A top doctor has warned that general practice in Scotland is unravelling like "a car crash in slow motion" after a survey found that a quarter of family doctors plan to quit their practice within two years.
Of the 850 GPs who responded to BMA Scotland's annual wellbeing survey, just 5% said their surgery would be sustainable in the long-term, and nearly two thirds (60%) said they feared that losing just one doctor from their team could tip the practice into collapse.
A further 5% revealed they already have - or are actively considering - giving up their contract to provide medical services, meaning that it would be up to the health board to take over the running of the practice or to disperse patients into other practices in the region.
It comes days after Braemar Medical Practice in Grampian - with a patient list of 700 - became the latest to confirm plans to hand its contract back to the health board after "repeated attempts" to find a replacement for a retiring GP had failed.
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Dr Andrew Buist, chair of the BMA's Scottish GP committee, said it would once have been considered a "plum job" but the escalating crisis in general practice is now spreading to surgeries in affluent communities as well as small rural practices and those in urban deprived areas.
He added: "We are watching a car crash in slow motion. We're flagging it up to the Government and they're going 'yeah, we know, but we've got bigger priorities in Accident and Emergency and waiting lists'.
"Primary care is just not their top priority in health.
"It needs significant investment to turn the situation around, otherwise we will continue to lose practices one by one."
The BMA Scotland survey also found that one in four GPs expect to leave their practice in the next two years - for example, through early retirement - while three quarters said experiences over the past year have made them more likely to leave the profession altogether.
The vast majority (85%) said they "sometimes, or regularly" struggle to cope and 28% said their current workload is unmanageable.
A string of practices have folded over the past year including Invergowrie Medical Practice in Tayside and Friockheim health centre in Angus, while patients registered with Methven GP surgery in Perthshire were told this week of plans to transfer them to the practice's main premises in Perth - 12 miles away - due to difficulties recruiting GPs.
The situation has been exacerbated by the closure in 2019 of a GP practice in Bridge of Earn, which resulted in 3,500 patients being dispersed to other surgeries in the area.
READ MORE: 'It's falling apart' - GPs on the future of general practice in Scotland
In Aberdeenshire, the Fyvie Oldmeldrum Medical Group - a practice with nearly 9000 patients in an affluent part of Aberdeenshire - ended its contract with NHS Grampian in April, while one of Scotland's largest GP surgeries - the 25,000-patient Inverurie Medical Practice - was also on track to end its contract in September due to a doctor shortage.
However, its partners reversed the decision in May, saying they will adopt a "new business plan" based on an expanded team of support staff such as nurses and physiotherapists.
Dr Buist said: "It's a drip-drip of things getting slowly worse.
"That presents us with difficulty recruiting GPs, it means practices struggling with workload, closing their lists, and eventually it means practices becoming unsustainable and returning their contract.
"Once they close, they will probably never re-open so you have this domino effect because those patients have to go somewhere else.
"That's what we see with practices like Bridge of Earn: 4000 patients had to be put into the existing capacity at Perth, but it's already expanding rapidly. Many hundreds of new houses are being built up the west side of the A9.
"So we're building many more houses - in the southside of Edinburgh too, there's huge population expansion - and the supermarkets are being built to cater for these people, and the schools because they have to, but not the GP facilities.
"People are going to wake up one day and suddenly go 'where are my services?'"
In 2017, the Scottish Government pledged to increase GP numbers in Scotland by 800 within 10 years, but Audit Scotland warned in February that progress is "not on track".
"We are producing more GPs, but we're basically only keeping up with the losses," said Dr Buist.
"People are leaving and more people are coming in, but not enough, so we really need to address retention of the current workforce."
The workforce is also shrinking in real terms as a growing share of GPs have cut their sessions or work part-time.
As a result, GP numbers - counted as whole-time equivalent (WTE), and excluding trainees - have fallen from 3,675 in 2013 to 3,494 in 2022.
The number of GPs who are partners - the doctors financially responsible for owning and running practices - is declining at an even steeper rate as more newly-qualified GPs opt to work on a salaried or locum basis instead.
Growing numbers of experienced GPs are also pulling out of partnerships.
Between 2012 and 2022, the percentage of GPs in Scotland who were partners fell from 77% to 62%.
Meanwhile, there are fears that the private sector will expand to fill the gap as NHS-based GP services disappear, exacerbating health inequalities.
One former senior medical leader in Scotland told the Herald on Sunday that they believe private GP clinics - historically rare in Scotland - could outnumber NHS practices within five to 10 years in cities such as Edinburgh or Glasgow.
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Dr Buist cautioned that such a sea change "would take a very long time or some massive collapse of the whole system", but that he does expect private healthcare in general practice to "gradually increase".
He said: "If these trajectories continue - practices closing, patients getting put into other practices, those practices coming under greater strain - then you've got the same number of appointments serving 12,000 people compared to 8000 previously, so it's harder to get an appointment.
"In that situation people can start to say 'well, there's a private GP in the city centre who'll see me privately tomorrow so that's what I'll do'.
"Once that starts to pick up it becomes a viable business for GPs to do that, so the business model starts to take off and the whole thing starts to unravel."
A spokesman for the Scottish Government said: “We are grateful to GPs for the vital service they provide and thank them their efforts in the face of sustained pressure.
"GPs can access a range of resources, including the National Wellbeing Hub, a 24/7 compassionate listening service, confidential mental health treatment, coaching for wellbeing and psychological therapies.
“We have delivered a record number of GPs working in Scotland, with more per head than any other country in the UK, and we are making good progress on our commitment to recruit at least 800 new GPs by 2027.
"Since 2017, Scotland’s GP headcount has increased by 291 to a record high of 5,209 in 2022.
“To support general practice we currently have 4,731 staff working in Multi-Disciplinary Teams providing services including physiotherapy, pharmacy and phlebotomy, giving an average practice access to more than five additional multidisciplinary team members.
"We continue to support development of these teams through our investment of £170 million per year in the Primary Care Improvement Fund.”
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