A tricky Christmas contract for GPs

Doctor's stethoscope - credit Lidor

Christmas can be a difficult time for the self-employed amid disruptions to normal timetables.

This festive season will be especially tricky for family doctors in Scotland, who on top of all the usual pressures, will have just one month to respond to the proposals for a new funding model.

The new contract, thrashed out in lengthy talks between the BMA and the Scottish Government, is designed to address the increasing pressures on GPs and the health and social care system in general, which has seen longer waiting times and fewer doctors attracted to the profession.

It promises a radical redesign of the system, including a minimum income of £80k, longer consultations with more complex patients and a workload shared with primary care NHS partners without a loss of funding.

It seems odd, then, that they are being consulted on the proposals during their busiest month of the year, where winter ailments strike their ageing patients and supporting services enter holiday mode.

No matter what the doctors on the front line make of the proposals, the outcome of the survey will be discussed at a meeting of the BMA’s Scottish GP committee in January, which will then make a final decision on whether to accept the contract or not.

As a trade union, the BMA might have been expected to have opened that decision directly to members. What about the much fought for right to collective bargaining?

Furthermore, the Scottish Government says the public will have no direct involvement in shaping the new model, rather that it has been based on feedback during the ‘Healthier Scotland’ consultation – that patients say they want better access to GPs “when they really need them”.

One in three GPs is approaching retirement, while the GP Recruitment and Retention Programme has attracted just 18 people in two years.

While the current crop of GPs will no doubt welcome the additional funds and reduced business risk on properties associated with the new contract, does it have enough to attract new people to the profession?

Can it prevent heads being turned by the significant financial returns and acclaim of consultant surgery when young medics are considering options in medical school?

GPs fiercely defend their autonomy. It is why patient records are not shared in full between services. GPs say it gives them an intimacy with their patients built on a lifetime of trust.

GP Euan Paterson described it as “the art of medicine” to Holyrood this year, explaining why he had taken early retirement.

“If we lose the relationship, I think we lose it all,” he warned, pointing to the role community doctors have played in secular society.

What the new contract does not represent is a significant pay rise, and the much-coveted autonomy of the profession seems set to be weakened in favour of some guarantees over workload.

Instead, the GP will be a more integrated part of the NHS, leading a multidisciplinary primary care team.

Unlike the direction of travel in England and Northern Ireland, the new Scottish GP model follows a pattern which has seen more and more practices taken under health board control. By 2043, it suggests, all premises could be in public ownership.

Could GPs become regular salaried employees of the NHS by then, with patient records accessible by the whole system?

Meanwhile, if there is a concern that many of the current generation of GPs might resist such a shift in direction, perhaps the hope is they will be too busy over Christmas to read between the lines.