This week I took part in a parliamentary debate on the NHS and Redesigning Primary Care.
I stressed the importance of everyone in Scotland having the means and services to enable them to enjoy optimal health, and a properly resourced health service there when we need it. We know only too well the impact of inequality on health.
Read on for the full text of my speech.
It really is essential that we do all that we can to ensure that everyone in Scotland has access to a GP when they need one, yet, as we have heard, that is becoming more of a challenge than ever before. This year, here in Lothian, practices in Ratho and Bangholm have struggled to provide primary care to patients. At the time, a constituent who lives in Ratho village wrote to me and told of the
“extraordinary position that we find ourselves in living in Ratho Village”,
“We will have no doctor in the surgery for the next week. We have only had a doctor for two days a week for the six weeks beforehand.”
My constituent advised that he had been offered an alternative surgery in Leith, which involves a journey of about 10 miles one way. In terms of cost and travel time, not to mention time off work or school, it is difficult to imagine a less convenient option.
Like many people, my constituent wants to understand the events and circumstances that led to that, and he asks that the local health board provides an explanation of the systems and planning that have led to the situation. He asks:
“Why has this happened?”
He used the word “extraordinary”, and the lack of access to a GP is indeed unexpected, unusual and extremely worrying. There are many reasons why it has happened, but I am pleased to say that there are solutions.
We have moved from a position where there was intense competition for GP positions and several applicants for each post to one where, as reported in MSP meetings with NHS Lothian, interview dates have been cancelled due to a lack of interest in and candidates for an advertised post.
As GP vacancies increase, the burden on existing staff increases, adding to workloads that the BMA describes as being “already unsustainable.” The BMA tells us, too, that morale among GPs is at an all-time low, that more GPs than ever before are leaving mid-career and that senior GPs are retiring early. I know one such GP, who told me recently that the bureaucracy that he was dealing with meant that he simply could not do the job that he had been doing before and the job that he wanted and needed to do. Unfortunately, he felt that he could not carry on. He worked in a practice in an area with many social challenges, and the loss of his skill, passion and experience will have a negative impact. I am pleased that the burden that is QOF is being removed.
We have heard, too, that there are practices with restrictions on their lists. For example, potential patients may be able to register only on certain days of the week. Lack of access to primary care often results in patients seeking assistance at hospitals, sometimes heading straight to accident and emergency departments. In some cases, because patients have been unable to access primary care, an initially non-serious illness becomes acute and requires attention in hospital.
I welcome the Government’s commitment to address the issue and the on-going work to agree a new GP contract from 2017, because it is clear that action is required. It is really important that we listen to and work with the profession to ensure that we get the change right. The Royal College of General Practitioners, the BMA and the Royal College of Emergency Medicine have been working hard on engaging with Government and parliamentarians.
Martin McKechnie, the vice president of the Royal College of Emergency Medicine, asks us to invest in GP training and retention in order to ensure that fewer patients head to accident and emergency departments for care. He credits the Government with increasing consultant numbers and asks that even more is done so that every hospital in Scotland can provide a 365-days-a-year service. He highlights the loss of graduate emergency registrars, a lot of them to Australia, and the RCGP tells us that many qualified GPs are leaving to practise abroad, and that insufficient numbers are undertaking GP specialty training. The RCGP has told us that GPs want to look after their patients and not the books. They want a more appropriate replacement for the QOF to evolve—one that works for patients and GPs. Further, the BMA asks us to recruit, train and value doctors and wants all parties in this chamber to work with it to support Scottish general practice.
We need to make being a GP in Scotland a really attractive career that attracts people in the way that it did before and to which GPs who take a break will return. I hope that the current work on agreeing the new contract will take those factors and more into account.
GP practices have worked on a small-business model since the 1960s. That might be the preference of many practices, but more and more GPs do not want to be partners and do not want to work full time; they might prefer to be employed by the practice or by the NHS. New models and changing contracts could make being a GP a more attractive career to a greater number of people.
Working with and listening to health professionals in this country will give us the possibility of developing and delivering a healthcare model that will better support those working in the NHS, helping them to keep our growing and ageing population well. Sir Lewis Ritchie’s out-of-hours model makes a lot of sense and fully involves a range of allied health professionals in primary care in a transformative way that will have positive impacts on in-hours care.
It is important that, foremost in all debates on health, we focus on the need for a preventative approach. In that regard, the BMA’s suggestion of providing a portion of fruit or vegetables to all primary school children in Scotland every day is well worth looking at, as is the living wage.