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. Despite all their best efforts, they were unable to continue delivering services to patients due to the lack of GP recruitment. This year, things are no different. This is still happening across Scotland.
Multidisciplinary teams (MDT) have been seen as the way to solve the crisis in primary care: that means more pharmacists, advanced nurses, physiotherapists, etc, who can free up GP time to see patients with more specific medical requirements. Unfortunately, most NHS boards have been unable to employ anywhere close to the Scottish Government’s targets for MDT staff to support general practice.
This is leaving practices in increasing difficulty as they have been unable to meet this shortfall in MDT staff by recruiting additional GPs, due to the current crisis in GP recruitment. As you might be starting to see, it’s a vicious cycle.
If you, as a patient, have a more straightforward health problem, seeing a nurse, physiotherapist or pharmacist quickly is a good thing. If you suffer from a number of illnesses, have more complex health needs, or are elderly or frail, it will mean waiting even longer to see your GP. Rising admissions to hospital and unnecessary tests will apply further pressure to an already overstretched hospital system.
At the risk of sounding like a broken record, we desperately need the Scottish Government to not only fulfil their promise of 800 new GPs by 2027 but, crucially, to increase the figure. We have heard time and again that they are on track, but they are not reporting how many full-time GPs are included in the 800. Indeed, a recent Audit Scotland report stated that the Scottish Government is nowhere near meeting its target, with the fully qualified GP workforce having increased by just 113 (headcount) since 2017. In fact, Public Health Scotland estimates that the GP whole-time equivalent workforce actually decreased between 2017 and 2022. With no additional funding in the current contract to pay for the additional GPs, I fully expect numbers to continue to gradually reduce, something which I am sure no one wants to see happen.
So, what next? Options for practices who hand back their contracts are for other medical practices to come forward to take them on, or to become a practice run by the health board, rather than by the GPs – which costs more than a GP-run practice and means that the continuity between GP and patient is all but extinguished. One of the main concerns is that health boards simply cannot afford to run all the practices which hand back their contracts – so you end up with no other option but to share patients between open practices, further increasing pressures on the GPs in those practices and making it even more difficult for people to get appointments.
I will finally meet with the new Cabinet Secretary for Health next week and my plea to him will be to urgently assess the current situation in primary care. There must be rapid movement to address the problems and protect patient care. We are over the tipping point now and beyond crisis.
Dr Andrew Buist is chair of the BMA’s Scottish GP Committee