Covid Scotland: GPs hit back at face-to-face consultation pledge in healthcare recovery plan

GPs have insisted the future of general practice should be a mixture of remote and face-to-face consultations, as the Scottish Government promised a return to in-person appointments as part of its £1 billion recovery plan.

Doctors said their stretched workforce needed to be able to treat patients without increasing footfall in surgeries.

Under the NHS recovery plan, unveiled on Wednesday by First Minister Nicola Sturgeon to address backlogs in healthcare as a result of the pandemic, £23 million would be put into transforming urgent care.

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Investment in national treatment centres would also be increased to more than £400m, contributing to delivery of over 40,000 additional elective surgeries and procedures per year. A further £130m would be put into treating and detecting cancer.

Mental health support for healthcare workers is included in the plan.

However, the Scottish NHS cannot cope with further demands on its services without extra workers, medical staff have warned, despite the government’s aims of increasing capacity in the health service by 10 per cent.

The publication of the plan comes as NHS Lanarkshire said it was postponing the majority of non-urgent elective procedures amid “unprecedented pressures”.

The health board is facing issues with a steady flow of more than 700 patients across its three hospitals over the past few weeks and months.

Reacting to the healthcare recovery plan, GPs said a “priority” return to face-to-face consultations as laid out by the government would be detrimental to patients.

Dr Chris Williams, joint chair of Royal College of General Practitioners (RCGP) Scotland, said: "At the beginning of the pandemic GPs and their teams rapidly transformed the way that they deliver care to their patients, with the majority of consultations being delivered remotely. We have still continued to see patients face to face when it has been clinically necessary to do so.

"We view a mix of face to face, digital and telephone appointments that meet the needs of patients as the future of general practice. However, the priority of GPs and their teams at the moment is ensuring that they can protect their most vulnerable patients from the worst effects of Covid-19 while continuing to meet the individual needs of all of their patients.

"In many cases, the best way to do this is to limit the footfall within practices and offer remote consultations for those patients where this is an appropriate course of action.”

Dr Williams said the organisation was awaiting updated guidance on the government’s plans to reintroduce face-to-face appointments more widely, but warned that solutions would look “very different across the many different physical spaces that GPs and their teams work in” and “will take time to implement”.

He said: "General practice is already working beyond capacity and the changes outlined in the recovery plan will take time and resource to embed. We would ask that patients bear with us while practice teams assess what they need to do to be able to safely offer more face-to-face appointments at this time.”

British Medical Association Scotland chair Dr Lewis Morrison said: “The plan rightly also focuses on primary care – and what support is in place for GPs. However, we need to be clear that GPs, as with clinicians in other parts of the healthcare system, are having to manage overwhelming demand and ensure patient and staff safety.

"In that context, they are already seeing patients face to face where appropriate and we must continue to allow those careful judgements to be made.

"We didn’t have enough GPs before the pandemic, and workload from Covid illness in the community, which is currently rising rapidly, falls on GPs both in and out of hours. We have to be careful of not making an already difficult situation worse.”

Dr Morrison said a 10 per cent increase in capacity would be “unrealistic without the staff to do it".

Other medical organisations warned there was little detail in the plan on how staff shortages would be addressed. In 2017, the Scottish Government pledged to recruit 800 more GPs over the following ten years.

Professor Andrew Elder, president of the Royal College of Physicians of Edinburgh, said: "The allocation of substantial financial resource, with funding of £1bn over five years across the plan, is welcomed and necessary.

"However, it must be matched by the human resource required to deliver care. As such, whilst we greatly welcome, and have previously lobbied for, the increase in medical undergraduate places and widening access places, this will not provide the immediate support that is needed to realise the plan over the next five years.”

The recovery plan sets out key actions for the next five years to help address backlogs in healthcare and increase capacity in the service. The plan outlines a range of reforms across primary and acute NHS services to help recover from the impact of the pandemic.

Meanwhile, £8m will be invested in mental health care for healthcare workers, while at least 10 per cent of frontline health spending will be dedicated to mental health, and recruiting 320 additional Child and Adolescent Mental Health Services (CAMHS) workers.

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Spending in primary care is to be increased by 25 per cent, with support for GPs, community pharmacists, dentists and optometrists.

To reduce waiting for diagnostic tests, £29m will be invested, with ministers saying this should allow 78,000 more procedures to be carried out this year alone, with this rising to 90,000 more tests each year from 2025/26.

Plans are also being put in place to recruit thousands more staff, with £11m being spent on national and international campaigns aimed at taking on 1,500 staff for national treatment centres, as well as 1,000 mental health link workers in the community and 800 additional GPs.

Cancer charities warned that detail was needed in how funding would be implemented. There are thought to be 7,000 “missing” or undiagnosed cancer cases in Scotland as a result of the pandemic.

Macmillan head of advocacy for Scotland, Kate Seymour, said: “We’re pleased to see a commitment to increasing the cancer workforce and to tackling the worrying backlog of people waiting for diagnosis.

“It’s also reassuring to see a renewed commitment to the partnership with Macmillan that will ensure everyone with cancer in Scotland is offered help with their emotional, practical and financial needs. However, we look forward to seeing the detail behind the commitments and how the urgent and widespread issues in the cancer care system will be met.”

She added: “The scale of the challenge facing the cancer care system is immense. Even before the pandemic, the system was struggling to cope with the sheer numbers of people in need of treatment and support.

“After 18-months of disruption to diagnosis and treatment, and despite the herculean efforts of NHS staff, there are thousands of people in Scotland living with undiagnosed cancers or being diagnosed late. It is absolutely vital sufficient funding and workforce is put in place to deliver it.”

Scottish Conservatives health spokeswoman Annie Wells described the NHS recovery plan as an “embarrassingly thin, flimsy pamphlet”.

Ms Wells also highlighted key omissions over Long Covid, the lack of new A&E funding, and the absence of ideas to tackle Scotland’s record levels of alcohol and drug deaths.

She said: “If this flimsy pamphlet is the best that [health secretary] Humza Yousaf can come up with, Scotland’s NHS is in real trouble.

"This delayed plan is mostly a lift from their manifesto and a regurgitation of undelivered promises from failed SNP health ministers of old. It’s embarrassingly thin – made for PR purposes, not for our NHS.”

Scottish Labour deputy leader and health spokesperson Jackie Baillie said: “Frankly, this plan does not even begin to chart a path to the full re-mobilisation of our NHS. And targets promised before the election have disappeared from the plan.

"Most disappointing of all is that the SNP has entirely failed to comprehend the size of the NHS backlog. In this plan the majority of the new national treatment centres will not be opened until the second half of the Parliament. This is simply not good enough.”

Scottish Liberal Democrat leader Alex Cole-Hamilton said: “With A&E departments more stretched than ever and more than 200,000 operations lost to the pandemic, patients and NHS staff deserved more than wafer-thin commitments and re-packaged promises. The government is chancing on money, redesign and technology to dig them out of a hole.”

He added: “GPs are being asked to do more, but with the same increase in capacity that was planned pre-pandemic. It doesn’t add up. This plan doesn’t even know whether a key recruitment target is 2026 or 2028 – it can’t be both.”

Ms Sturgeon was joined by Mr Yousaf to launch the recovery plan during a visit to the new national Centre for Sustainable Delivery, which will play a key role in supporting improvements in outpatient and inpatient capacity as well as diagnostics.

She said: “This plan will drive the recovery of our NHS, not just to its pre-pandemic level but beyond.

“As we maintain our resilience against Covid-19 and other pressures, the Scottish Government is providing targeted investment to increase capacity, reform the system and ultimately get everyone the treatment they need as quickly as possible.”

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