Meeting of the Parliament 10 November 2022
Primary care is the backbone of the NHS, and it is at breaking point. With increasing demands and limited capacity, it is in a perpetual extreme winter. The expectations that are being placed on GPs and their practices are causing burn-out and demoralisation and are, ultimately, forcing doctors to leave a profession that they love.
This is a typical Monday in a GP surgery. I am in for 8 am and start with paperwork—and, believe me, there is a lot to plough through. In the background, I hear the volley of ringing phones and our fantastic surgery staff handling call after call—and, indeed, dealing with a lot of abuse, too. They are really under the cosh.
By about 8.30, I have started to see patients. Some on a long waiting list for surgery will be struggling in pain, while others will have chronic conditions like chronic obstructive pulmonary disease or diabetes. There might be a happy mum-to-be, but there might also be patients who need to be seen by a specialist in hospital immediately. GPs cannot afford to miss a sign that someone is going into crisis.
By lunch, I have had 30 patient contacts. After stretching my legs at a house call and catching some fresh air, I go back to the surgery, where, over the afternoon, I will usually have another 25 patient contacts. During the day, I will be checking blood results from the laboratory and overseeing other clinical staff including advanced nurse practitioners, allied health professionals and paramedics. There will be questions from pharmacists—and what about repeat prescriptions? In Scotland, all practices—or at least the vast majority—have an online request system, but unfortunately each and every prescription must be wet-signed. In other words, we must sign prescriptions with a pen, and I do about 300 in a day.
That is a typical day for GPs across our country, so alternative pathways to primary care provide a vital way of alleviating the burden on overstretched GPs and other healthcare professionals. I appreciate that we are focusing on primary care pathways today, but we should be mindful of the wider NHS that GP practices are part of. Primary care cannot and does not function in isolation.
The British Medical Association Scotland has made it clear that the NHS is struggling under workload pressures and workforce issues. Pressures that doctors were used to dealing with in the winter are now affecting the NHS all year round, with staff now feeling as if they are working in a perpetual winter. As for general staff welfare, we need only consider surveys by the Medical and Dental Defence Union of Scotland. According to those surveys, 78 per cent of junior doctors in Scotland have experienced burn-out; 42 per cent say that a lack of access to nutritious food at work is a contributing factor; and 66 per cent report that they fear patient safety is at risk when hungry and tired. That is really worrying, and it is symptomatic of a management culture that does not prioritise front-line healthcare workers.
Dr Andrew Buist, chair of the BMA’s Scottish GP committee, has said:
“Failure to support general practice now could have dire consequences for patient care across the country this winter.”
He goes on to say that the Scottish Government
“pledged a £30 million sustainability support package for general practice, to be paid in two instalments.”
The trouble is that, last month, the BMA was informed that the second £15 million “was being cut” to £10 million. Dr Buist says:
“That announcement came shortly after more than £50 million intended to support the development of health board teams within GP practices—-such as pharmacists, nurses, physiotherapists and mental health specialists—was withdrawn.”
As for alternative pathways to primary care, we need to be frank and ask whether we are doing enough to provide and communicate alternatives to GPs as the first port of call. Let us consider high street optometrists, who are well equipped with highly-specialised equipment to monitor and treat eye issues. However, a lack of funding is a barrier to these high street specialists acting as an alternative pathway. According to Optometry Scotland, the sector would, with additional funding, be able to offer an enhanced range of services and thereby ease pressures not just on general practice but on secondary care.
Then there are link workers. Glasgow health and social care partnership has said that the recruitment of community link workers is stymied by a lack of funding.
On social prescribing, Alison Leitch of the Scottish Social Prescribing Network has said that a lack of leadership in Scotland is holding social prescribing back. She said:
“no one, sadly, is taking charge of social prescribing. That is where Scotland falls down. In England, there is a head of social prescribing in the NHS; in Wales, that is dealt with through public health.”—[Official Report, Health, Social Care and Sport Committee, 22 March 2022; c 9.]
The Scottish Government is aware of that problem.
On dentistry, by cutting the funding multiplier that is paid to dentists, the cabinet secretary is presiding over the death of NHS dentistry in Scotland. In August, the BBC reported that, in Scotland, 82 per cent of NHS dental practices are now not accepting any new adult patients and that 79 per cent are not accepting new child patients.
On communication, the Scottish Government talks about promoting alternative pathways such as going directly to opticians, physiotherapists, podiatrists and pharmacists for support and even treatment, but the public are largely in the dark about that. According to The Royal Pharmaceutical Society, there is a lack of public awareness among patients about using alternative pathways. There has been no meaningful national publicity around changes to the GP practice teams and the roles of different professionals within the team. People become aware of that only when they are directed to the pharmacist, for example, as part of routine contact.
The Scottish Conservatives want to work constructively on alternative pathways and get them flowing. We would invest 11 per cent of the overall NHS budget in general practice by the end of this parliamentary session. We would also increase the number of training places to deliver the 800 more GPs by 2027 that we were promised, and we would ensure that all GPs are supported by a multidisciplinary team.