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Independents' Day

Rural GPs 'unanimously' oppose new Scottish GP contract

The Rural GP Association of Scotland (RGPAS) has taken a ‘unanimous view’ against the new Scottish contract, the association’s chair has said. 

Dr David Hogg tweeted that the contract had had ‘lots of opportunities missed’, adding that RGPAS members ‘are concerned’ that rural issues are not being addressed. 

He told Pulse that ‘it’s a unanimous view at the moment’ and depends on how much the association is ‘able to engage with the Scottish GPC’ before the profession votes on the contract. 

He said: 'We're keen to stress that it's a unanimous view at the moment, hence why we're keen to use the opportunity we have before the polling day to work with the SGPC on that.

'It's not an absolute position as yet, depends how much we're able to engage with SGPC over the next fortnight.'

Dr Hogg added that the new contract ‘has fallen short of reassuring rural GPs that their funding is safe and that payment for the job will reflect the additional services they do’.

The contract proposes to have GPs working as the head of a multi-disciplinary team to work with GP practices to provide direct access to services for patients.

But Dr Hogg said this part of the contract ‘will increase the expectation’ that general practice can provide additional services, adding ‘if that is not there people are naturally going to come back to the GP’.

He said: ‘We want to make very clear that involving our colleagues, including pharmacists and physiotherapists in the wider healthcare team makes total sense, there is no question about that but in smaller practices the staff are simply not there or there has been a very haphazard approach...

‘The real damage the contract could do is raise expectations again.’

Despite this, he said RGPAS is not at the stage yet of voting against the contract on 1 December.

He said: ‘We’re not advising our members to vote no at the moment. We are hoping to continue the dialogue we’ve had with SGPC to help our own clarity on what they mean by certain aspirations and we’re hoping to get more commitment on some of those kind of aspects before the profession goes to polling.’

Other rural GPs have also expressed their disappointment with the new contract.

Dr Iain Kennedy, vice-chair of Highland LMC, said rural GPs are ‘not confident the rural package is going to appear and that it is going to be robust and protect us from health board cuts’. 

He added: ‘The loss of autonomy is also a major concern as at the moment we have the ability to directly employ clinical staff and some influence on the design and delivery of services.’

It comes as Dr Miles Mack, who stepped down as RCGP Scotland chair earlier this month, warned that GPs will lose their autonomy to employ and manage their practice team under the new GP contract.

Readers' comments (7)

  • You are worried the staff won't be there in rural areas, well nobody is convinced these staff will appear in urban areas!!!
    Does absolutely nothing to address/manage rising demand.
    Pie in the sky stuff.

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  • Vinci Ho

    This unanimous view should be respected. And as I wrote before, there should be amendments before giving the whole thing for you guys to vote upon. The danger is always trying to fit all with one size.

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  • 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.

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  • Agree with most of the above but I think it's only areas of deprivation that will benefit or maintain the status quo. There is no interest in supporting general practice elsewhere. Resources always go to deprived practices in the forlorn hope of a quick fix for health inequality. Practice income stability is a highly misleading concept as it does not cover all income streams and no account is taken of increasing expenses. Sadly, I have grave doubts that the profession will have the courage to vote no.

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  • 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.

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  • Have just returned from the Lanarkshire roadshow hoping to have a better understanding and degree of optimism over the proposed new contract. Sadly I fear this has been a missed opportunity for GPs to stamp their worth to the NHS. The BMA representatives seem to have forgotten that they are a trade union for doctors and have cosied up to the politicians a little too much. Tonight I heard that the NHS doesn't want to make us salaried as it is costing Boards 2 to 4 times more to run practices they have had to take over. Therefore we should all be happy to remain as independant contractors getting paid half of what we are truly worth. I always new our Governments undervalued us but I never thought I would see our representatives undervalue us so much. I will be voting No unless my younger colleagues convince me otherwise.

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  • Essentially the contract proposals and negotiators appear to have ignored the interests, issues and challenges of rural and small practices in favour of the benefit to larger, urban practices.

    It is, of course, equally important that the issues in town practices are addressed but the proposals lack any sense of balance and create a very distinct urban and rural divide.

    Small and rural practices will effectively be allowed to continue to take a financial hit from lack of investment while the majority of other practices in Scotland will benefit.

    Many small and rural practices already have significant recruitment issues.
    The inevitable outcome would seem to be a significant impact on future sustainability and recruitment to these practices.

    The figures across the country show that the contract proposals will establish a divide with 2/3 of Scottish practices receiving significant investment from £23m that has been clawed from the previous allocation to the remaining 1/3 of GP practices.

    Protection has then been applied which offers some temporary reassurance.

    However, if there is a move to phase 2 there must be concern that that could be lost - particularly as practices who have not received additional funding will be in a minority.

    It's important to recognise that the overheads for smaller practices continue to be proportionately greater with consequent chronic reduction in profit. These proposals will cause a further relative reduction in earning potential and stability and result in increased difficulty to recruit to rural practices especially those challenged because of the size of their patient list.

    Rural practices will also be less likely to receive support from the highly anticipated, although unclear, extension of the primary care workforce.
    Whatever professionals are recruited to support general practice, from an aspirational workforce plan, are more likely to be directed towards urban areas in line with what happens just now

    It needs to be highlighted that a positive poll in favour of the "contract" will be to the detriment of many rural GPs and the longer term sustainability of certain types of practice.

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