What will the new GP contracts mean for patients and doctors in the most deprived areas of Scotland?

The Scottish Government has announced changes which health secretary Shona Robison believes will give family doctors the chance to spend more time with the patients who need their care most. The new GP contract – agreed and co-designed with the British Medical Association – is intended to free doctors up from administration and provide them with more support from an extended community healthcare team, including nurses, physiotherapists, mental health workers and pharmacists.

The strategy is a response to a crisis in general practise which has seen demoralised GPs quitting the profession early and an alarming decline in the number of trainee doctors committing their lives to a career in general practise.

It is also a chance to address the way primary care creates a fundamental paradox known as the inverse care law. This states that patients in areas with the highest need tend to receive a lesser service – with fewer GPs, who are harder to access, struggling with higher caseloads and sicker patients.

The problem was first identified by pioneering Welsh GP Julian Tudor-Hart and has since been confirmed by multiple research studies. The perverse consequences of the funding of primary care have meant the NHS risks increasing rather than tackling health inequalities.

Concern about this anomaly and the various questions it throws up about fairness led to the formation of the Deep End group of Scottish GPs, membership of which is open to those working in the 100 most deprived areas of the country.

Talking to one of them, Dr Petra Sambale of Keppoch medical practise in Glasgow’s Possilpark gives some idea of why general practise in these areas in particular is struggling.

Until recently, she says, the workload for members of her practice, which has many patients on its list with complex conditions, multiple comorbidities and a corresponding level of paperwork, was unsustainable. “It was taking a toll on our own health,” she says.

A change came in the shape of the Deep End Pioneers scheme, which put newly-trained doctors in practices to alleviate the pressure on experienced GPs, while also undertaking academic courses on working in deprived areas. Morale is up “tremendously” in hers and the four other practices piloting the scheme, she says.

The Pioneers project is time limited, but Dr Sambale has high hopes for the new GP contract, which she hopes will address the underfunding of work in the communities with the worst health problems. She also welcomes the encouragement the proposed contract offers for multidisciplinary work which will ultimately free up GPs to spend more time with patients who need it.

Doctors at the Keppoch practise already see patients for 15 minutes instead of the standard 10, but that is not enough to properly understand the combination of poor health conditions many patients are experiencing.

There are caveats to Dr Sambale’s enthusiasm. Practices are awaiting the allocation formula which will underpin the new contract, and it is this which will determine whether the inverse care law can really be overturned.

Patients will also have to go on a “journey” as some realise that they may not see a GP at all but instead be referred to a physio, advanced nurse practioner or other professional, leaving doctors free to see those in most need, she says.

But Dr Sambale is optimistic, particularly as Scotland is not following the path of anonymous supersized practices being pursued in England. “I am proud to be a part of our Scottish NHS, which is trying a different way,” she says. “Surprised, and proud.”