The GP crisis in Scotland - and the Minister that won't show face

The GP crisis in Scotland - and the Minister that won't show face

by Jamie Greene
article from Thursday 5, October, 2017

BACK IN 2016 the British Medical Association called for urgent action to tackle a number of problems in Scotland’s NHS. Instead, investment in GP services has fallen from 9.8  per cent of NHS Scotland’s spending in 2005/06 to just 7.2 per cent in 2015/16.

2016 wasn’t the first time the Scottish Government had warnings over a pending crisis in GP numbers. Here we are, more than a decade after the SNP took power and therefore with no one else to blame, and we can see we are on the verge of a GP crisis in Scotland.

A lack of forward planning by the Scottish Government has resulted in GP recruitment shortages across Scotland, meaning that practices cannot meet their basic staffing demands. Health has been devolved to the Scottish Parliament since devolution in 1999, the SNP has been in power for more than ten years, the First Minister was Health Secretary for five of those years.

Warning after warning that you cannot magic GPs overnight – there is a lengthy tail in recruitment and training, and we need to retain those that do qualify.  Not just warnings from opposition politicians, but from experts from across the medical world. We neede to take action yesterday.

Quelle surprise, and the number of patients being looked after in so-called “2C” surgeries have practically doubled in the last decade.

Unfortunately, the struggle to recruit new GPs has resulted in more GPs approaching retirement age than joining as new entrants.

When surgeries hand back their contracts to local health boards they become classified as 2C practices. This is becoming increasingly common across Scotland with 52 Scottish GP practices now 2C practices. The Royal College of General Practitioners released figures that show the number of patients treated at 2C practices has almost doubled from 83,000 in 2007 to 160,000 in 2016.

Locally I witnessed this most prominently in West Kilbride in North Ayrshire where the local surgery was left with just three GPs, down from four. After months of living on the edge financially – vacancies gone unfilled and financial pressure to fill those gaps – the remaining doctors were forced to hand back the contract to the local health board.

Practices under the control of their local health boards only tend to offer minimal level of care and patients treated by locums at 2C practices also risk receiving a less consistent care service as the locums treating patients regularly change.

It must also be noted that my local NHS board, Ayrshire and Arran, is already running a £5 million healthcare deficit. We know anecdotally that 2C practices cost twice as much to run as a General Practice. The law of logic says that the system of locums delivers a poorer quality of service at a higher cost to the taxpayer.

The joint secretary of Ayrshire and Arran Local Medical Committee, claimed that practices are just “trying to find ways to deal with the day-to-day pressures they are facing.” The crisis has so far resulted in many practices either closing or restricting lists of patients, with three practices in North Ayrshire and Arran closing their lists to new patients, and two in Greater Glasgow and the Clyde having restricted lists, resulting in many residents being forced to call for ambulances or travel to Crosshouse Hospital, which in turn only helps to cause more strain to services, already under intolerable pressure.  A+E waiting rooms are filled with folk who either can’t see their GP or in some cases can’t even register with one.

In our capital city, the majority of GP surgeries aren’t even taking on new patients. You can pop along and see an unknown doctor in an emergency. You are directed to the local Health Board who may force you upon a local practice list. Or you can turn up at 8am on a Tuesday morning and join a lengthy queue to register. To register! 

Is this the perfect model that the SNP proliferates? The universality of free healthcare at its best? Or in reality is it more a reflection of years of poor workforce planning?

It is a real thing. Not a political rant. Real people who can’t get an appointment to see their local doctor.

I’ve spoken with many constituents recently who tell me they now struggle to get a 10-minute appointment at their local practice, often having to wait weeks to be seen. Doctors themselves think that ten minutes isn’t enough to provide quality care. Earlier this year one thousand patients from Townhead Surgery in Irvine, North Ayrshire, were moved to a different practice due to a shortage of GPs after serious concerns that they would not be able to continue to deliver a safe service for its patients.

So what did I do to raise this issue? Well in traditional Holyrood fashion, I submitted a motion calling on the government to focus its attention on this. It was surprisingly supported by a range of political parties – with the obvious exception of the SNP.

The motion became a Members debate. Scarce turnout from the SNP was apparent. A picture paints a thousand words. Neither the First Minister nor the Cabinet Secretary for Health Shona Robison attended. Instead, the local representative for the constituency affected attempted to defend the SNP government’s handling of GP shortages in Scotland by blaming this decade long failure on everything and anyone bar the Ministers on his front bench. He went as far to say my motion was “scaremongering”. There is nothing scaremongering about losing your GP and waiting weeks for an appointment. Party allegiance over pragmatic debate was the order of the day. I admire his loyalty, if not his naivety.

The debate itself heard story after story of local practices, from Dumfries to Dundee, where the reality of this problem is hitting people. Labour, the Greens, the LibDems, the Tories, all saying the same thing almost word for word.  The Minister, head down, hard hat on and failing to listen or react.

The Scottish Government simply must acknowledge the crisis before dealing with it, you have to admit there is a problem before tackling it. Heed the call of the RCGP who have projected a shortfall of 856 GPs across Scotland by 2021, unless action is taken. Heed the call of politicians from across the political spectrum. Heed the warning that has been ignoried for a decade.

If SNP MSPs spent more time debating the provision of primary healthcare in Scotland, and less time on the constitutional politics of other EU countries, perhaps we might in turn have a government that does actually focus on the day job.

As far as scaremongering is concerned – the only people who should be scared are Scottish Ministers who know they’ve taken their eye off the ball on this.

I make no bones about being vocal on this matter.

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