Key aims of Scottish GP contract 'will not be met' by April 2021 deadline

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Dr Andrew Buist, chair of the Scottish General Practice Committee, said "these temporary measures are absolutely not seen as long-term solutions".

It comes as GPs - who are holding their annual Scottish conference online today - lodged motions on behalf of members in Glasgow, Lothian, Ayrshire and Arran, Grampian, and Forth Valley noting their "deep disappointment" at the "slow progress" towards creating multi-disciplinary teams (MDTs).

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This vision was key to the landmark 2018 Scottish GP contract - the first negotiated independently of the rest of the UK - because it promised to alleviate unnecessary GP workload and reduce the financial burden on practices by requiring HSCPs to employ support staff on behalf of practices.

Under this model, GPs would become the 'expert medical generalists' able to devote more time to complex patients, while those whose care could be better managed by another professional could see them instead without having to be referred onto a hospital waiting list.

It was also seen as vital to tackling a recruitment and retention crisis by making general practice a more attractive career.

Physiotherapists, pharmacists, and mental health workers were to be embedded within practices, while HSCPs delivered the childhood immunisations and established community treatment hubs where patients would go, for example, to give blood samples for tests.

The plans were backed by £250m paid to HSCPs, but frontline medics who spoke to the Herald said it was unclear what had happened to the money.

One well-placed source said: "For approximately 1000 practices in Scotland, you’re talking £250,000 per practice - a huge amount of money - and I don’t know where that’s all gone.

"My main feeling is that the investment and the idea are welcome, but I don’t think it’s been utilised efficiently."

They added that the MDT vision was “way off target even prior to Covid” and fundamentally flawed by the lack of available workforce.

They said: “We simply don’t have pharmacists. There’s been some tension now between community pharmacy and general practice because there’s been some community pharmacists pulled away from community pharmacy to come and work with us, and they’re now having problems recruiting. You can’t knit pharmacists.

“We were led to expect that by April 2021, all our prescriptions would be handled by someone else, that the more minor illnesses would be seen by someone else, and that meant that our time would be freed up for example to focus on the elderly patient with five separate diseases, who’s on multiple medications and so on.

"You really need the time and space to concentrate on that properly and that’s a good aspiration, but the reality is that I don’t think our workload has changed much at all."

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Dr Iain Kennedy, an Inverness GP and secretary for the Highland Local Medical Committee, said the majority of practices in his region had benefitted from pharmacist input, with some also getting in-house physiotherapists - although he cautioned that hospital waiting times are "in many ways simply being transferred into practices".

"Mental health has been a huge disappointment," added Dr Kennedy.

"Not one practice has had a mental health worker as a result of the contract.

"There are simply not enough community psychiatric nurses around and we think the psychiatric services felt worried that they would lost staff to general practices. That has been a complete failure."

He said he believed some of Highland's share of the £250m was still unspent, and called for it to be devolved to practices instead.

“There has to be an acceptance that the best way to deliver care to patients is by resourcing practices,” said Dr Kennedy.

Glasgow HSCP, which received around £18.6 million - of which £2.2m was spent on its criticised winter flu vaccine rollout - is understood to have run out of money.

In a statement NHS Greater Glasgow and Clyde said there has been "substantial progress" across its six partnership areas - which encompass 234 GP practices - including recruitment of 335 support staff for various roles with plans to recruit a further 375 staff during 2021/22.

It said vaccinations for children and pregnant women have now been transferred from GPs to HSCPs, that all practices "have access to" pharmacy support, and "many practices" can access additional support from advance nurse practitioners, physiotherapists, and mental health.

Dr Anne Mullin, chair of the Deep End project, which represents 100 practices in Scotland's most deprived areas, was among those who voted against the 2018 contract.

She said: "I really didn’t think it was deliverable in the form presented. We knew there wasn’t the staff out there to redistribute around general practice."

The GPs who spoke to the Herald agreed that HSCPs, rather than practices, had been given the cash due to fears that a minority of doctors would use the funding to boost their own earnings instead of improving patient services.

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Although publicly funded, GP practices operate as independent contractors and their spending is not audited.

However, Dr Mullin suggested funding could have been done on a cluster basis like the acclaimed Govan SHIP (Social and Health Integration Project), which was directly funded by the Scottish Government.

It enabled four GP practices to integrate a team that included social workers, mental health and district nurses, a pharmacist and physiotherapist, while freeing up GPs for extended consultations.

"The project held the budget, but we had to account for every penny we spent," said Dr Mullin.

SHIP was seen as a blueprint for the MDT model, but funding was discontinued after three years in December 2018 - to the dismay of Deep End GPs.

Dr Buist stressed that the shift to MDTs "remain a key commitment" and that there are "many examples of excellent redesign of services in some areas".

"But it is also clear that there is still some way to go before all that was promised as part of the 2018 contract will be in place," he added.

"There are many reasons for this – from issues with staffing, premises and management support and of course, so much has been put on hold this year due to Covid."

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A spokeswoman for the Scottish Government said they "share the disappointment" of GPs but remain "absolutely committed to the contract offer", adding that the pandemic had impacted on recruitment.

She said £155m would be invested toward recruiting multidisciplinary teams in 2021/22.

She said: "We have, with the BMA, jointly agreed on the next steps for the multidisciplinary team commitments made in the 2018 contract offer.

"Boards will have a contractual responsibility to provide multi-disciplinary support from April 2022, and those practices who continue to deliver services which are no longer their responsibility will receive transitionary support until these are transferred.”