NHS Covid crisis: I worry about health service's future and we need to be realistic about what it can do – Dr Andrew Buist

Since the NHS began, I doubt there can have been a more difficult time for everyone involved with health and social care.

The pandemic has greatly disrupted our NHS, with waiting times for hospital investigations and treatments rising steadily. Never before has the co-dependency between community health and hospital care been so apparent.

The pressures on social care are great, and are arguably the most pressing, because if care of our frail elderly patients in the community fails then hospitals cannot hope to function. We need to recognise and value our paid and unpaid carer workforce more.

I am particularly concerned about general practice where the imbalance between workforce and demand is significant. We simply don’t have enough GPs; the average full-time GP has over 1,500 registered patients – that is too many to provide the kind of service patients want and need, and despite providing over half a million appointments each week in general practice, we are still failing to meet demand.

GPs are a resilient group, we have to be, but I do fear for the well-being of individuals trying to do their best and it not being enough. Right now, we are working collaboratively with Scottish government to build something better in general practice, but it is taking longer than expected – in part due to the pandemic but also due to a shortage of healthcare workforce.

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I still believe what we are doing is going to make for a fairer, more sustainable service where our elderly are treated with greater dignity and where we are better placed to tackle health inequalities.

The pandemic has exposed what many of us knew pre-pandemic – namely that our healthcare model, and the way the system operated was unsustainable in the face of rising demand caused at least in part by an ageing population.

The average full-time GP has over 1,500 registered patients, too many to provide the kind of service that they need (Picture: Hugh Hastings/Getty Images)

In world terms, Scotland is a wealthy country, but our resources are not unlimited. Pursuit of impossible targets within ever more stretched budgets has raised expectations that cannot be fulfilled, frustrating the public, burning out our workforce and leading in some cases to energies being invested in obstruction, diversion, internal disputes and a culture dominated by fear and blame.

That’s why I think we need to rebuild better with a realistic, achievable model of care.

In my view, we have been too hospital focussed. The 2005 national framework led by Professor David Kerr had the right approach where NHS boards put in place systems to care for the most vulnerable people with long-term conditions at home or in their communities, with more multidisciplinary team working, self-care, more preventative care and better use of technology, but we largely failed to grasp that opportunity. I think now is the time to revisit those recommendations.

So, as we face the second winter of this pandemic, I confess I have anxieties for the NHS. It is going to take many years for the NHS to recover from the pandemic, indeed I am not convinced we will ever get back to where we were. Meantime we all need to cherish our NHS and use it with care.

Dr Andrew Buist is chair of the British Medical Association's Scottish GP committee

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