THE number of GP practices in Greater Glasgow and Clyde which have closed their lists to new patients is at a record level "and climbing" as doctors struggle to manage spiralling workloads.

In some cases practices are also dropping services such as joint injections and reducing the areas they cover in bid to stem demand.

Dr Patricia Moultrie, a medical director for the Glasgow local medical committee (LMC) - the body which represents GPs in negotiations with the health board - said family doctors are increasingly concerned that pressures on the system mean they might never get back to focusing on the frail elderly and multi-morbid patients who can benefit most from primary care.

 

 

Dr Moultrie said: "It's fine to move to these sorts of emergency provisions for a period of time but our worry now is that this has been going on for so long, when what we really want to get back to is providing that long-term care and prevention like the things we do to reduce cardiovascular risk, for example.

"It's really important that we do get back to that. It can't all be about avoiding admission that day - we need to be thinking about avoiding the harm that would be coming to patients in six or 12 months' time."

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The Glasgow LMC, which covers the largest health board region in Scotland, has adopted a tracker system which monitors the "heat" in general practice on various key measures.

This includes the number of practices with closed lists - meaning they are not accepting any new patients.

Pre-pandemic, Dr Moultrie said there were typically one or two practices in this situation, but this has "steadily increased" over the past two years in is now in the teens.

She said: "That's at much higher figures than we've ever seen before, and it's climbing.

"Another thing we track is the number of practices which are amending their catchment areas - the geographical space that they'll take patients from.

"It's very difficult for practices to control their workload but one of the ways they can do that is to consider not having such far flung patients.

"To be clear, that doesn't mean removing patients outwith the new practice boundary - that doesn't happen - but it means practices don't take new patients from outwith the boundaries.

"The board don't normally get a lot of applications for that but that has increased significantly recently, so again it's a sign of the pressure people are under."

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In the GGC region, general practice has retained and refined a so-called escalation framework first implemented nationally during the pandemic.

This enables practices to temporarily suspend non-essential activities - such as minor surgery or joint injections for arthritis patients - and in some cases focus solely on urgent and emergency consultations.

“There are different levels of escalation, but there are no practices that are not escalated in GGC just now," said Dr Moultrie.

"All practices are in some level of escalation and some – not a big number, but a persistent few - are at higher levels that others."

This was an important way of drawing health board leaders' attention to the fact that all practices are "facing significant challenge meeting patient demand", said Dr Moultrie.

She added: "None of these things are easy for practices to do because we know patients need these services and this particularly becomes a problem the longer this situation lasts.

"There's really nothing that practices can stop doing that doesn't have an impact on patients, and GPs are concerned about that."

Earlier this month GPs in Ayrshire and Arran were also told to step down routine activities in order to prioritise urgent and palliative care, screening programmes, and out of hours services amid "overwhelming demand".

Health board bosses blamed a combination of staff absences, high flu and Covid levels, and soaring hospital occupancy resulting in "high volumes of frail patients" requiring complex care to recover in the community.

There are signs that the strain on hospitals has eased slightly, with respiratory viruses in decline and a reduction in the number of patients spending over 12 hours in A&E.

However, a total of 6,362 people spent over 24 hours in emergency departments during 2022 - 390 of them more than two days - compared to just 48 in 2019.

This has led to an increased focus on whether primary care could do more to keep people away from hospitals - for example through weekend opening.

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GP practices in NHS Lanarkshire began opening on Saturdays during the recent winter pressures and the Scottish Government has encouraged other health boards to consider the move.

Dr Moultrie said she personally does not like the framing of general practice as a “gatekeeper” whose role it is to protect hospitals and avoid admissions.

She said: “It should be about appropriate use of hospital facilities, appropriate admissions.

"We don't go into work every day with a mindset of 'I have to protect hospitals' - we're aiming to try to meet the patients' needs, provide personalised quality generalist healthcare - and part of that is not making an ask of secondary care that's not appropriate and necessary."

Figures show that the GP workforce in Scotland has shrunk by 6.5 per cent in real terms since 2013, while the number of patients over 65 - who require the most care - has increased by 20%.

At the same time, a dwindling proportion of GPs are willing to be partners - the doctors who own practices - casting doubt on the sustainability of general practice in its current form.

Dr Moultrie said: “We're in conversation - with a small number I'm glad to say - of GP partners who are considering whether or not to resign their contract, particularly where people have been trying to recruit for a long time and haven't been able to.

"It's a common conversation to have with GP partners who say ‘this has just got beyond the point where I can sustain this’.

"People can see all the benefits [of the partnership model] but it's just coming at too high a personal cost.

"That's a problem for retention but also for recruitment because the publicity around how hard things are in general practice is bound to have an effect on young doctors qualifying in their career choice."

A spokesman for NHS GGC said: “NHSGGC works closely with our GP community to provide support and guidance in relation to operational issues and care delivery.

“We have an agreed escalation process in place for issues such as closed lists and we will continue to work with individual GPs to ensure that when such decisions are taken, it is done in the best interests of our patients and healthcare practitioners