GPs leaders question 'one size fits all' approach to contract
GP representatives will raise concerns about a ‘one size fits all’ approach in the new Scottish contract at the upcoming annual local medical committee conference.
Delegates will vote on a range of motions around a lack flexibility in the contract, which came into force in April this year and will be implemented over a three-year period.
Issues to be raised by several LMCs cover the failure of the contract to ‘adequately support rural general practice’ and calls on allowing the direct funding of practices to provide services where health boards are unable to do so fairly.
There are also several motions calling for practices to retain the ability to hire their own clinical support staff, including nurses, pharmacists and mental health workers.
LMCs proposing greater flexibility for practices in implementing the new contract point out there is much to applaud including the minimum income guarantee and the potential to make general practice a ‘desirable career option’.
Ayrshire and Arran LMC will ask that the rural short life working group, set up to address some of the strong concerns from rural practices around the contract, urgently produces specific detail on the resources available and practical guidance on delivering the first phase of the contract in remote and rural areas.
It comes as the Rural GP Association of Scotland issued further warnings in their response to a petition calling on the Scottish Government to adjust the new contract to protect rural practices and patients.
They say the way the contract pays practices does not reflect the extra workload associated with services provided by rural GP practices.
And point out that ‘many of these promised services are simply impossible to provide in rural areas or will be disruptive and problematic to provide on the scale and approach being proposed’.
IT delays and problems and increased workload associated with general data protection regulations are also set to be discussed at the conference to be held on the 30th November in Glasgow.
GPs and GP trainees in Scotland suffering from mental health conditions, including stress and depression should have access to a service which is at least comparable with the NHS GP health service available to GPs in England, the conference will hear.
And Lothian LMC will warn that online providers of GP services threaten to undermine NHS general practice and will ask members to support their view that the Scottish Government should introduce legislation and funding differentials to ‘deter providers from cherry picking patients and failing to offer a full range of services’.
The conference is taking place on Friday 30 November.
Motions in full
Agenda Committee, to be proposed by Ayrshire and Arran LMC: That this conference whilst welcoming much of the provision of the new contract:
i. is concerned at the “one size fits all” approach
ii. believes that the implementation of the contract fails to adequately support rural general practice
iii. insists that the Rural short life working group urgently produce specific detail on the use of the resource committed to the “rural package” in 2018/19
iv. insists that the Rural short life working group urgently produce practical guidance on how local development plans can use this to deliver phase 1 in remote and rural practices/areas
v. seeks a more flexible approach that directly funds practices to provide services
where health boards are unable to do so in an equitable manner.
Agenda Committee to be proposed by Highland LMC: That this conference welcomes the aims of the new Scottish contract to reduce workload but asks SGPC to:
i. make provision for practices to directly employ mental health workers
ii. make provision for practices to directly employ pharmacists
iii. make provision for practices to directly employ (ANPs) advanced nurse practitioners
iv. work towards enabling patients to continue to have long term conditions monitored in their own practices
v. demand that health boards do not prevent the recruitment or re-deployment of mental health nurses into general practice.
Lothian LMC: That this conference believes that with respect to online providers of GP services:
i. there is a lack of evidence to support the safety of such services
ii. such services threaten to undermine NHS general practice
iii. patients should not be allowed to separately register with two separate practices whether traditional or online
iv. SGPC should ask the Scottish Government to introduce legislation and funding differentials which deter providers from cherry picking patients and failing to offer a full range of services.
Agenda Committee: That this conference believes that whilst the occupational health service now available to GPs is a welcome step forward:
i. it demands that SGPC works with the Scottish Government to deliver a comprehensive confidential NHS service for all GPs and GP trainees in Scotland suffering from mental health conditions, including stress and depression which is at least comparable with the NHS GP health service available to GPs in England
ii. the Scottish Government should be aiming to provide a specialised primary care service which recognises the unique problems which doctors with acute and chronic illnesses face.