What does the country get for bounty bestowed on doctors?
EACH year an unseemly fight breaks out amongst opposition parties to find a single example of the failures in the NHS. Eventually some poor individual is found who has experienced distress in a recent encounter with the NHS. It reduces the very real experience of individual human suffering to a baseball bat with which to beat the government of the day. It’s an insult to the everyday heroics of hospital staff who struggle to face down elements beyond their control and the patterns of inequality in Scotland which engulf the NHS at this time of the year.
It also betrays a simplistic attitude, bordering on the contemptuous, towards ingrained cultural problems deep within the system of healthcare delivery. Better to hurl easy calumnies over one family’s distress than properly to drill down into some of the institutional difficulties in healthcare delivery.
Each day someone from the Scottish Government makes a phone call to the chief executives of every health board in Scotland. They are asked the same questions: how many beds; how many waits; how many trolleys. This would be fine if our targets were in the right areas but they are not.
The targets should be focused around the delivery of health and social care. There are currently no targets measuring the effectiveness and efficiency of social care and none were set when the Government moved to establish its flagship policy of Integrated Joint Boards in health and social care. The IJBs were supposed to open up more social care provision for patients thus getting them out of hospitals. It’s reckoned that between 10 and 20 per cent of people in hospital don’t need medical and nursing care but they can’t get out because there isn’t sufficient social care provision. One of the principal reasons for this is that the money set up to fund the IJBs was instead diverted by local health boards to keeping wards open. Audit Scotland has pointed this out repeatedly.
When, too, will someone in our political establishment address the curious set of privileges accorded to Scotland’s GPs? The contract that is currently close to being agreed highlights the egregious anomalies that exist in the relationship between GPs and the system of health delivery. I’d suggest that Theresa May quickly identifies the person negotiating these contracts on behalf of Scotland’s GPs and parachute them into the Brexit negotiating team.
The new contract represents the biggest overhaul of GPs contracts since 2004. The new contracts will make what is an already cosseted existence enjoyed by many GPs even cosier still. It will ensure that no GP in Scotland will earn less than £80,430 per annum. They will also have one extra session per month (which will be protected) for something called “clinical leadership”. How will this be scrutinised to ensure that it isn’t spent on an afternoon’s golfing? The new contract will also divest these hardpressed GPs from some minor clinical duties such as prescribing and dispensing contraceptive advice. What is the country receiving in return for all of these sweeteners?
If you really want to ask searching questions about the unbearable pressure on the NHS during the winter months then perhaps we should be asking why local surgeries are permitted to close for four days at Christmas and New Year at a time of year when the elderly and the infirm are vulnerable to illness and infection. Yet many end up in hospital because our first respondents in primary care are basting turkeys on 80 grand a year. Yet if you work in a busy accident and emergency facility you will be expected to work during periods of high pressure with the expectation you’ll get time off elsewhere in the year.
Our GPs are granted leave to do this because while they enjoy all the benefits of belonging to the NHS, such as attractive pension provision and IT support, they are not actually part of it. They are local entrepreneurs who run their surgeries like businesses. Thus they are not required to work weekends or work beyond normal office hours. On those occasions that they do they can claim up to £1K a session.
The average annual wage of a skilled worker in Scotland is around £27K. Many, especially those who are selfemployed, acknowledge that a certain amount of unpaid overtime will be expected. I don’t know of anyone on a salary that exceeds £80K a year who doesn’t expect to put in some unpaid overtime for such a quantum.
The concept of a patient-centred NHS begins to fray when you factor in Scotland’s pattern of inequality. The Scottish Government persists in citing our ageing population as a stress factor in health service delivery. If you live in a disadvantaged neighbourhood you are far less likely to reach the stage where you can be included in “our ageing population”. Perhaps it would be better to make the iniquities of health inequality in these areas a priority. Despite some changes GPs will still largely be funded on the number of patients on their register, regardless of what postcode they service. In healthy and affluent areas there is less demand for GP services than in those where there are multi-faceted and complex patterns of ailments brought about by extreme poverty.
The sweeteners and privileges embedded in GP contracts are a direct consequence of a recruitment crisis. But are they a price worth paying when there is a winter flu epidemic or yearround pressure on hospital beds and waiting times? One of the central aims of the new contract is to make partnership more attractive for younger GPs to help tackle the huge recruitment problems. These have left one in four practices with at least one GP vacancy. One of the reasons for this is that, having trained in a vibrant and demanding hospital system, many young doctors don’t relish the prospect – no matter how well-paid – of working in a couthier local surgery environment.
Yet, if they were salaried, full-time employees of the NHS this could be addressed. We could bring GPs fully into the NHS and rotate their duties so that they also receive some experience in the acute wards. It’s time to deploy their skills fully in reducing the pressures on our busiest hospitals.
Theresa May should identify the person negotiating these contracts for GPs and parachute them into the Brexit negotiating team
‘GPs enjoy all the benefits of belonging to the NHS, such as attractive pension provision and IT support, but they are not actually part of it. They are entrepreneurs.’