingly, on the shelf.