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Independents' Day

MSPs call for ministers to consider fully salaried GP service

Members of the Scottish Parliament (MSPs) are calling for urgent revisions to the GP contract, including potentially a fully salaried service.

The Health and Sport Committee has been leading an inquiry into the supply and demand for medicines in Scotland, but it published significant conclusions on general practice.

Its report, published on Tuesday (30 June), says the system of supply and demand of medicine 'does not have a focus on patients', and is focused on 'market forces, public sector administrative bureaucracy, under resourcing, inconsistent leadership and a lack of comprehensive, strategic thinking and imagination'.

They concluded that the Scottish Government should consider whether GPs' roles as external contractors are beneficial to the patients they serve. 

The committee's executive summary said 'it is clear prescribers are instinctively reaching for the prescription pad', adding that 'there is not a strict adherence to the principles of realistic medicine, patients are not equal partners in discussions on their treatment'.

It concluded: 'We believe the Scottish Government’s contract with GPs is failing to mandate these behaviours and actions and must be revised. In the long term, without systematic changes the Scottish Government should consider whether the system of GPs being external contractors works well for patients.

'An approach which pays GPs from the public purse with no monitoring or evaluation of their actions is not acceptable.'

However, their stance has been heavily criticised by the RCGP, with the Scottish division lambasting its suggestion that GPs are quick to prescribe as ‘deeply unfair'.

Chair Dr Carey Lunan stressed how GPs focus on the 'whole' patient, as opposed to a single condition, but did welcome the report's calls for urgent action in the realm of healthcare IT systems.

Dr Lunan said: ‘It is deeply unfair and inappropriate to suggest that the default position of GPs and other medical professionals is simply to “reach for their prescription pad” when considering care options for patients. GPs always strive to deliver the highest standard of care for their patients, which is built around the principles of realistic medicine and shared decision making, and they do this day in, day out in often very challenging circumstances.

‘GPs are trained to consider the whole person, rather than the single condition, taking into account the values and beliefs of individual patients, and the evidence base for any treatments offered. They do all of this within the confines of a ten-minute appointment, which in many cases is simply not long enough.

‘We have consistently called for action to be taken to increase the number of GPs in the workforce, which would in turn allow for GPs to move away from 10-minute appointments, providing more time for patients and clinicians to more fully explore the treatment options that are available to them.'

RCGP Scotland, which intends to continue working with the Health and Sport Committee and Scottish Government, cited the particular example of patients with mental health issues. Dr Lunan emphasised that options for GPs to utilise non-medicine alternatives are ‘severely limited’ in this area, with waiting times for access to talking therapies being ‘too long’.

Calling for greater collaboration across healthcare, Dr Lunan cited the prediction that the Covid-19 pandemic will exacerbate mental health issues.  

It comes as the BMA has warned of GPs facing a ‘tsunami’ of extra work, due to a ‘lack of robust IT systems’ in secondary care.

Readers' comments (15)

  • LOL. Bring it on. As a GP mid 50s I will happily accept salaried service as long at matches the ‘old’ consultant contract with 3 SPAs, discretionary points and EPAs. I would even do OOH as part of my job plan. Let’s see how they fit my current job into that arrangement.
    I could even delay retirement to see it happen and milk the system.

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  • More great reporting. Deserves an award.

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  • Bring it on. I can forget CQC and go off sick often, take them to tribunals and work to rule. GPs do not like to prescribe but where are the CBTs, counsellors, physios etc? The waiting lists are far too long not to prescribe to keep people away from pain. Once again, smeared while trying to help.

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  • I think this won't end well for the government. GP is held together by Doctors (largely Partners) going well above their allowed hours to get all the work done.

    Will I be checking blood results after I get home if I'm salaried? I think not.

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  • They needs to be careful that they get what they wish for. As above, if they want a clock off culture they can have it.

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  • The rate of property takeover promised since the new contract has been glacial at best, so good luck finding the funding to buy out every GP partner in Scotland with any haste...

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  • "focused on 'market forces, public sector administrative bureaucracy, under resourcing, inconsistent leadership and a lack of comprehensive, strategic thinking and imagination"
    One of the best definitions of the Department of Health I have seen, and definitely the mission statement of any salaried service

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  • agree with above comments. would be very careful before signing any salaried GP contract - suspect it will contain an obligation to a number of OOH and urgent care sessions per month, plus a 'catch all' of having to provide cover in any practice in an 'emergency' situation. For once totally agree with RCGP spokesperson. Overall UK GPs give a great service above and beyond what they are paid for, this goodwill and commitment could very soon be totally lost. Caveat emptor.

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  • paid for overtime time and a third and double for OOH and BH - 37.5 hr per week, paid study leave, paid petrol for home visits, paid gmc, rcgp, insurance fees, sick leave, maternity and adoption leave, equipment paid for, locums paid for and access to tribunals for unfair practices, not trained to do it - not doing it, manager informed - bring it on.

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  • The Saintly Nicola saved us from abusing ourselves with drink and cigs, she can easily deliver further salvations.

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