The pressure on Scotland’s GPs is putting strain on the doctor-patient relationship, writes Tom Peterkin.
Occasionally a half-remembered comic song drifts into my mind. Sung by the late Andy Stewart, its chorus goes something like this: “Way, hey Dr Finlay, we would all agree, is without a doubt – let’s shout it out – the finest wee GP. He travels far in his little car. And all the ladies say: ‘Oh! We never eat an apple ‘cause it keeps the doctor away’.”
One does not have to be a Wee Andy aficionado to recognise the ditty as a homage to the famous fictional Scottish family doctor created by the novelist A.J. Cronin.
Its couthy suggestiveness may not be regarded as the height of sophisticated humour these days, but it is redolent of days gone by when the GP was as ubiquitous as the dominie, the Kirk minister or the parish priest. It speaks to Dr Finlay’s Casebook, the world of the country GP – stethoscope in pocket, Gladstone Bag in hand – doing his rounds, dealing with life’s dramas and dispensing medicine and reassurance in equal measure.
Whether or not this sort of kailyard arcadia – typified by nostalgic imaginings of Tannochbrae – ever actually existed is debatable. But it is true to say that the Dr Finlay character was true to life in one vital respect. For as long as anyone can remember, the General Practitioner has been part of the fabric of Scottish society.
Given the family doctor’s traditional and invaluable role, reports that Dr Finlay’s modern day successors are facing a recruitment crisis must be taken very seriously indeed.
According to a briefing paper produced by the Royal College of General Practitioners (RCGP), Scotland faces a shortfall of 856 GPs by 2021 (a figure which excludes registrars, retainers and locums). Against that backcloth, it is of deep concern that Scottish Government attempts to address this shortage do not seem to be working.
Earlier this week it was revealed that Health Secretary Shona Robison’s £25 million flagship drive designed to attract more GPs has succeeded in recruiting just 18 new recruits in the two years since its launch. The Scottish Government retorted that Scotland still has more GPs per head of population than the rest of the UK. But the lousiness of the return on the recruitment drive so far becomes more alarming when the age profile of the GP workforce is considered.
With one fifth of the workforce aged 55 or over, the profession faces a retirement time bomb. This is backed up by a British Medical Association survey conducted last year, which found that more than one third of GPs in Scotland intend to retire in the next five years.
The issue is exacerbated by the difficulties GPs face in recruiting locums with only of a quarter of practices able to fully fill staffing shortfalls that emerge as a result of unforeseen circumstances such as sick leave.
All this is happening while demand for GP services is increasing. The Scottish Government has embarked on a strategy to provide more care at home. On the face of it, it is a sensible proposal designed to take pressure off hospital services. But it is extremely challenging when the rising number of consultations dealt with by family doctors is considered.
The most recent figures suggest that the number of GP consultations rose by 2.5 million (11.5 per cent) from 2005/06 to 2012/13.
Meanwhile data mentioned in Audit Scotland’s annual health check of the NHS revealed that the number of GP practices nationwide dropped six per cent from 1,027 in 2007 to 963 in 2016. In the same period, practice lists – the number of patients registered with a GP – rose 12 per cent on average from 5,280 to 5,880.
No wonder family doctors are complaining of soaring stress levels and fatigue as they wrestle with 10-minute consultations for patients with conditions of ever increasing complexity.
By any reasonable standard, GPs are handsomely rewarded for their work. But the recruitment challenge is not going to be helped by the latest NHS figures suggesting that Scottish wages are falling relative to doctors working south of the border.
The average salary for independent contractor GPs in Scotland, who account for 3,568 out of the country’s 4,913 local doctors, was down 2.5 per cent from £91,800 in 2014/15 to £89,500 in 2015/16. Meanwhile, their English counterparts enjoyed a one per cent increase from £103,800 in 2014/15 to £104,900 last year. But this is not just about money. GPs are motivated by the idea that effective treatment is helped by meaningful doctor/patient relationships. They resent being reduced to prescription-writing sausage machines.
This notion of relationship was described by a retiring GP Euan Paterson, 58, in an interview with Holyrood magazine last month. “If you’re having to chase your tail, having to make sure you have all the hard, scientific clinical stuff, the whole art of medicine is in danger. And it is an art,” he said.
“Relationship is all. The things that were beginning to really affect me and bother me, and in part led to my decision to leave early, was that everything suggests the relationship is going to become harder and harder to create and maintain. If we lose relationship, I think we lose it all ... Not enough people value the core of this, to cherish it. I think they’ll value it when they see it disappearing, but by then it will be gone,” he warned.
Dr Finlay would have understood what Dr Paterson was talking about. Eroding the role played by GPs risks eroding the fabric of our society.