Colin Smyth MSP on the GP Crisis

I spoke on Tuesday 26th September about the growing GP crisis in our country but particularly the problems in Ayrshire. The Scottish Government cut training places and now we are seeing its impact. Read my full speech below or watch here:

https://youtu.be/UWd3rhdzBEw?t=19m30s

I thank Jamie Greene for lodging his motion, which has provided an opportunity to debate the GP crisis both in Ayrshire and across Scotland.

GP practices are at the heart of not only our NHS, but our local communities. As many as 90 per cent of patient interactions are with primary care, and for many, GPs are the vital first point of contact with our healthcare system. However, a decade of Scottish Government cuts to the share of NHS spending for GP services and to training places has left that point of contact at breaking point in far too many of our communities.

It is estimated that in Scotland there are 171 GP vacancies, 73 per cent of which have been open for more than six months. Right now, a practice is being forced to close almost every month, with a total of 14 practices closing since 2016. In many communities, the situation is stark. Jamie Greene has rightly highlighted the particular problems facing North Ayrshire and NHS Lothian, but in my home region of Dumfries and Galloway, the number of GPs has fallen from 134 in 2012 to 118 in 2016. Villages such as Wanlockhead have lost their outreach surgery because of a shortage of GPs in the Moffat area who provided that service, and admissions to Thornhill hospital were closed because the local GP practice providing the cover at the hospital could not fill its vacancies.

That practice is not alone, as 42 per cent of practices in the region have a vacancy—that is 16 posts—largely unfilled for six months. NHS Dumfries and Galloway has had to take over the running of two GP practices, and that number is set to rise. The problem is set to get worse, because 26 GPs in Dumfries and Galloway are aged over 55 and are, therefore, likely to retire within the next five years. In addition, as a result of Brexit, applications from the European Union for health posts in the region have all but dried up. It is, frankly, a ticking time bomb—a crisis that is happening on the watch of this Government, and a crisis that the Government should have seen coming.

In 2008, Audit Scotland called on the Scottish Government to collect comprehensive data on GP and GP practice staff numbers to support proper workforce planning. In 2014, the Royal College of General Practitioners warned that the underfunding of GPs was putting patients at risk; yet, by 2015-16, the proportion of NHS spending that was allocated to GP services was at an all-time low. After 10 years of ineffective action and countless ignored warnings, tackling the GP crisis in the short term will not be easy, not least because the current shortage is adding to the workload of those GPs who remain, impacting further on recruitment.

It is also impacting on patient care. A recent BMA survey revealed that 91 per cent of responding GPs said they felt that the quality of care that their patients receive has been negatively affected as a result of their growing workload. Urgent action is needed. Professional bodies across the primary care sector support a move towards a multidisciplinary approach in GP practices to take pressure off GPs, provided that the crucial role of the GP is protected. Such moves are simply not happening quickly enough, and Audit Scotland has rightly called on the Scottish Government to

“provide strong leadership by providing a clear framework to guide local development”.

There are clear examples of successful models such as the Govan SHIP project, which Alison Johnstone mentioned, which show that, if general practice is properly funded, major benefits can be achieved for patients, for GPs’ workload and for recruitment and retention.

Funding is the key, whether that is for a proper, high-profile recruitment campaign that reaches beyond the EU or an increase in the share of funding for general practice, which fell from 9.27 per cent in 2006-07 to just 7.2 per cent in 2015-16. It would be helpful if the minister could tell members, in summing up, whether the Government intends to ensure that 11 per cent of the total NHS budget will go to general practice to deliver improvements in patient services, reduce the strain on our GPs and help to make the profession an attractive choice of career for medical students again. Without fairer funding, there is no doubt that the crisis that we face in GP practices will continue.

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