Members of the Scottish Parliament (MSPs) are calling for urgent revisions to the GP contract, including potentially a fully salaried service.
The Health and Sport Committee has been leading an inquiry into the supply and demand for medicines in Scotland, but it published significant conclusions on general practice.
Its report, published on Tuesday (30 June), says the system of supply and demand of medicine ‘does not have a focus on patients’, and is focused on ‘market forces, public sector administrative bureaucracy, under resourcing, inconsistent leadership and a lack of comprehensive, strategic thinking and imagination’.
They concluded that the Scottish Government should consider whether GPs’ roles as external contractors are beneficial to the patients they serve.
The committee’s executive summary said ‘it is clear prescribers are instinctively reaching for the prescription pad’, adding that ‘there is not a strict adherence to the principles of realistic medicine, patients are not equal partners in discussions on their treatment’.
It concluded: ‘We believe the Scottish Government’s contract with GPs is failing to mandate these behaviours and actions and must be revised. In the long term, without systematic changes the Scottish Government should consider whether the system of GPs being external contractors works well for patients.
‘An approach which pays GPs from the public purse with no monitoring or evaluation of their actions is not acceptable.’
However, their stance has been heavily criticised by the RCGP, with the Scottish division lambasting its suggestion that GPs are quick to prescribe as ‘deeply unfair’.
Chair Dr Carey Lunan stressed how GPs focus on the ‘whole’ patient, as opposed to a single condition, but did welcome the report’s calls for urgent action in the realm of healthcare IT systems.
Dr Lunan said: ‘It is deeply unfair and inappropriate to suggest that the default position of GPs and other medical professionals is simply to “reach for their prescription pad” when considering care options for patients. GPs always strive to deliver the highest standard of care for their patients, which is built around the principles of realistic medicine and shared decision making, and they do this day in, day out in often very challenging circumstances.
‘GPs are trained to consider the whole person, rather than the single condition, taking into account the values and beliefs of individual patients, and the evidence base for any treatments offered. They do all of this within the confines of a ten-minute appointment, which in many cases is simply not long enough.
‘We have consistently called for action to be taken to increase the number of GPs in the workforce, which would in turn allow for GPs to move away from 10-minute appointments, providing more time for patients and clinicians to more fully explore the treatment options that are available to them.’
RCGP Scotland, which intends to continue working with the Health and Sport Committee and Scottish Government, cited the particular example of patients with mental health issues. Dr Lunan emphasised that options for GPs to utilise non-medicine alternatives are ‘severely limited’ in this area, with waiting times for access to talking therapies being ‘too long’.
Calling for greater collaboration across healthcare, Dr Lunan cited the prediction that the Covid-19 pandemic will exacerbate mental health issues.
It comes as the BMA has warned of GPs facing a ‘tsunami’ of extra work, due to a ‘lack of robust IT systems’ in secondary care.