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‘Disappointed’ LMCs demand progress on Scottish GP contract

GP contract

Over three quarters of LMC leaders are ‘disappointed’ by the lack of progress on implementing the Scottish GP contract, which had aimed to reduce workload.

At today’s BMA Scotland LMCs conference, 77% of delegates voted that they are ‘disappointed by the continuing slow progress in implementing the 2018 contract’ and said it has as yet failed in its aim to reduce GP workload ‘in any significant way’.

Delegates also said they want the Scottish Government to appreciate GPs ‘disappointment, frustration and anger’ and warned that the ‘resulting demoralisation’ from the lack of contract progress could cause ‘a greater crisis in the retention of GPs’.

LMC leaders also voted that whilst welcoming the publication of the second memorandum of understanding (MOU), they ‘remai[n] concerned about the pace of implementation of the MOU services’.

The motion, passed unanimously, called on the MOU signatories to ‘provide clarity’ on:

  • nationally agreed levels of service provision for vaccinations, pharmacotherapy, and community treatment and care service (CTACS);
  • practice transitional arrangements and funding for MOU services not fully delivered by April 2022;
  • the expectation of practice provision of travel advice, and the balance of CTACS provision for immediately necessary care.

Speaking at the conference, Scottish health secretary Humza Yousaf said that he is ‘absolutely committed to the full implementation of the GP contract’ and will ‘honour the commitment made by my predecessor to give you permanent access to multi-disciplinary teams through putting them on a contractual footing’.

He said: ‘I share and understand your frustration that we’ve not been able to move as quickly as we would have liked to with our reform programme that was initially set out in 2018.’ 

It comes as a joint letter from the BMA and Scottish Government last year set new timelines for the removal of several services from general practice to become the responsibility of multi-disciplinary teams employed by NHS boards.

They agreed that other services due to move to health boards, including pharmacotherapy and community treatment and care, will be in place by 2022-23 – a year behind April 2021 as originally planned when the new GP contract was introduced in 2018.

At the 2019 BMA Scotland LMC conference, Scotland GP Committee chair Dr Andrew Buist said there had been an ‘insufficient pace of progress’ in delivering the first phase of the Scottish GP contract.

Speaking at today’s conference, Dr Buist admitted the implementation of the GMS contract had still ‘not progressed as far as anyone would have wanted by this stage’. 

He said: ‘We need the physiotherapists, the pharmacists, the nurses that are all key parts of multi-disciplinary teams in place if we are truly to deliver the vision the contract sets out. The pandemic has only underlined the importance of all professionals working closely to deliver the right care to patients from the right person.

;So, we need [a] proper strategic plan and to redouble our focus on delivering these staff to support practices across the country, and we need that urgently.’

He highlighted changes to the GMS contract that had already been made, including the removal of vaccinations in October, and assured delegates that by April 2022, ‘regulations and directions will be in place to define what Pharmacotherapy services and Treatment Room services practice patients can expect from their local health board’.

He added that the workforce crisis is a key issue holding back new community services, and said workforce supply is ‘something the Scottish Government urgently needs a credible plan to improve on’.

Meanwhile, 96% of delegates said they deplored abuse from the public, and called for the Scottish Government to reinforce their zero-tolerance policy for all kinds of abuse, while explaining the pressure general practice is under to Scottish MPs and the public. 

The motion also called on GPC Scotland to negotiate stronger sentencing for those who abuse practice staff, and for practices to be able to immediately remove abusers from their lists under general medical services (GMS) regulations.

Mr Yousaf said GPs have faced an ‘unacceptable amount’ of ‘unfair criticism’, and that he ‘completely reject[s]’ the suggestion that GPs are refusing to see patients face to face for no good reason. 

He said: ‘You and your teams have put up with an unacceptable amount of abuse, you’ve put up with an unacceptable amount of, I think, unfair criticism.’

He added that ‘low morale within the service’ is to ‘everybody’s detriment’.

Motions in full

MOTION 10 – LOTHIAN: That this conference is disappointed by the continuing slow progress in implementing the 2018 contract, and feels that so far it has failed in its aims of reducing GP workload in any significant way, and asks SGPC to consider and update the profession on alternatives to the 2018 GMS contract. PASSED

MOTION 11 – GLASGOW: That this conference, whilst welcoming the publication of the MOU 2, remains concerned about the pace of implementation of the MOU services and calls on the MOU signatories to provide clarity with regards to 

(i.) nationally agreed levels of service provision for vaccinations, pharmacotherapy, and CTACS (community treatment and care service) PASSED

(ii.) practice transitional arrangements and funding for MOU services that are not fully delivered by April 2022 PASSED

(iii.) the expectation of practice services for travel advice PASSED

(iv.) the balance of CTACS provision for immediately necessary care. PASSED

MOTION 13 – AGENDA COMMITTEE TO BE PROPOSED BY GLASGOW: That this conference deplores the abuse from the public that GPs and practice staff have endured during the pandemic with the risk of the staff sustaining moral injury and harm and calls 

(i.) on the Scottish Government to make clear it has a zero-tolerance policy for any verbal, physical or online abuse PASSED

(ii.) for changes to the GMS (general medical services) regulations to allow for immediate removal of an individual from the practice list for any form of abuse PASSED

(iii.) on Scottish government to explain the capacity challenges facing general practice to MSPs and the public PASSED

(iv.) on SGPC to work with the police to agree support for the practice PASSED

(v.) on the BMA to lobby for increased sentencing for those abusing general practice staff. PASSED

MOTION 17 – AGENDA COMMITTEE TO BE PROPOSED BY FORTH VALLEY: That this conference wants the Scottish Government to understand the disappointment, frustration, and anger felt by many GPs at the failure to deliver so much of the 2018 GMS contract and the MoU and hopes that the government can turn this around before the resulting demoralisation leads to a greater crisis in the retention of GPs. We are disappointed that the MoU2 priorities certain workstreams and calls on SGPC to negotiate: 

(i.) the multi-disciplinary team services roles which reduce GP workload can continue to be expanded and prioritised including ANP (Advanced Nurse Practitioners) mental health nurses and advanced physio practitioners PASSED

(ii.) for GMS contractual terms that guarantee practices will benefit from a minimum number of ‘extended MDT’ appointments per month or transitional payments will apply PASSED AS A REFERENCE

(iii.) local flexibility be given to progress those workstreams that will afford the greatest GP workload relief. PASSED

Source: BMA