We need a systemic and cultural shift to rebuild our primary healthcare system

A coordinated recruitment campaign will be required if the Scottish Government is to hit its target of increasing the number of GPs by at least 800 over the next decade. Picture: Getty

Scotland’s healthcare system is at a critical point. Societal shifts, an increasing and ageing population, increasing prevalence of multi-morbidity and resource pressures are placing significant demands on our health and social care services. The fastest growing age group in Scotland is the over-75s, whose number is estimated to rise by 79 per cent by 2040; which places substantial pressure on the system, particularly primary and social care provision. The current Scottish Parliament inquiry into this issue has come at a critical time.

As Scotland’s National Academy, the RSE is well placed to respond to this inquiry, drawing upon a range of relevant expertise and experience, including those working in and across primary care and general practice, nursing and e-health.

While we support the Scottish Government’s intentions to improve primary care, we believe that a systemic and cultural shift is required to rebalance the healthcare system. By gradually moving resources away from secondary and acute care, which dominate healthcare provision currently, into primary and social care; the Government can significantly reduce the extent to which patients are reliant on hospital-based clinical, acute and secondary care.

This is not without its challenges, least of all workforce planning. The Scottish Government aims to increase the number of GPs in Scotland by at least 800 over the next decade while Audit Scotland has recently reported a reduction of 4.3 per cent since 2013 in the whole-time equivalent GP workforce. The Royal College of General Practitioners (RCGP) Scotland has reported that 26 per cent of GPs think they are unlikely to be working in general practice in five years’ time. A coordinated recruitment campaign, including high-quality GP placements for undergraduates and an improvement in existing practice infrastructure, will be required to help meet the Government’s target. Increased investment in career paths for the medical, nursing and advanced health practitioner workforce will also be necessary.

Research is crucial to primary care delivery as it informs professionals and organisations of effective methods of treatment and care. However, contrasting trends between England and Scotland in primary care research indicate that Scotland is falling behind, with significantly fewer opportunities for research funding in primary care in Scotland compared to England. While the number of academic GPs – i.e. roles that combine research, teaching, and clinical work – in England has increased by 22 per cent between 2010 and 2018, there is no similar trend in Scotland.

How patient data are collected and shared will have a significant impact on the provision of care through informing health professionals and underpinning research. Scotland is in an advantageous position given that every patient has a unique Community Health Index (CHI) number.

However, the Scottish Government and NHS Scotland have not yet capitalised on this, failing to collect and share data effectively using the CHI number, as recently reported in relation to methadone prescriptions. Improvements are needed in the uses made of routine health data. Services can only be improved for 100 per cent of the population if there is information on 100 per cent of the population and this requires information from routine clinical data. To gain public approval, the Government and NHS Scotland need to produce and popularise examples of health data being used in this way.

Achieving the changes necessary will need both public and political acceptance and a coordinated engagement plan. The Scottish Government is currently developing a programme to inform patients of changes to the approach in the provision of healthcare and why these changes are necessary. As part of this, the Government needs to present evidence and uses of routine data showing the impact and advantages of the shift towards primary care provision.

Professor Graham Watt, Chair of the RSE Working Group on the Future of Primary Care, is Emeritus Professor at the Institute of Health and Wellbeing at the University of Glasgow

We need a systemic and cultural shift to rebuild our primary healthcare system– Prof Graham Watt