GP PRACTICES are the heart, and the frontline, of the NHS, but general practice in Scotland has also started to look like a patient itself at times. The symptoms are obvious: the long waiting times to get a consultation, the stress and burden on the doctors, and the fact that young trainees are reluctant to take on what they see as the thankless task of being a GP. There is no other word for the current state of general practice in Scotland: it is a crisis.
It also appears to be a crisis that is getting steadily worse. According to the latest GP staff survey, there has been a sharp increase in the number of vacancies in Scottish practices, with a quarter now short of at least one doctor. The Primary Care Workforce Survey found that nearly 24 per cent of practices who responded to the survey reported current vacancies, but the comparison with recent years is alarming: in 2015, the figure was 22 per cent; in 2013, it was just nine per cent. Clearly, for the sake of patients and doctors, that cannot go on.
In a complicated situation, there are a number of different reasons for the increase in vacancies.
First, some doctors are retiring early, many of them fed up of the workload and financial pressures they face day to day.
Second, many GPs are working part-time, sometimes to pursue other interests in the health service, sometimes so they can make their job work round family commitments. All of which would be fine if junior doctors were coming through at the same time to replace them, which they are not.
Part of the reason for that is that young doctors entering the health service can see the situation for what it really is. Yes, GPs are paid relatively well – and few of them have to work evenings or weekends – but many young doctors also see the pay gap between GPs and consultants and so favour working towards becoming the latter rather than the former.
Junior doctors – and patients as well for that matter – can also see that GP surgeries in Scotland do not have the resources they need and are struggling to cope with admin and paperwork. The ageing population is also turning the screw. In theory, the idea of treating more people in the community rather than in hospitals is a good one, but in reality that means more (and more complicated) work for GP surgeries.
The new GP contract currently being negotiated for Scotland may tackle some of these issues, although the fear is that in some areas it may actually make things worse. Will it do enough, for instance, to attract GPs to rural areas, where the recruitment crisis is particularly acute?
The new contract will also have to tackle the issue of workload if it has any chance of tackling the current crisis in recruitment and retention. As GPs rightly point out, their resources have come under increasing pressure at exactly the same time as more of their patients have started to suffer from multiple, complicated and long-term conditions. GPs cannot be expected to tackle that while also retaining all of their current responsibilities too.
Part of the answer is more support staff in surgeries, which has been promised as part of the new contract, although the danger remains that the surgeries that struggle to recruit doctors will struggle to recruit support staff too. Then there is the issue of funding. Many GPs have been handing the running of their practices to health boards because they say the current funding simply makes it impossible for them to carry on.
All of these factors are making the job of GP less attractive and bearable, but they are also making life hard for patients too. Everyone wants general practice to be the welcoming frontline of the NHS. But we also need to be honest about what it has really become: an essential part of the service being starved of what it needs.
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