Walls falling down on rural GP practices

It saddened me deeply to see Furnace and Inveraray surgeries featured in the Argyll Advertiser for all the wrong reasons.

I hugely enjoyed a time of employment as a relief GP in smaller Argyll and Western Isles surgeries many years ago. I sympathise with the opinions expressed by current GPs in your pages.

The four walls really are falling down on remote and rural UK General Practice:

1) The Harold Shipman fiasco generated a cumbersome new workload for medics. To a significant degree, the problem was generated by poor performance of regulators. But our London GMC inflicted bureaucratic mayhem on NHS GPs, in terms of burdensome appraisal and revalidation bureaucracy. Tick box processes drive medics into early retirement. Bureaucracy is winning!

2) Our NHS problems now bear a resemblance to the great Post Office fiasco being uncovered. Sub-postmaster victims were scandalously ill-treated, even while their overseeing senior leaders gained bloated salaries and benefits. GPs work very hard, yet some non-clinical NHS senior managers get far higher salaries, for just an administrative role. Financial folly reigns!

3) I switched to working in the NHS hospital sector pre-retirement, and did a ministry training course. But I maintain contact with a number of rural GP friends, who report frustration at a new emphasis on telephone and written activities, rather than the client-centred contact which gives them job satisfaction and a sense of purpose. GPs’ “raison d’etre” is all too easily being eroded!

4) Complaints and service users’ rights have a pivotal importance. But are GPs becoming fed up with vexatious complaints from a small group of their clients? Many mainstream UK GPs feel overwhelmed towards the end of their working life. They eventually get worn down by the treadmill of mainstream urban UK practice. Some might even like sessions in Furnace-Inveraray!

A lot of imagination was previously applied, often very successfully, to ensure that all UK communities had primary care facilities with on-site medics. The Associate and the Retainer schemes, once attracted GPs.

They offered stable employment to people seeking part-time or sessional work, who did not want the administrative or financial burden of being full-time GP partners.

I do hope, even by some miracle, that Inveraray and Furnace surgeries can be retained or rejuvenated. It’s sad to reflect on how such pleasant communities, even in an area of outstanding beauty, presently struggle to have normal NHS GP services provided locally.

Retired GP (name and address supplied)

Local democracy reform

Your December 22, 2023 issue helpfully drew our attention to exploratory “proposals by Argyll and Bute Council for major public sector reform and ‘fundamental changes’ to how local decisions are made in Argyll and Bute”.

A “key” committee looked at the single authority model (SAM) which “could see the council and other public bodies in the area join forces to oversee the delivery of local services” including the prospect of decisions being delegated to communities via community councils.

We learned much of one councillor’s negative views on the matter, including the contextless statement that many community councillors are unelected, without clarification of the reasons for this.

Here are the reasons:

We have in Scotland 32 enormous councils charged with providing not just the strategic co-ordination of services but also the truly local delivery of community work which in England and Wales and most European states is delivered at community level. It is an impossible task and whatever one’s political views it is a situation long overdue for reform.

Community councils are filled with elected or (if not enough come forward) appointed councillors. They have lots of commitment, pitiful funding and no significant power.

If they had more of the last two (as the SAM proposal would require) then the role would attract more of those keen to match this impressive commitment with real community change and empowerment. Democratic deficit sorted.

However, the council’s chief executive says, “we are only exploring this, and if they [the councillors] do not want to proceed, that will be the deciding factor”.

We all know, because your paper provides excellent coverage of it, that Argyll is blessed with an astonishing range of community enterprises, trusts and charities delivered by enterprising groups and active local citizens. There is no question that this area is bursting with the skills, energy and motivation to make the SAM proposal work and crying out for the opportunity to do so.