A battle of semantics is raging across Scotland's health service. Government officials touring the country want to know what health boards and local GPs would like from a ‘more Scottish' GP contract. This has been interpreted by some as a precursor to a completely separate contract, but at present, this is far from the likely outcome.
With increasing divergence in the way primary care is delivered across the UK – largely as a result of the health and social care reforms in England – there are areas of the contract where it is now appropriate to discuss whether we can create more flexibility between different parts of the
UK. The contact is already sufficiently flexible to accommodate some differences – for example, the global sum has always been divided among Scottish practices via a Scottish allocation formula, which was negotiated separately to reflect Scotland's unique geographical and population differences. Likewise, most enhanced services are negotiated and agreed separately in Scotland to reflect local priorities.
In addition to using the existing flexibilities, the Scottish Government has expressed interest in adapting the QOF to Scottish needs. It doesn't plan to change clinical indicators, but there is already some variation on the organisational indicators as a result of reforms in England. The Scottish Government agrees with us that there is no point reinventing the evidence base for clinical indicators that are the same for every GP and patient wherever they live and work, but we have also agreed to continue looking at the Scottish allocation formula to ensure it best meets the needs of Scotland.
Uncertainty and extra work
Talk of a ‘Scottish contract' is largely a misunderstanding of terminology rather than an overt drive to separate us from our UK contractual agreements. There is
a danger that, by touring the nation and asking health boards what they'd like to see done in general practice, the Scottish Government will raise expectations and create anxiety and uncertainty. The inevitable result is the recommendation that ‘GPs are ideally placed' to do extra work. This risks passing even more underfunded and unresourced work onto an already stretched GP workforce, and everyone will
be disappointed with the outcome. Any changes that the Scottish Government proposes as a result of this consultation will be negotiated and agreed with the Scottish GPC.
Just about every GP in the country is dealing with a level of workload that is neither good for patients nor for the wellbeing of the GP. We cannot deliver the Scottish Government's agenda of shifting the balance of care, anticipatory care, patient safety, improved access, reduced referrals and improved primary prevention with the current workforce. Each GP needs more time to do this and practice teams need to be supported and expanded.
In fact, this contractual debate is overshadowing the real challenges for Scottish general practice. As in the UK, the increasing demand for care of a growing population to be provided by primary care means much more must be invested in the workforce and GP premises.
What is important is that any proposals we develop with the Scottish Government must be clinically driven and evidence based. They should prioritise improving patient outcomes, not simply cost savings, and they must be achievable and deliverable by GPs.
I have no problem with the Scottish Government consulting with health boards to inform its primary care policy. However, they must be honest with themselves and those they speak to. This is not about a separate contract. This is about identifying priorities across the health service in Scotland and giving GPs the tools, resources and support to be part of the solution.
Dr Alan McDevitt is chair of the Scottish GPC and a GP in Clydebank