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Funding imbalance causes GP ‘sink holes’ in certain areas

The systematic weakening of general practice in Scotland is likely to get worse creating an increasing number of ‘sink holes’ in areas where GPs are abandoning the profession, a leading GP academic has warned.

Professor Graham Watt, honorary senior research fellow at the University of Glasgow and the architect of the Deep End Project, has told MSPs that a decade of preferential investment in specialist services has led to an imbalance in the NHS.

In a letter to the Health and Sport Committee in response to their consultation on the 2017/18 budget, Professor Watt said likening the NHS to a ship, too much investment on one side has put it at risk of capsizing.

He told Pulse his letter was a ‘warning shot’ asking the committee to keep in mind the big picture.

‘No point in sorting the deckchairs if the ship is heading for the rocks,’ he said.

The patients getting the ‘worst deal’, he says, are those with multiple conditions whose care spans several specialties and who need ‘personalised continuity of care’.

‘The NHS weakens such care at its peril, yet this is what it has done, grossly disturbing the balance between specialist and generalist care, and relying on emergency care to pick up the pieces,’ he said.

Professor Watt points out that while consultant numbers and the budget for community health services in Scotland have increased in the past 10 years, general practice’s share of NHS funding fell by a sixth.

It has led to patients ‘flooding through the gate’ and using out of hours, A&E and acute hospital admissions, to which the answer is not more A&E consultants he says.

‘The problem is likely to get worse,’ he writes.

‘For the next decade at least, as a result of the trends described, the general practice landscape will feature increasing numbers of “sink holes” as practices can’t fill vacancies, are abandoned by GPs and replaced by Heath Boards using stop-gap arrangements.’

He called on MSPs to assess the draft budget for 2017/18 by the ‘extent to which it recognises and addresses this issue’.

The Health and Sport Committee held a consultation which closed at the end of July to ask for submissions on whether the budget for 2017-18 reflected the government’s stated priorities and where should resources be directed for 2018-19.

Last year the Scottish government announced £500 million to be spent in primary care by 2020 to bring the share to 11% of the NHS budget.

It has been confirmed that £250 million of that will be in direct support of general practice.

In this financial year £71 million has been promised for general practice.

Negotiations for a new contract for GPs are ongoing with an announcement expected at the end of this year.

The BMA has said it is essential is that the bulk of additional funds promised for general practice are not diverted into short-term one off projects but used for ‘sustainable, recurring spending’.

And that a substantial proportion will be needed to ‘train, recruit and employ additional community healthcare professionals who will be members of expanded primary care teams’.