The RICHEST patients should be charged a flat fee for GP visits “in a bid to reduce demand” on overburdened practices, a group of family doctors has said.
The suggestion has been put forward by the Grampian Local Medical Committee (LMC) as doctors from across Scotland prepare to hold their first in-person conference since the pandemic in Clydebank today.
It comes amid warnings that general practice in Scotland is at a “breaking point” with figures from a workforce survey estimating the number of GPs has fallen in real terms from 3,613 in 2019 to 3,494. in 2022 at a time when the number of patients registered with practices has decreased. rose 1.8 percent.
Results from the BMA Scotland well-being survey, shared exclusively with the Herald ahead of today’s conference, also found that 75 per cent of responding GPs are more likely to leave the profession, take early retirement or reduce their hours over the next year as a result. of “excessive workload”.
Dr Andrew Buist, Chairman of the BMA’s Scottish General Practitioners’ Committee (SGPC), will today convene a national conversation on the future of the NHS, warning that without urgent change “we risk sleepwalking into the death of general practice as we know it”.
Among the options put forward for debate are proposals by Grampian LMC doctors calling on the Scottish Government and the SGPC to “consider the introduction of limited co-payments, excluding patients who are unable to pay, as a way of reducing demand on general practice and not subsidize current funding streams”.
Co-pays are most commonly found in insurance-based healthcare systems where a patient is required to pay a certain amount, for example, at each visit to a doctor.
Higher-income patients in Ireland, where there is no NHS, pay between €45-65 per GP visit (£39-56) and there is some evidence that the model reduces unnecessary demand.
In the UK, where access to GPs is universally free, appointment uptake tends to be disproportionately higher among wealthier patients, helping to exacerbate health inequalities.
The proposals are the latest to open the door to a two-tier NHS, with controversial leaked minutes revealing some health board directors suggested asking wealthier patients to pay for operations to help subsidize the troubled service. of liquidity.
First Minister Nicola Sturgeon has ruled out the move, and the Scottish government is likely to veto similar suggestions for general practice.
However, there is growing anger among the profession that promised support staff have not materialized, with fears that rising energy costs make some GP surgeries “financially unfeasible”.
Just 18% of GPs who responded to BMA Scotland’s wellbeing survey said they would recommend a career in general medicine, up from 28% a year ago.
Dr Buist, a GP for 30 years, said he is now among those reluctant to recommend general practice, saying “the sheer volume of workload exceeding our capacity has made the job unbearable at times “.
He said GPs require “the support of a full multidisciplinary team”, including pharmacists, physiotherapists, mental health workers and specialist nurses, to reduce the workload on GPs and allow doctors to spend more time with the most complex patients.
A key point of the 2018 Scottish GP contract provided for the creation of these multi-disciplinary teams (MDTs) integrated or directly available to all practices in Scotland, but employed by the local board of health.
However, almost five years of MDT implementation have fallen short due to a shortage of professionals needed across the NHS.
Dr Buist said: “Without this change, we risk sleepwalking to the death of general practice as we know it.
“We can make general practice a great career choice again – at the heart of this must be making working as a GP not only bearable and manageable, but really putting the joy and satisfaction back into work.”
“Once again we call for a national conversation about the future of our NHS – honest and open communication involving the public, politicians from all parties, key stakeholders, doctors and other health workers.
“What should we expect from our NHS, how are we going to finance it properly and how can we deliver it?”
Ahead of today’s conference, doctors at Lothian LMC said the independent contractor model, a cornerstone of general practice since the inception of the NHS, “is no longer fit for purpose”.
They also warn of a “GP retention emergency”, adding that the “mismatch between the GP workforce and the current workload… poses a significant risk of harm to all”.
It comes as figures this week showed that GP numbers, counted as full-time equivalents (WTEs), have dropped by 119 since 2019.
In 2017, the Scottish Government committed to increasing the number of GPs in Scotland by 800 by 2027, but only in terms of staff, which does not take into account a growing trend towards part-time work.
GPs attending today’s conference have called on the Scottish government to provide clarity on “the number of patient-facing sessions and full-time equivalents for the additional 800 GPs proposed for Scotland”.
Fife LMC physicians also warn that “increasing cost of living and energy bills will make practices financially unviable” for physician partners who own and run practices, with “potentially damaging consequences for patient care and a further destabilization of the NHS”.
Meanwhile, Dumfries and Galloway LMC cautioned that the move to an MDT model employed by the board of health “encourages the development of multi-site practices” in which a small number of GPs span across multiple surgeries that belong to the same group of general practitioners, with the majority of staffing made up of health-related professions.
This “risks the demise of longitudinal family practice in favor of transactional practice that is not in the best interests of patients or the interests of the profession,” they add.
Glasgow LMC doctors also say the practices are facing “increasing lawsuits after patients have undergone surgery in the private sector, both in the UK and abroad” requiring aftercare by the NHS, and they added that it “deplores the lack of specialized follow-up care.” that is being provided to these patients.
A Scottish Government spokeswoman said: “We are immensely grateful to GPs and GP practice staff across the country who do amazing work in a very challenging period. We are absolutely committed to ensuring that being a GP remains an attractive career option with a manageable workload.
“Despite the pandemic, we have recruited 3,220 full-time equivalent healthcare professionals to support GPs, backed by an investment commitment of over £500m.
“We have a record number of GPs working in Scotland and are committed to an additional 800 GPs by the end of 2027.”