GPs have voted in favour of a controversial proposal that would see them funded to employ their own practice staff directly after complaining that health boards’ HR departments were taking months to fill vacancies.
The vote reverses a key plank of the new GP contract which was supposed to ease pressure on family doctors by transferring responsibility for employing support staff back to the NHS so that they did not have to deal with recruitment or paying salaries, pensions and national insurance from practice funds.
Dr Andrew Buist, the chair of BMA Scotland’s GP committee urged members to vote against the motion at the profession’s annual conference in Clydebank yesterday, arguing that it “goes against the ethos” of their 2018 contract.
However, it was passed by a narrow majority after doctors in the room argued that they should be given the choice to request cash from their local Health and Social Care Partnerships (HSCPs) in order to fill posts directly, if they preferred.
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The new contract, introduced in April 2018, set out a vision for GPs in Scotland to become the ‘expert medical generalists’ in their practices, leading an expanded team that would include pharmacists, physiotherapists, advanced nurse practitioners, mental health specialists, and even social workers and debt counsellors in areas where they are most needed.
The aim was to reduce GP workload, but the creation of these multi-disciplinary teams hinged on HSCPs funding the posts and recruiting the staff to fill them.
Traditionally it has been up to GP partners to decide how to staff their practices, but that also came with the liabilities of being an employer.
However, the motion, brought to conference by Lothian GP Dr Iain Morrison, called on the Scottish Government and BMA leaders to “free up funding to be given directly to general practices and enable them to employ the healthcare teams required (where practices request this autonomy)”.
Dr Morrison said: “Board HR departments are taking months to draw up adverts and even longer to make an appointment.
“GPs are seeing people placed in their practices that they don’t know, and are powerless to intervene when better offers are made to tempt away their best staff.
“Many practices may not want the responsibility for recruitment, by when HR departments are taking ages to do the job we say give practices the choice.
“By all means ringfence the funds and let HSCPs see how the money is spent. But let people who are used to getting things done get on with it.”
One GP, also from Lothian, complained that her practice had lost an advanced nurse practitioner (ANP) “due to tardy recruitment practices”.
“It’s often taking months for these people to come through,” she said.
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Another GP, from South Queensferry said his practice had employed a Band 8 APN but the HSCP would only pay for APNs up to Band 7, while another GP expressed frustration that it was up to the HSCPs, not practices, to authorise part-time hours or annual leave for support staff, which did not always fit with the practice’s needs.
Opponents said it would be foolish to transfer the financial burden and risk of being an employer back to GPs, however, at a time when the practice team is expanding.
One insisted that GPs “do not want to take on the risk of employing greater and greater numbers of support staff”.
Fears were also raised that the move would widen the gap between GP practices who had the resources to devote to recruitment and those which did not, and would have to rely on HSCPs.
Dr Buist said: “There’s no doubt that HR practices need to improve. They are far too slow in the HSCPs.
“The idea of Phase 1 was to reduce GP workload. I accept that’s not happening because not enough staff are in place, but I think this motion is premature and it does let [HSCPs] off the hook.”
Earlier in the day, GPs warned the conference that Scotland did not have enough pharmacists and physiotherapists available to ensure that Phase 1 of the contract - which covers the roll-out of the new multi-disciplinary teams - would be completed by the March 2021 deadline.
There were also calls for the Scottish Government to remind HSCPs that they have an obligation to implement the GP contract “regardless of financial pressures” by hiring practice support staff and providing vaccination programmes previously done by GPs.
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