A LEADING GP has warned that Scotland is "sleepwalking into a two-tier health service".

Dr Andrew Buist, chair of the BMA's Scottish GP committee, said the situation facing general practice in Scotland is "dire and only going to get worse" as he hit out at the failure to deliver on the landmark Scottish GP contract nearly five years on.

The criticisms come after a special investigation by the Ferret and the Herald laid bare the pressures facing general practice, including a rise in private GP clinics charging up to £250 for a 15-minute consultation and some family doctors solely responsible for more than 4000 patients.

Some patients described demand for appointments becoming so acute that they have had to make hundreds of phonecalls just to get through to their GP surgery, only to be told that all slots had been filled.

Dr Buist drew comparisons between the current crisis engulfing dentistry, where the majority of practices have closed their lists to new NHS patients and in many cases previously basic procedures such as teeth cleaning or denture repairs are only available on a private basis.

READ MORE: Watchdog warns 800 extra GP target for Scotland 'not on track'

Writing in a blog for BMA Scotland, shared with the Herald, Dr Buist said that Scotland is "sleepwalking towards a two-tier health service...that will see a continued loss of GPs, with practice contracts given back to their health board, the subsequent closure of some practices, and an emergence of under-doctored areas where patients have difficulty registering with a GP".

He added: "This in turn will lead to increased levels of health inequalities, and create opportunities for private GP services, just look at our big cities, it is happening there already.

"If you really doubt this, just look at dentistry, without a doubt unless there is a change of policy, general practice is next."

It comes ahead of the five-year anniversary of the first ever Scottish GP contract, negotiated by BMA Scotland and the Scottish Government, which came into effect on April 1 2018. Previously, GP contracts had been agreed on a UK basis.

It included a commitment to create multi-disciplinary teams (MDTs).

These were to include a range of healthcare professionals, such as physiotherapists, pharmacists, and mental health workers, who would be employed by local health and social care partnerships (HSCPs) but based in GP practices.

The goal was to free up doctors to spend more time with the most complex patients.

READ MORE: 'It's falling apart' - Scots GPs on their fears for the future of general practice 

According to Audit Scotland, some progress has been made. By April 2022, 95 per cent of GP practices in Scotland had access "to some health board pharmacy support" and 75% had access to "some health board-delivered nursing support".

However, this falls short of a goal that all practices would be covered, and there is considerable variation in how much pharmacy or nursing support is available to each practice.

The total number of MDT healthcare professionals providing support to GPs increased by 3220.1 whole-time equivalent (WTE) between 2018 and March 2022, but Audit Scotland has warned that a target to increase the GP headcount by 800 by 2027/28 is "not on track".

Between 2017 and 2022, GP numbers - excluding trainees - grew by just 113. In real terms, adjusted for part-time working, the GP workforce has shrunk at a time when the number of registered patients has increased.

Dr Buist said the development of MDT services has been "geographically patchy" and that there is currently "no prospect of achieving one of the ultimate contract goals of freeing up GP time...to manage patient complexity and better prevent unnecessary admissions and referrals to hospital".

READ MORE: Call for housebuilders to ease pressure on GP surgeries 

He added that an increasing number of practices, unable to recruit GP partners to cope with growing patient lists, will face collapse with health boards forced to take over the running of practices instead.

"I would go as far to say almost no practice can consider themselves immune to the recruitment and retention problems that could force them to give up their contract," said Dr Buist.

"We have also failed to develop a solution to create new practices in those areas of Scotland witnessing population expansion due to a local house building boom...In short, the present situation is dire and is only going to get worse without intervention."

The Scottish Government said it had increased investment in line with inflation to £170 million to increase MDT recruitment, and that it is also "making good progress" on its 800 extra GPs target.

It added that there are a "record number of GPs working in Scotland, with more per head than the rest of the UK".

A spokesman said: "We know the difficulties staff are facing and want to repeat our thanks to all those working across all health and social care services to make sure people receive the care they need."