Many patients are unaware of changes, leading to frustration and sometimes abuse of practice receptionists, the Scottish Parliament’s health, social care and sport committee heard in the first evidence session of an inquiry into alternative pathways to primary care on Tuesday.
Digital exclusion and other barriers to accessing alternative care pathways have also contributed to “tragic” health inequalities, experts said.
Margaret McKay, Chair of the Patient Participation Group at one of Scotland’s largest GP practices, Riverside in East Lothian, said changes as a result of the new GP contract from 2018 have not been communicated.
Patients often become frustrated in trying to access care at Riverside, she said, facing long waits to speak to receptionists and sometimes finding they cannot receive the care they expect as the pathway has changed.
“The actual getting over to the public that general practice is changing, why it's changing … and what’s going to be put in place in order to ensure that health care needs are still fully taken care of, I would say there's been an abysmal failure in that,” Ms McKay said.
“There really needed to be a communication plan that was at national … health board or local authority area.”
Val Costello, patient adviser at Citizens Advice Scotland Patient Advice and Support Service, said: “I think that we need to really improve knowledge of alternatives and how people can find out about these services, because they have changed, and we have not changed our message to let them know that they have changed.”
Dr Chris Williams, joint chair of the Royal College of General Practitioners in Scotland, said in the wake of the new contract the college was “trying to understand the re-focus of the expert medical generalist”. He stressed staff shortages were the source of many of the challenges in general practice in Scotland.
Dr Williams said: “The very real root of some of the issues that we're discussing today is we do not have a large enough GP workforce.
“We have known for some years that we don't have a large enough whole-time equivalent workforce, and some of the measures [in the contract] are built in to to try and support things.”
He added: “I think there's there's also elements where we're picking up on new ways of working, and we’re also trying to understand a bit about how third-sector organisations can bring in new ways of doing things, new ways for people to understand their health and do things that are not medicalised.”
Panel members also warned in some cases alternative routes to care had increased health inequalities.
This included routes which required digital access, or support available far away from a patient’s home or not accessible by public transport.
Ms Costello said: “Right now we have a situation where there is an excluded group. That's unfortunate, but more than that it's very tragic, because they may need services and they're not able to access them. That’s just not right.”