The crisis in Scotland's GP services as another rural practice folds

The potential closure of yet another Scottish GP surgery has led to new warnings

The Fife Arms, Braemar, has been at the heart of the village for over 100 years. Pic: Contributed

There have been fresh warnings of a crisis in primary care after another rural GP practice handed back its contract with the NHS.

Braemar in Aberdeenshire is on the brink of losing its only GP surgery, Braemar Practice, due to the sole partner taking retirement.

Dr Donald Cruickshank, who has delivered “exceptional 24/7 patient care” for over 700 patients who live more than 50 miles from the nearest hospital, has been unable to recruit a successor.

The disappearance of another rural community’s GP healthcare is symptomatic of a healthcare system which is struggling with retention and recruitment - between 2012 and 2022 Scotland has lost ten percent of its GP surgeries.

The potential disappearance of another rural community’s GP healthcare is said to be symptomatic of a healthcare system which is struggling with retention and recruitment - between 2012 and 2022 Scotland has lost ten percent of its GP surgeries.

Of the ones remaining, nine per cent have closed lists - meaning they won’t accept new patients. In Fife, the figure is 40 per cent.

And the future is bleak - according to the Royal College of General Practitioners’ (RCGP) annual survey, more than a third of GPs say they are “unlikely” to be working in the NHS in five years’ time. More than 30 per cent GP staff said their practice was at risk of closing in the next few months.

In Braemar, Dr Cruickshank said: “I think everyone in the community will know that this is not the position I wished to be in, however, continuing as I am is simply not possible. It has been both an honour and a privilege to serve the patients and community of Braemar, as their GP, for more than 29 years”.

The local health board, NHS Grampian, is now in a race against time to provide healthcare in the region. Dr Cruickshank retires in December.

“The practice has tried to recruit a new GP,” said Janine Howie, the partnership manager for South Aberdeenshire, “however, this has not been possible and as a result Dr Cruickshank has had to take this difficult decision.

“It is our intention to work closely with Dr Cruickshank and the community to ensure that we can provide a robust and sustainable service to the Braemar community going forward.”

Aberdeenshire councillor Anouk Kloppert, whose ward includes Braemar, said she was “very sad to hear about the situation”, and thanked Dr Cruickshank for the “truly exceptional care provided for many years”.

“It is in everybody’s interest that a new partnership of GPs or similar might bid to take over operation and management of the practice. I was informed this week and will soon be invited soon to an health and social care partnership meeting to discuss how we might work together for the benefit of the Braemar community.”

Scottish Conservative MSP for Aberdeenshire West, Alexander Burnett, who has met with the community amid concerns over the future of Braemar Medical Practice, said the situation was “deeply worrying” and “underlines the incredible pressures that practices in rural communities such as Braemar are facing”.

“We have known Dr Cruickshank’s retirement has been on the cards for the last two years but despite repeated calls to NHS Grampian, no progress has been made in finding a replacement.

“Recruitment is well behind what’s needed to deal with increasing patient numbers in the area and no help has come from Humza Yousaf and the SNP Government.”

Scottish Labour’s North East MSP, Michael Marra, added that it was “a hammer blow to the local community” .

Dr Catriona Morton , the deputy chair of RCGP Scotland, and a GP in Craigmillar, Edinburgh, said it was “very concerning”.

“The problem is Scotland-wide. We have a huge shortage of GPs across Scotland. The Scottish Government has said it wants to increase GP by 800 by 2027 but Audit Scotland has said it won’t achieve that.

“Working time equivalent (the number of full time hours worked by GPs) numbers have dropped. We have roughly the same level of GPs as in 2013, but since 2019 the number of working time equivalent GPs has dropped.

“In the meantime, the population has gone up by a quarter of a million, and the population is ageing.”

According to Dr Morton, there are “two big factors” at play - GP numbers are inadequate, because GPs are leaving, and the other is workload.

“We’re caught in a spiral,” said Dr Morton. “Every GP looks after, on average, more patients, when actually we should be looking after fewer because they are now more complicated due to the ageing population.”

Dr Andrew Buist, chair of the BMA’s Scottish GP Committee, said the closure of GP surgeries is because of the difficulty in recruiting GPs - “an issue we foresaw and warned the Scottish government about some time ago”.

“In the three years between 2019 and 2022 Scotland lost 23 GP practices – that’s not practices that were taken over by their local health board, that’s practices which fully closed and patients dispersed elsewhere.

“Despite all the best efforts of those practices, they were unable to continue delivering services to patients due to lack of GP recruitment.

“We desperately need the Scottish government to not only fulfil their promise of 800 additional GPs by 2027, but also – crucially – increase the figure.”

A spokesperson for the Scottish Government said: “We have already delivered a record number of GPs working in Scotland, with more per head than any other country in the UK, and we are making good progress on our commitment to recruit at least 800 new GPs by 2027.

“Since 2017, Scotland’s GP headcount has increased by 291 to a record high of 5,209 in 2022.

“We are significantly investing in a range of retention initiatives so that being a GP remains an attractive career choice and our new GP Retention Working Group will produce a set of recommendations to improve GP retention at all stages of the career pathway.

“As an incentive for GPs to take up rural positions we also have a £10,000 ‘golden hello’ scheme for those who join and stay for two years.”