GP shake-up plan to give more time with patients

Proposals are being considered which may mean family doctors in Scotland no longer employ their own practice staff and pass on jobs such as ensuring patients with long term conditions are regularly monitored.

The planned shake-up by Scottish ministers and the British Medical Association comes as GP surgeries face a recruitment crisis - with a survey earlier this year finding 17 per cent are short of at least one doctor.

It would fundamentally change a key element of their current contract where practices receive points, and funding, for delivering a range of goals such as keeping blood pressure down in high risk patients, reviewing asthma sufferers and offering smokers support to quit.

It is envisaged that the new health and social care boards which are taking over responsibility for running community services will assume responsibility for delivering such goals.

Dr Alan McDevitt, chair of the British Medical Association's Scottish GP Committee (SGPC) and a central player in the negotiations, said: "The reason we are doing this is all about making sure we free-up GP time not just for more appointments but also because the complex care we have to do for elderly patients means 10 minute appointments are not long enough. We have to start preparing for the future (with more elderly patients). We need to make sure we can give more time to older patients with complex conditions."

The Glasgow GP admitted the re-organisation would not be easy, saying: "We are in a difficult financial time. We do not have enough GPs and there are a lot of things that could go wrong."

However, he said the BMA and the Scottish Government have been travelling the country gathering views on how to address the issues in a way which works for patients and doctors and attracts young medics back into the profession.

Dr McDevitt said: "One of the concerns that frequently comes up is this could damage continuity of care. If it does we have failed. There are all sorts of challenges, but I think it is about getting a general practice that is right for patients and right for doctors."

He strongly denied it would lead to some jobs, like that of practice managers and receptionists, being centralised. He said: "We are absolutely clear that this is about sustaining local practices and bringing staff in to give people services back closer to their homes and relationship based care, but in the modern world."

In some areas, health boards have been forced to step in and take over the running of surgeries which collapsed because vacancies for doctors could not be filled.

Shona Robison, Scottish Health Secretary, addressed an audience of GPs in Edinburgh this week at an event organised by the medical magazine Pulse. She called the ideas on the table "compelling".

In an article in its online edition, she describes the proposals as "quite different" to the current set up. She also said: "We have had this discussion... about moving away from the kind of gatekeeper role of general practice to a model of primary care being a wider health team, with GPs being the clinical experts.

"That's something that I know the BMA and the Royal College of General Practitioners have said is a more sustainable model."

The last time GPs signed a radically different contract was in 2004 when they gave up responsibility for looking after patients outside surgery hours. NHS 24 took over answering calls to GP surgeries during evenings and weekends and hit crisis as it could not cope with demand.

The new proposals are part of a new contract for Scottish GPs due to be implemented in 2017. They are being discussed at a BMA conference in London this week and consultation is expected to continue into the summer.

A government spokesman said: "We're working closely with the SGPC of the BMA and others, including the RCGP, to discuss ideas for the future of general practice in Scotland. The Scottish Government remains open to new ideas from all key stakeholders." He added that the process was at an early stage.