A RECORD number of GP practices in Scotland are now being run directly by health boards amid a spiralling crisis in recruitment and retention of family doctors.

Figures obtained by the Herald reveal that 52 surgeries are being operated by health boards instead of GP partners, equivalent to around one in 20 across Scotland.

The number is up by nearly 25 per cent in two years with a previous survey in July 2015 finding that 42 GP practices were under direct health board control.

The measure was originally designed to ensure primary care could be provided in remote and rural areas or to provide a specialist care such as a GP practice for homeless people.

Most surgeries are owned and operated as partnerships between GPs, who are employed by the NHS as independent contractors paid to deliver a range of mandatory and optional patient services set out by the Government in the General Medical Services (GMS) contract.

However, with fewer junior doctors choosing to specialise in general practice and pension changes capping NHS doctors retirement pots at £1 million being blamed for spurring many GPs into early retirement, an increasing number of practices have struggled to fill vacancies and become unsustainable - even in urban areas.

In the Lothian region, 11 practices are now being run by the health board, with three in Forth Valley, two in Fife, two in Greater Glasgow and Clyde and three in Tayside - including two in Dundee.

In addition, there are 15 in Highland, seven in Grampian, five in Shetland, one in Orkney and one in Dumfries and Galloway. Only Lanarkshire, Borders and the Western Isles have none.

In Ayrshire and Arran, one practice is currently under NHS control but a second, Glencairn Medical Practice, is due to be taken over from August after the partners resigned the GMS contract, citing "impossible funding" and "UK-wide staffing and workload pressures".

Typically, a health board will hire salaried GPs instead, but in some cases practices end up closing altogether with knock-on effect for neighbouring GPs.

Dr Alan McDevitt, chair of BMA Scotland's GP Committee, said: "The root of it is there are not enough GPs to keep the jobs going. In practices where they can't recruit, it eventually gets to a stage where the workload levels become unsafe and it's not safe to carry on with two GPs for example where before you had four or five. GPs are already maxed out when everybody is there so it gets to a stage where you just can't keep running the practice.

"There is a mechanism for the health boards to take over the practice but that doesn't solve all the problems. There are parts of Scotland where even when they've taken it over they couldn't find anyone to run it so they've had to dissolve it and what happens then is you get a domino effect on the other practices nearby who are struggling, because if they suddenly get a new thousand patients they haven't got the staff to see them. That's what's happened in Edinburgh where a lot of the practices have got closed lists now because it's the only way the ones nearby can survive."

Across Lothian, around quarter of surgeries now have closed lists. A BMA survey previously revealed that one in three GPs in Scotland is considering retiring in the next five years, while only around 15 per cent of medical students indicate an interest in entering general practice compared to the 50 per cent required.

Dr Miles Mack, Chair of RCGP Scotland, said: “These figures clearly show that the present situation of general practice requires immediate attention. Patients across Scotland will be concerned. Funding commitments need to be followed up with a visible demonstration of new resources to maintain practice sustainability."

Mr Colin Angus, Chair of Patient Partnership in Practice, added: “This situation will exacerbate already strained access to facilities for patients, especially while demand for GP care grows, the population ages and people find themselves in greater need.”

Health Secretary Shona Robison said: “Earlier this year I announced an additional £71.6 million in 2017 for direct support of general practice, helping transform the way services are delivered in the community. We are committed to reinvigorating general practice so we can attract more people into it, make things better for people already working there, and ensure it has a bright future.

“NHS Boards can directly run GP practices for a variety of reasons not necessarily related to a practice being in difficulty, for example to tailor services to local needs.

“Boards have historically either had involvement in the running of, or provided some degree of support to practices, as part of their responsibility to ensure that everyone in Scotland has access to GP services.”