Simply increasing GP numbers will not fix NHS problems, report warns

The Scottish Government has argued for a major rethink of Scotland’s medical workforce, warning that simply boosting the number of GPs will not fix the system.

A report from the Scottish health secretary and CMO, published this month, argued that only increasing the number of GPs in Scotland is not the solution to current challenges, and said that ‘infrastructure, IT and service design’ must also be interrogated as factors contributing to the lack of productivity and professional cohesion in the NHS.

Surveying 1,817 doctors and conducting focus groups with 207 of them, the Scottish Government found the most acute workforce concerns to be job security, training quality, IT infrastructure, feeling undervalued and the risk of burnout. And a major concern cited in the report was training bottlenecks for doctors.

The report anticipated increasing workforce requirements alongside increasing service demand, taking into account that the Scottish Government has already increased the annual intake of medical places at universities and funded additional foundation places creating 850 additional posts across multiple specialities since 2014.

But it said that despite rising workforce numbers, productivity within the system is ‘below pre-pandemic levels’.

The report said: ‘Increasing the number of doctors, with no other changes, will not solve our problems, and there will be a need to explore and embrace new innovations and opportunities to ensure best care.’

It added: ‘Discussion with doctors suggests that alongside increasing the GP workforce, more consideration should be given to blurring the lines between primary and secondary care.

‘Creative thinking about how secondary care services (including diagnostics, outpatients and long-term condition management) could be delivered in the community or through greater interface working, could be one way in which we overcome [the challenges].’

Another structural issue highlighted in the report was the lack of GP influence in NHS management structures, which leaves frontline clinicians feeling sidelined in key policy decisions.

Those surveyed cited ‘a lack of clinical influence and voice’ within management structures, and a system in a ‘constant reactive “firefighting” response state’.

The report also said that the public currently perceive doctors as ‘gatekeepers withholding access to services in the context of waiting lists and under-resourced services’ and predicted a need to shift towards ‘prevention, lifestyle advice, and holistic care alongside treatment’. It cited a ‘need for more generalist medics’ who can provide ‘holistic care’.

Doctor leaders in Scotland have called for a workforce plan for years, but the BMA said that the report still doesn’t deliver a plan to meet the needs of the population.

BMA Scotland chair Dr Nora Murray-Cavanagh said : ‘Without the kind of decisive action and meaningful change we have being calling for, the ability for the NHS to deliver safe, sustainable care across Scotland remains at serious risk.

‘The document fails to look closely at the impact of the roles of PA and AAs are causing in the system, both on patient safety and on capacity for resident doctor training.

‘Only doctors, with their full medical training can deliver what we rightly ask of doctors. There are no shortcuts or short term fixes.

‘The report rightly acknowledges the complexity of the issues, but these are far from new problems and have been allowed to develop over a period of time due to inadequate planning.’

Earlier this month, the BMA has raised concerns over an independent watchdog’s conclusion that the NHS in Scotland is ‘financially unsustainable’ – while hailing a recent funding deal for general practice as ‘a positive start’.