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Independents' Day

Have Scottish GPs reached the promised land?

Editor’s blog

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15392 1 nigel praities duo 2940x1960px

GPs in Scotland have been waiting a long time to learn details of their new contract with the NHS. Their leaders have kept them in the wilderness for a while waiting on a Promised Land where the profession would be made attractive again. They finally arrived today.

And at first glance, there is much milk and honey. The 70-page document marks the most radical redrawing of general practice anywhere in the UK since 2004, with GP partners promised a guaranteed minimum income of at least £80k; direct reimbursement of expenses, longer consultations with more complex patients and the transfer of workload to the NHS with no loss of funding.

But it is perhaps the whole theme of the document that is refreshing. The reassertion of the GP role as the ‘expert medical generalist’; the citation of Barbara Starfield’s ‘four Cs’ (contact, comprehensiveness, continuity and coordination) as ‘guiding principles’ and the whole emphasis on reducing workload and risk. It all makes the GP Forward View in England look rather cold and mechanistic, rather like a Haynes manual put next to a glossy brochure for a new car.

But I have no doubt there will be many GPs concerned about how this all will play out in the real world. The aspiration of all GPs giving up their premises by 2043 would mark probably the biggest nationalisation of healthcare estate seen since 1948, and for individual partners surely the point of no return in terms of their relationship with the NHS.

Also, as GPC chair Dr Alan McDevitt, hinted at when speaking at Pulse Live earlier this month, the whole package ‘is not intended to give GPs a large pay rise’. No practice will lose funding, but there will be little opportunity to increase it either, with what amounts effectively to a freeze in new local enhanced services.

There will be a sizable injection into the GMS contract next year – an average of £24k per practice, although it will be those in deprived areas and those with more elderly populations who will benefit most – but it is not clear how this relates to the rest of £250m that is planned ‘in support for general practice’ by 2020. Will that simply be siphoned off by the rest of the NHS?

The BMA claims that they have retained ‘independent contractor status’ for the profession, but looking at the package as a whole, it looks rather like it has traded a big chunk of the profession’s autonomy for guarantees on income stability and workload. Now this is perhaps a fair trade, considering the pressures on GPs and their practices at the moment. The alternative is the direction of travel in England, where only the stronger practices survive and a small group of super-partners reap all the benefits of a ‘bigger is better’ system that employs an army of salaried GPs. Or Northern Ireland, which is heading out of the NHS entirely. But I can’t help but wonder how all this will be perceived by a profession that has traditionally fiercely defended its independence at all costs. 

And I wonder about the immediacy of it all. With one in four practices with at least one vacant position for a GP, and nearly three quarters of them open for more than six months, how will this all help right now?

These are exciting times for Scottish GPs. They have been offered a genuine alternative, with many things to recommend in it. But we will find out next month if they choose it over the status quo. 

Nigel Praities is editor of Pulse. You can follow him on Twitter @nigelpraities

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Readers' comments (7)

  • Nigel, you seem to have a bizarre understanding of what most people consider 'exciting times'.
    And a pay 'freeze' in times of increasing costs (personal and professional), is in basic common understanding, a pay cut?

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  • Nigel, my apologies. Maybe you were referring to the ancient Chinese curse?

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  • Vinci Ho

    ‘These are exciting times for Scottish GPs.’
    While I am certainly no expert on general practice in Scotland(so , correct me if I am wrong), my common sense would say the result of the ballot on this contract merely reflects the depth of the crisis in general practice.
    If most GPs vote for this contract , perhaps the nature of the crisis is consistent with the understandings from those representing GPs , hence BMA in this case .
    On the other hand , the opposite result will imply that the problems in general practice are a lot more far reaching and only a radical rethinking can make GP ‘attractive’ enough for retention as well as new recruitment.
    So Nigel , I would say , ‘ These are exciting times for SOME Scottish GPs’ . Question is how many is SOME?

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  • New "minimum" GP partner salary is £80430 -will this be the target come 2021? strip out employer contributions and this is approx £64,440 for 40 hours which is deemed to be 8 sessions. Many GPs working 8 sessions will be working 50-60 hours per week.

    A new hospital consultant earns over £78000 and will work roughly 40 hours per week.

    If i were a young doc choosinga career in primary or secondary care which would i choose?

    Where is the recruitment incentive in this contract? Even the complete lack of salary clarity beyond 2021 means that many young docs will be put off. If a young doc chooses GP now they will not enter the workforce until 2022. Why would you chosse a career when you have no idea what salary who might earn?

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  • The promised land, is that down s**t street , and up f*** you avenue in the UK.I thinks its more like a short plane ride to NZ/AUS or Canada at the moment,or a ride in the sunset for our lucky retirees.

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  • If the promised land is purgatory then yes we probably have reached it. I think the sGPC should be ashamed of this rubbish they are selling to us. It is salaried by the back door and nothing less. Still us taking on all the risks and us being responsible for any and every decision made by the shiny team they are proposing. It certainly does absolutely nothing to address recruitment or retention problems. No junior doc will be choosing GP because of this load of guff. The Scottish government must be delighted at this proposed contract.

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  • I find it difficult to believe it will attract young graduates or retain those wanting to leave.

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