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Scottish GPs -Chair’s end of year message

As we approach the end of 2023 it seems timely to reflect on what progress has been made in general practice. We have come through the pandemic, and now life seems to be dominated by the financial downturn in the economy, the difficulties our people and governments are having making ‘ends meet’ but also the terrible conflicts in Ukraine and now Israel-Gaza. In writing that I am conscious that our issues seem very trivial by comparison. Our thoughts are with those suffering in these war-torn places.

These terrible things are not within our gift to resolve so we must focus progress on where we have some influence to change things for the better. General practice in Scotland, indeed the whole of the UK is in a difficult position. Our patients need our services, they are increasing in numbers and aging, with the challenges that brings and yet our capacity to manage that demand is falling. The workforce figures issued last week showed that our GP capacity continues to fall and is 5% less than in 2013, so the 800 new GPs promised by the Scottish Government are not coming anytime soon.  Despite the NHS being built on what we do, the increased funding required to keep pace with patient demand has not been forthcoming, such that simply retaining services is seen by some as a victory.

General practice and general practitioners have been under great pressure due to excessive workload – our well-being survey carried out this year showed that 85% of GPs struggled at times with their physical and mental well-being because of their workload demands. Some relief has been had through our revised Safe workload Guidance issued in September to help practices manage their particular workload situation. It includes the important concept that the responsibility to provide all required appropriate care lies not with the practice but with the Health Board, so that there may come a point for all GPs where a safe maximum is reached, their capacity is exhausted and where taking on further care and demand compromises what they are already providing, as well as risking clinician burnout. That will regrettably on occasion put pressure on other Board services, but it demonstrates where additional capacity is needed. Boards and Government need to take note, it is no longer acceptable to continue to absorb unsafe levels of workload and to ignore working unsafely. Practices are now telling us that applying the guidance is helping them in ways that we had not anticipated to redress their workload imbalance. We hear of a few areas trying to give practices a hard time with vague threats, but provided practices follow the BMA guidance they have nothing to fear and if they feel they are being unfairly treated, they should raise this with their LMC in the first instance and with us at the BMA in the second.

The Scottish LMC conference on 1st December was an unexpectedly ‘together’ event – that is to say it felt that while we as a profession are not in a great place, we were at least united in our resolve as to what the system needed to do to support improvements to the patient services that we provide and that we were in this together and not in-fighting about who has it worst. I believe, there is a growing recognition that the balance of health care expenditure in Scotland is wrong – we spend too much on specialist care and not enough on primary and social care. This was identified back in 2005 in the Kerr Report but we failed to heed the warning. And I think our Health secretary understands the need for a change in approach, I look forward to working with Scottish Government to turn the tide. He certainly indicated this was the direction of travel in his speech. Unfortunately, there are many factors that have pushed the NHS system to where we are; from politicians, commercial interests and parts of the media, to name just some.

The cumulative impact is that a prevailing view has formed which focusses on the idea that quick fixes, largely based on secondary care will improve how care is provided. When the public then try and access GP services, they can be surprised to discover that the care basics that they need on a regular basis are not being adequately resourced. To bring just a small part of that resource upstream would make a massive difference and reduce the dependency on secondary care.

And yet additional resources into primary care alone cannot change the situation, we need to do more to bring the people of Scotland with us, we need a concerted and prolonged resetting of public attitudes to healthcare and health interventions so that they see the fundamental value of good social care, from well supported, trained and paid community staff and the benefits of just enough medicine, where less really can be more. This is the real Realistic Medicine agenda that we in Scotland seem to have lost sight of. It is innate to general practice and something I would encourage all our colleagues across the NHS to push forward with adopting. It is about listening to what is important to our patients, being pragmatic, tailoring their care plan to their priorities and sometimes, maybe even often, working with patients and families to understand when it is right not to intervene and instead prioritise compassion and comfort over longevity. Alongside that more also needs to be done to enable people to take greater responsibility for their health, to eat the right things and maintain healthy weight and levels of activity. Government policy here can make a huge difference to make this happen.

So in conclusion I wish you all a good festive period, if you are working please do get some down time, and I hope that 2024 can be a good year where we can begin to turn around our health and social care system to make it fit for the future.

Dr Andrew Buist is Chair of the BMA’s Scottish GP committee