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A Scottish contract is long overdue



We are all going to have to get used to the rear view of GPC Scotland chair Dr Alan McDevitt if he continues with his ostrich-like approach to a Scottish GP contract (A Scottish contract isn’t the answer).

On the face of it, the rapid divergence of health north and south of the border and the prospect of a vote on Scotland’s independence in two years’ time would both seem reason enough to be at least investigating the idea.

But more compelling reasons lie in the structure of the present contract itself.

The fact that 95% of Scottish practices required a correction factor when the new contract was introduced tells its own story about its suitability for Scottish general practice.

That figure has been reduced over the following years, most recently by the expedient of using the majority of any pay rise to offset the correction factor, with the result that practice income has been stationary – or, in the case of rural areas, actually falling – while expenses move ever upwards.

Practices have reacted to this in several ways. Skill mix has been taken as far as it can go.

Enhanced services are the only source of increased income, and these are generally short-term, inadequately funded pet projects dreamed up by politicians and managers with little clinical benefit.

Meanwhile, more and more salaried GPs are being employed, creating a disenfranchised group with no prospects, which weakens the profession – something a previous generation fought long and hard to get rid of in the 1960s.

We are constantly told we can use the ‘existing flexibilities’ in the contract to make it more suitable for Scotland, but my question is: what are they and why on earth have they not been used already?

The basic problem with the present contract was built into it at the very beginning – the money attached to a Scottish patient was woefully inadequate.

Previously, adding 1,000 extra patients to the list was a cause for rejoicing, as the practice was funded to take on another partner.

But now it is a curse as the extra income is not remotely sufficient to take on another doctor so everyone just has to work harder.

All we hear from our leadership is the mantra ‘we are stronger together’, but repeating the same thing over and over again does not eventually make it true.

Are they happy that the pay gap between Scottish and English GPs currently stands at £25,000, that practices have no incentive to expand, that every GP in the land is working a lot harder for a static or falling income and that rural recruitment is falling through the floor?

I dare say most of my colleagues are not.

Surely it is time GP leaders in Scotland removed their heads from the sand, accepted that the current situation is untenable over the long term and negotiated a Scottish contract that is genuinely suited to Scottish general practice.

From Dr Sandy Sutherland, Lauder, Berwickshire – Former chair of the Scottish LMCs conference