DOCTORS HELD TO RANSOM BY £764-A-DAY LOCUMS
CRISIS is an over-used word in politics but nothing else will do to describe the situation facing Scotland’s GP services right now. Here are just some of the stories that MSPs have heard in recent weeks from family doctors across the country.
One GP service in Lanarkshire wrote to us recently about the chronic staff shortages they face. The practice is reliant on locum doctors to fill in shifts and as a result the locums can effectively hold them to ransom.
In one incident, for a day’s work seeing 24 patients, the practice was charged £764 – plus the cost of a return flight from the locum’s home in the Isle of Man and the taxi fare to and from the airport.
Precious funds which could have been spent on better care for local communities was instead frittered away. Or take Edinburgh – the city I represent. Across town, GPs are telling me they are now closing their lists to new patients, such is the strain they face. Indeed, 40 per cent of practices in NHS Lothian now say they are full or restricting registration. In Ayrshire, two GPs in a West Kilbride practice recently announced they were leaving the service because of the workload they faced.
That prompted the remaining doctors to hand the practice back to the local health board. Residents are now deprived of the local link to a family doctor which communities so value.
Similar stories could be told by just about every GP in the land. The Royal College of GPs in Scotland has revealed there are now 52 practices across Scotland where local doctors have handed their surgery over to the local health board because they feel unable to meet their obligations – the highest number on record.
The college estimates that by the next Holyrood election in 2021, Scotland will be short of 856 family doctors. We are staring at a service on the brink.
So how did it come to this? Survey after survey has shown that GPs are the most valued part of our NHS infrastructure. For many of us, the NHS is the local GP clinic.
has‘was But over the past decade, investment in the NHS has been pushed into other areas, leaving general practice deprived of the cash that it needs.
General practice is the only major part of the health service that has experienced a sustained, realterms drop in funding. The result has been obvious. It forced GP partners to restrict their own numbers. Those that remain have had to work much harder, and for longer hours, leading to widespread disenchantment within the profession.
Not surprisingly, many GPs have retired or decided to work abroad. At the same time, it has become harder and harder to recruit new GPs to replace them: after all, who wants to join a profession in crisis?
To be fair to the Scottish Government, these issues are not unique to Scotland. GP recruitment and retention is now a major crisis for all parts of the UK. But the truth is the SNP was warned repeatedly that this crisis was coming – and failed to act to prevent it.
As Scottish GPs have pointed out, the proportion of NHS funding that goes to general practice is lower in Scotland than it is south of the Border – with Ministers prioritising spending elsewhere in the NHS.
Had it been the same level in 201516, an extra £188 million would have been available for GP practices to hire more doctors and ensure staffing levels were maintained.
As an immediate priority, it is time for the Government to heed pleas from GPs across Scotland to reverse this historic funding deficit.
Nicola Sturgeon last year claimed to have listened to doctors by pledging to spend an extra £500 million. But it has since emerged that only half of this will go direct to general practice, with the rest being allocated to ‘primary care’. The fear among GPs is that this cash will simply disappear into NHS Boards and won’t make its way into the front line.
Enough of the confusion: the SNP should make a clear commitment to ensure cash goes straight to GP clinics. With extra funding, we can then do what all parties have backed over recent years, which is to ensure that more of our health service is delivered locally by GPs, rather than in hospital.
This is where the failure to support GP services is so self-defeating. Studies have shown that the lack of investment in surgeries has meant they have been unable to play their traditional role as NHS ‘gatekeeper’. As a result, we have seen a rise in emergency admissions and in unnecessary elective work hospitals.
As Professor Graham Watt of Glasgow University recently put it: ‘If general practice is systematically weakened, as has happened during the past decade, patients will flood through the gate, accessing out-ofhours A&E services or acute hospital admissions.’
In other words, not only is the lack of GP funding depriving people of a local service they appreciate, it is increasing the burden – and the cost – of providing hospital care, not to mention those sums being spent on locums who, very often, are the only thing stopping a GP clinic from closing its doors completely.
As well as an increase in funding, we need to see Ministers embark on a longer-term drive to recruit more GPs to the profession and train more medical students in Scotland.
As former SNP Health Secretary Alex Neil has acknowledged, we are not admitting enough young people from Scotland into our own medical schools – in some, fewer than half the medical students are from Scotland. We need to face up to the fact we are not training enough young people to get into medicine.
The situation facing the profession is stark. In rural Scotland, we now know that some practices are having to use nurse practitioners to see patients.
In others, GP receptionists are being employed as ‘care navigators’, screening patients to help GPs cope with work overload.
But it is not too late to turn this around. This week, we will be launching our own campaign to save our surgeries. But MSPs from all political parties in Scotland know radical action is now required.
Too often in Scotland in recent years we have heard the Government talk about the things it can’t do. Fixing the crisis in our GP clinics is one thing that is in its gift to achieve – right now. It’s time we worked together to do it.
The SNP warned a crisis was coming but failed to act