I agree Roderick that this should not be seen as a rural v urban issue the disinvestment in Scottish General Practice has seen cities like Edinburgh , Dundee and Aberdeen at a tipping point that threatens the vey survival of General Practice across the whole country. The £250 million promised by 2021 is 2% of the Scottish NHS spend and exactly mirrors the 9% to 7% disinvestment we have seen in comparison to the rest of the NHS in recent years. Apparently we should be grateful that we are getting our money back in the dim and distant future ,managed not by us but middle mangers in the NHS. I feel sorry for the young enthusiastic GPs I am privileged enough to train.
This new GP contract could be the death knell for remote and rural practice. Despite the Earnings and Expenses survey showing remote GPs have the highest costs , the lowest income and spend the longest time with their patients the new Scottish Allocation Formula removes any rural weighting and gives the vast majority of the new £23 million to urban practices. You might think the BMA or especially the Scottish Government would care about the needs of rural Scotland, but this cavalier attitude means that remote practices will remain the hardest to recruit GPs to, never mind the promised by 2021 expanded team of staff.
Maybe we should not be surprised as our negotiators are yet to apologise for letting GP partner income here fall 2.5% in 2015/16 . An annual loss to practices of £23 million .... where have I heard that figure recently ?
This is either incompetence which I actually doubt or a deliberate attempt to exert pressure on Scottish GPs to sign up for their proposed not quite as good as salaried model.
Hopefully Scottish GPs especially those in rural areas will think long and hard about what this contract offer means for them and their patients.
We Scottish GPs are a patient lot having waited since 2014 for a new contract and one year late this is the best that the BMA and Scottish Government can come up with. I do not foresee a rush to fill GP training places based on this.
Scotland's GP service might be in crisis but there seems to be no rush to get much needed help direct to Practices, additional staff will not be finally delivered until 2021 and there is neither a workforce plan in place or an agreement from Health Boards to employ them.
In 2019 we get the headline figure of £80 000 minimum income guarantee for a full time Gp Partner which after removing Employers superannuation and defence fees ( 2K in Scotland) falls to £66 500 for a GP who may have may years experience. In comparison the starting salary for a consultant here is £78 000.
The BMA needs to reflect on why their poor negotiating skills have left Scottish GPs with falling income which is the lowest of all the UK countries.
Premises is a major issue and waiting till 2042 for GP owned premises to be taken over by the NHS is certainly taking a long term view.
Phase 2 sounds like a move towards a salaried service with a hoped for consultant equivalent payscale. But page 21 lets the cat out of the bag as they cannot agree affordability and may never happen even if we wanted it..
I suspect many Scottish GPs will find it hard to find much that is going to transform their working lives in this damp squib of a contract proposal. The new money needs to go to practices so they can find solutions that suit their local circumstances and help manage increasing demand.