In August 2017 patient lists in North Ayrshire were closed for eight practices covering a population of 57,000.
It followed months of severe recruitment difficulties, with several practices warning they were on the brink of collapse.
The affected towns of Kilwinning, West Kilbride and Three Towns – an area covering Saltcoats, Stevenston and Ardrossan – had seen multiple GPs retire or leave, with no one to take their place.
One surgery, in West Kilbride, had recently been taken over by the health board after resignations from all the doctors at the practice, leaving the town with no full-time GP.
‘The patients we see are complex with lots of multimorbidity and social problems’
Dr Lynsey Murdock
The previous year, Three Towns Medical Practice, which serves 7,000 patients, had also been taken over by the health board and had been forced to close a branch surgery.
This left overwhelmed practices in Scotland’s western coastal area fearful of being inundated with patients they did not have the capacity to take on.
Dr Lynsey Murdock was a locum at the beleaguered Three Towns Practice 18 months ago, but for the past six months has worked there as a salaried GP.
She has taken up one of several new GP with special interest posts developed to attract younger GPs who want more flexible portfolio careers.
There are now four such GPs employed in Ayrshire with a recent recruitment drive attracting nine more applications.
Three Towns Practice is one of Scotland’s ‘deep end’ GP surgeries, which serve the most deprived populations in the country.
‘Even without the [recruitment] issues we have had at the practice, the patients we see are complex with lots of multimorbidity and social problems,’ says Dr Murdock.
With two GPs currently on maternity and sick leave, the practice is still heavily reliant on locums but the picture is not quite as bleak as it was a year ago.
‘We have been making a lot of changes. We have a new pharmacist in place, we have more admin staff’
Dr Lynsey Murdock
‘GPs that come to work here point out how nice the staff are and that there is good morale,’ she says.
‘And we have been making a lot of changes. We have a new pharmacist in place, we have more admin staff and are making greater use of their skills, which has made a big difference – before the admin was almost unmanageable.
‘We have a link worker and we are hoping to get physios and mental health workers in line with the new GP contract,’ she says.
The team has also done a lot of work on contingency planning and getting better systems in place. ‘There are still gaps in the rota but we are functioning,’ she adds.
Dr Louise Wilson has been a partner at the large 12,800-patient Kilwinning Practice for 10 years.
Two years ago, two married partners retired and recruiting new GPs proved almost impossible.
When a third partner moved out of the area, the practice reached crisis point and asked the health board and LMC for help. The other practice in the town was facing similar difficulties.
‘There are still difficulties but it does feel like there is a light at the end of the tunnel’
Dr Louise Wilson
To help tackle the issues, an advanced nurse practitioner was employed, a triage system introduced and the pharmacist’s role extended.
A BMA speed-dating style event also led to the recruitment of a new partner, which has improved the situation, says Dr Wilson.
‘We are still looking to recruit and we are interested in the new GPSI role. There are still difficulties but it does feel like there is a light at the end of the tunnel,’ she says.
Ayrshire and Arran LMC secretary Dr Chris Black says the list closures were designed to bring about some stability.
‘There continue to be challenges that face general practice in the area and we recognise this, but we’re in a much better place now than we were this time last year.
‘In addition to the recruitment of GPs to the area, we are also starting to develop a bit of momentum in the implementation of the new GP contract,’ he adds.