Andy Drane: Problems facing GP practices need more than contracts
As an advisor supporting doctors’ practices on the many legal issues they must navigate, I have seen first-hand the unprecedented crisis facing the sector. But will the new GP contract address this? It must tackle a range of issues including rising patient demand, stagnation in health outcomes, recruitment challenges (especially in rural areas), and a major shortage of trainee GPs. These and other factors have resulted in many practices reducing services or even closing. There is an estimated shortfall of 800 GPs in the system.
Under the new agreement, GP practices will continue to operate as private businesses with the partners’ remuneration dependent on their level of profitability. Primary care has been run on this basis since its inception with most people within the NHS, including GPs, agreeing this model is the cheapest and most efficient means of delivering.
The new contract does offer some further government support by removing elements of the risk of running a business from GP practice partners, allowing them to focus more clearly on meeting patient needs. This includes greater support in managing areas such as practice premises and data protection. As well as making more funding available, the new GP contract also reinstates the principle that doctors are expert medical generalists supported by a raft of other healthcare professionals who should therefore only focus on patients who actually need to be seen by them.
The new agreement seeks to deliver longer-term solutions to some core issues currently impacting on GPs, including the perception of many rurally-based practices that they are disadvantaged compared to counterparts in urban areas. The proposed income guarantee within the new GP contract should provide some reassurance. Many GPs in rural areas will, however, remain concerned that other health professionals might not be available to pick up additional burdens they are no longer meant to be taking on board under the new terms.
The fact that the new GP contract promotes a longer-term journey rather than an immediate fix will present major challenges for the Scottish Government. While it has already been working on the structures and regulations which will underpin the new agreement, there is much to do before it comes into effect in April and it’s unlikely we will get a clearer picture until nearer the time. In the short term, the new deal won’t deliver the 800 new doctors currently required across Scotland. Indeed, the recruitment crisis will unlikely be fixed for many years to come.
Issues around practice premises lease agreements and premises valuations will also continue. While the new GP contract pledges the NHS will take on all leased doctors’ surgeries as well as buy all owner-occupied premises by 2042, it will only take over those deemed to be ‘fit for purpose’. That means any practices based in an older building such as a traditional townhouse will not qualify and could therefore struggle to recruit new partners due to concerns about future lease-related dilapidation costs as well as future values.
Additionally, health boards and health and social care partnerships will apply the new GP contract and the support they are intended to provide in varying ways across the country, based on their own budgetary constraints.
The challenge for Scottish Government and BMA Scotland is to manage transitional issues in a manner which prevents unanticipated events from derailing the long term goal of the new GP contract. That leads to another issue; while the proposed GP contract arises out of a faultline between Scottish Government and doctors’ leaders, the crisis in the NHS is not just about lack of GPs. Addressing the recruitment crisis in other health professions, including nursing, is also critical in making significant improvements to a creaking system.
While it is a forward-thinking proposal that will provide support in the longer term, including some clarity on key legal matters facing practices, the new GP contract does not offer a quick fix. Policy makers who think this will solve the immediate problems facing GP practices, as well as the wider NHS in Scotland, are in for a rude awakening.
Andy Drane, partner, Davidson Chalmers