Scotland needs a Forward View too
Dr Miles Mack, RCGP Scotland chair
The General Practice Forward View, launched by NHS England last month in partnership with the RCGP, is a wide ranging document that acknowledges the ‘historic underfunding in general practice and the need for this to be reversed.’ Its most important contribution is a commitment to increase the proportion of the NHS England budget spent on general practice to ‘over 10%’ by 2020/21. This investment will be targeted on specific points to ensure the maximum benefit to GP patients and boost GP recruitment. RCGP Scotland calls for this commitment to be matched, if not exceeded, to bring about the changes required to ensure general practice in Scotland is able to meet the needs of its patients and support the aspirations of 2020 Vision and Realistic Medicine.
While simply draping tartan over NHS England’s move would be inappropriate , it is clear that Scottish patients’ safety is under strain
In Scotland there has been considerable work to address the falling morale, failing recruitment and increasing demand in Scottish general practice. This has been supported by general governmental commitment to increase funding to primary care. However, analysis of data from Irvine and Gomez has shown clear evidence that despite rising funding of community health services this has failed to lead to increased funding to the core services of general practice and district nursing that are key to delivering sustainable services to a population that is ageing and coping with increasing multi-morbidity. The Scottish Government’s Primary Care Fund announcement of June 2015, little of which spending is immediately attainable by grassroots general practice, has made little difference to GPs’ experience.
The current Scottish scenario unfortunately makes for grimmer reading than that in England. When Simon Stevens, NHS England’s chief executive, said he was no longer ‘in denial’ about the state of general practice in England as he launched the Forward View, the service received 8.4% of NHS England spending. NHS Scotland spending allocated to general practice had fallen to only 7.4% by 2014/15, was held steady in cash terms in 2015/16, and indications are that it will have fallen further as a result of the current budget, approved in February 2016. While in England one in ten training places were left vacant last year, in Scotland the figure is two in ten. Scottish general practice needs a clear, specific and detailed commitment to invest in general practice. This funding would allow the calls we made in A Blueprint for Scottish General Practice, in July 2015, to be fully realised.
The present situation needs urgent action. While new models of care are being trialled and developed in Scotland the general practice service is in danger of folding before those new models can be delivered. In March, 33 out of 127 practices in Lothian alone were operating restricted lists. A recent ComRes poll for RCGP Scotland found that 89% of GP in Scotland worry that a lack of resources is putting patient care at risk and that 93% believe that, without more resources, waiting times for appointments will increase, despite frequent reports of patients waiting for three weeks already. 79% worry that general practice will be unrecognisable as we know it by the time of the 2021 Scottish parliamentary election, 9% plan to leave the profession over the coming year and 58% of respondents say they are planning to either leave in the next five years or reduce their hours. 77% worry about missing something serious with a patient because of their workload. For healthcare professionals this is simply unacceptable.
While simply draping tartan over NHS England’s move would be inappropriate to Scotland’s developing healthcare system, it is clear that Scottish patients’ safety is under strain as a result of the lack of appropriate resources being provided. Scotland needs equivalent investment to the General Practice Forward View.
Dr Miles Mack is Chair of RCGP Scotland and a GP in Dingwall