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Fighting to keep a UK contract

Dr Alan McDevitt is stepping into his new role as chair of the Scottish GPC at a crucial juncture, amid an overhaul of health services both north and south of the border, and as Scotland considers a fresh break for independence from the UK.

Arguments over Scotland's political sovereignty are mirrored by the ongoing discussions over the future of the UK-wide GP contract, which appears increasingly under threat.

The debate on whether Scotland would be better off pursuing a separate contract is raging, agitated by a right-wing think tank pushing for a fully Scottish contract earlier this month, while the Scottish Government seeks a distinct ‘tartanised' version of the existing UK deal.

The softly spoken Dr McDevitt replaced the more voluble Dr Dean Marshall as Scottish GPC chair in July, with Dr Marshall remaining on the GPC team after being elected as a UK negotiator.

One notable difference north of the border is the relationship between GPs and politicians, with GPs in Scotland enjoying a constructive relationship with former Scottish health secretary Nicola Sturgeon.

The new man in the hot-seat says he will be shortly be sitting down with Ms Sturgeon's successor, Alex Neil, to discuss specifics, including the possibility of Scottish-only QOF indicators that are tailored to Scotland's particular public health challenges.

‘They want to look at some of the public health areas of the QOF to see that they are meeting the requirements in Scotland as well as issues that might be relevant across the UK,' says Dr McDevitt.

‘They also want to look at organisational points and other things like that. It's at a very early stage, but they haven't said they want to negotiate the whole contract – in fact they have quite explicitly said they don't want that.'

But he admits it is almost inevitable that the contract will separate further because of the divergence in health policies in the two countries.

‘The reality is that if England moves away from the current UK contract with the Health and Social Care Act, then the UK contract may be less applicable to Scotland,' he says.

It has become common in the past few years for GPs to paint Scotland as a utopian paradise compared to the market-driven NHS in England, but Dr McDevitt stresses similarities in patient needs, which he believes justifies the UK-wide contract.

‘Scottish general practice requires the same kind of support as practices across the UK,' he affirms. ‘You have to remember back to how long it took to renegotiate the last contract. It took three years of intense negotiations, so that's not an easy process to go through, and we don't want to be spending time on something that at the end will be much the same.'

But he may face some resistance from hardliners who believe the time has come to separate, such as Dr Sandy Sutherland, former chair of the Scottish LMCs conference, who in a letter to Pulse this week accuses Dr McDevitt of adopting an ‘ostrich-like approach' to the need for a Scottish contract.

The Scottish Government is also consulting on plans to replace unpopular community health partnerships with new health and social care partnerships, with a wider remit to plan and budget across health and social care. Dr McDevitt is upbeat: ‘There's often been a failure in clinical engagement [in the past]. I am optimistic we will develop something worthwhile.'

Dr McDevitt recently stepped down as chair of Glasgow LMC  after a 17-year spell, and only stopped working full time at his five-partner surgery in Clydebank three weeks ago.

After 23 years, he admits it was ‘a tough decision' to go part time, but he insists he was willing to do it to protect an NHS under threat: ‘It's about being where the decisions are made – to ensure the continuation of British general practice, which I am very passionate about.'

Click here to watch the Big Interview with Dr Alan McDevitt