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Scotland is no utopia, but at least the government listens

Dr Dean Marshall, GPC Scotland chair, says the government is finally listening to GPs and involving them in the development of local clinical services.

Devolution has inevitably meant that over the past decade, there has been an increasing divergence in health policy across the four nations of the UK. 

With the recent reforms proposed for the health service in England, the gap has never been as evident as it is today and is likely to grow if the Health and Social Care Bill, as currently envisaged, becomes law. As a result, I am frequently asked to explain the difference between the NHS in Scotland and England.

GPs across the UK have shared values despite the variation in health policy. We have always argued that medical leadership in primary care can help to reduce waste, improve patient pathways and ultimately improve patient outcomes. In England, the political approach has been to give GPs leadership in the form of commissioning, creating a competitive marketplace for healthcare. Meanwhile in Scotland, the approach couldn’t be more different. The Scottish government has turned its back on private provision of healthcare and is making efforts to work in partnership with the profession.

Despite broad agreement on healthcare provision, Scotland is not the Utopia that some make it out to be. While we do not face the same challenges as our colleagues in the South, we suffer from a lack of clear policy on the direction of general practice in the future. 

That is why last year SGPC decided to do what the politicians had failed to do and published a policy document General Practice in Scotland: the way ahead. This document, based on public and professional consultation, considered the main challenges facing general practice, including access, out of hours, premises, IT and workforce and made recommendations for the future. The document has had a significant impact and in particular, the Scottish government has used it to stimulate debate on future policy for NHS Scotland.  As a result, I am pleased to report that, 18 months on, progress is being made. 

We have agreed new arrangements to support practices that are having difficulty delivering appropriate access for patients. New quality standards on out-of-hours care have been developed and there is greater collaborative working taking place between the providers of unscheduled care. GP trainees are now employed by NHS Education for Scotland for the duration of the GP element of their training, and there are discussions around appropriate secure access to GP records in secondary care. These measures have been developed in partnership with the profession and agreed with SGPC.  It is clear that by working together, we can continue to improve services for patients in Scotland.

As is clear, the Scottish government is beginning to recognise the benefits of bringing the profession along with them and is committed to working with SGPC, for example, to improve Community Health Partnerships, the local structures responsible for the interface between health and social care and primary and secondary care.

However, despite this positive relationship, in Scotland we are not immune from the political PR policies of government. There is still a commitment by the SNP to increase the number of practices providing extended hours and there remains a commitment to the evidence-free policy of over 40 health checks.

There are a number of compelling reasons why GPs are ideally placed to take a central role in planning and developing local clinical services but in our view this does not require an internal market, a policy of any qualified provider or significant changes to the GMS contract. We work with patients on a day to day basis and we have valuable insights as to where the pressure points are, how resources could be used more efficiently and how patient pathways can be made more effective. 

It is vital that governments across the UK value the clinical expertise and knowledge of those at the front-line of patient care.  Without this recognition, ill-considered and ill-advised healthcare policies we currently see in England could witness the demise of the NHS that we have worked so hard to develop and maintain and which we are so very proud of.

Dr Dean Marshall is a GP in Dalkeith, Midlothian, and GPC Scotland chair