With packed NHS surgeries and well-documented shortages of family doctors, private GPs are expanding in Scotland with £100 appointments and late-night consultations.
More than 8,000 patients were seen at private practice Your GP in Edinburgh this year, with the company to launch its new surgery in Aberdeen next month and a third to follow in Glasgow in early 2016.
GP leaders have expressed concerns over a two-tier health system and claimed the core NHS value of care being provided on need - and not the ability to pay - is being put at risk.
But those behind Your GP claim the business can be more flexible in meeting patient need while easing pressure on stretched practices who are dealing with increased numbers in appointments and a lack of doctors to treat them.
Dr Malcolm Valentine, the medical director of the new Your GP in Aberdeen, is well familiar with the strain on NHS surgeries.
After nearly 30 years, he was forced in September to close his surgery in Aberdeen - which served around 8,000 patients - because he could not find GPs to replace retiring partners.
Indeed, in the North East, it is estimated that one-in-five family doctors are due to retire by the end of next year. One surgery cut 200 appointments a week for three months due to lack of resources.
The Royal College of GPs in Scotland (RCGP Scotland) has claimed that Scotland could face a shortfall of more than 900 GPs within five years if current population trends continue.
Dr Valentine said : “I do think that workforce pressures have far from peaked yet.
“Each person who accesses an appointment here and is not having to pursue an appointment with the NHS, is taking pressure out the system.
“I think it is changing times. Local GPs see this as a welcome addition to medical capabilities and I see this as a complimentary service - I don’t see the conflict.
“If you had asked me a couple of years ago, I would perhaps have had some antibodies about a private practice.
“But I think life has moved on and I don’t see this as creating a two-tier service. It feels very similar to what I was doing before.”
Dr Valentine claimed some patients had been referred to Your GP by local family doctors, including visitors from outwith the EU whose services would be charged for on the NHS.
Medical records are not routinely requested by Your GP but will be sought if there are particular concerns, such as the prescription of certain medicines.
Consultation prices start at £100 for a 15-minute consultation with patients paying £165 for a 30-minute appointment, rising to £230 for an hour with a doctor.
In Edinburgh, the surgery is open seven-days a week until 7pm but Aberdeen will keep regular office hours for now.
Dr Miles Mack, chair of RCGP Scotland, said he did not want to argue against patient choice but would find further development of the private primary care route “regrettable”.
He added: “Private care can in no way be seen as a solution to the current watershed in general practice.
“The considerable work of the Deep End practices, those in areas of highest deprivation, has shown that there is a current trend for people most in need of care to receive least of it due to the resources available.
“That is the Inverse Care Law. Growth in private GPs would only exacerbate that. We risk a two tier health system developing throughout Scotland which would be completely against the ethos of the NHS and its widely cherished goals.”
He also claimed difficulties in sharing information between the private sector and NHS, both in primary care and secondary care, “may have serious consequences for patient safety.”
Dr Valentine said that all doctors in private practice has to pass the same thresholds of annual performance appraisal and periodic re-licencing as any NHS doctor, with the governance arrangements essentially the same.
Dr Valentine also claimed the NHS in Scotland would “collapse under the workload” if private medical sector was not used in the treatment of NHS hospital patients and said the RCGPS was at risk of propagating an “outdated polemic.”
Figures show NHS Scotland health boards spent £82.5 million on private health companies in 2014/2015, chiefly to help meet waiting times target.
Dr Valentine said: “Why should the same patient choice not exist in the Primary Care arena?
“Surely the way ahead in health care, is to collaborate on finding solutions to issues if and when they arise rather than to adopt a negative and critical approach to something - particularly without any great evidence for that negative approach in the first place.”
A Scottish Government spokesperson said spending on GP services had increased by £88.7m - or 13 percent - under the current government with an extra £60m announced in June to reduce GP workload and give GPs time to test new ways of working.
She added there were now more GPs per head of population in Scotland than England.
“We believe in healthcare which is free at the point of need and we work very closely with health boards to ensure all patients have access to appropriate GP services.”