Number of private GP clinics on increase in Scotland

Figures obtained by the Herald from Healthcare Improvement Scotland - the regulator responsible for inspecting private clinics - show that there were three private GP surgeries registered in 2019.

There are now 11 - mainly located in the Edinburgh and Glasgow areas, with one each in Stirling and Falkirk.

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However, this only covers practices solely providing general practice.

Many private GPs work in mixed clinics alongside other healthcare professionals - such as physiotherapists or psychotherapists - but HIS said the cost of extracting this data from annual returns would exceed the £600 threshold for responding to a freedom of information request.

In addition, the Private Healthcare Information Network (PHIN) - which tracks the number of consultants active in private hospitals - does not currently collect any figures the number of GPs working within private hospital-based clinics.

Separate data held by PHIN shows that the number of Scots self-funding private medical procedures, such as hip replacements or colonoscopies, increased 84% between 2019 and 2023.

The GMC - which regulates doctors practising in the UK - said its records "do not distinguish between [GPs] working in the NHS and those working privately".

There is also a reluctance among independent healthcare companies to disclose any potentially market sensitive intelligence on the number of GPs currently contracted with them.

Both Nuffield and Circle Health told the Herald they had no one available for comment, and Bupa and Spire did not respond.

However, Spire Healthcare - which operates a network of private GPs across the UK - reported a 41% increase year-on-year in October 2023 in the number of GP appointments it was providing.

Dr Andrew Buist said the increase in private GP services had been 'predictable' (Image: free)

Trade body, the Independent Healthcare Providers Network, has described private GP services - which typically charge around £300 an hour - as one of the "big growth areas" in UK private healthcare.

Dr Andrew Buist, chair of the BMA's Scottish GP Committee, said the trend was being driven by a lack of investment into core general practice.

He said: "I predicted this would happen, and the key thing is - it's not peaked yet. This will go on.

"When GPs leave the National Health Service they have to do a business plan to make sure it's cost effective.

"They'll start small and build up as the business takes off, so this trend will continue and of course it's just going to perpetuate this two-tier system in Scotland and widen health inequalities.

"This is happening because people can't get an appointment, and that's what these private clinics can offer: longer appointments, faster - and people are voting with their feet."

Audit Scotland has already warned that the Scottish Government's 2017 pledge to boost GP numbers by 800 by 2027 is "not on track".

GP numbers by headcount fell last year and over the past decade the size of the GP workforce in real-terms size has shrunk by 5.4% at a time when practice lists have increased by 7.1%, including a 19% surge in the number of patients over 65.

The number of full-time (WTE) GPs in NHS Scotland has declined since 2013 (orange line) while patient numbers have increased (grey) and consultant numbers have gone up (Image: BMAScotland/PHS)Face-to-face appointments account for the majority of GP consultations, but PHS data indicates that there has been a small decline in the number of monthly GP appointments compared to 2019 (Image: Public Health Scotland)

Statistics from Public Health Scotland show that GPs were providing 1.57 million face-to-face and virtual appointments combined as of January this year, down slightly from 1.67 million in January 2019.

This has been exacerbated by increased demand due to higher levels of chronic disease, pain, and mental health problems as a result of the pandemic, waiting list backlogs, and the cost of living crisis.

Dr Naushad Ali is among the GPs in Scotland making the move to the private sector.

Dr Ali had been a GP partner at a practice in the southside of Glasgow for 15 years but quit "reluctantly" in October 2023 amid the growing stress associated with running an NHS practice.

Although he still does some locum NHS work, he has focused on expanding the Glasgow Private Clinic in Newton Mearns, East Renfrewshire, which he founded in 2019.

It has gone from operating a fortnightly clinic pre-pandemic to offering a full range of services including general practice, gynaecology, dermatology, neurology, aesthetics, and plastic surgery.

A minor surgical unit recently opened, and ENT and gastroenterology services are being added.

The clinic employs 28 clinicians - including two GPs - most of whom split their time between the NHS and private work. A 20 minute GP consultation costs £110.

Dr Naushad Ali had been a GP partner in the NHS for 15 years, but is now invested in his expanding Glasgow Private Clinic - which provides a range of private healthcare, including GP appointments (Image: Colin Mearns/Herald&Times)

Dr Ali said the demand has grown "astronomically" since the pandemic.

He said: "These are all clinicians who are still working in the NHS but are recognising that waiting lists are getting longer on the NHS and a lot of them are now looking to dabble in the private sector for lots of different reasons.

"The stress of working within the NHS is obvious - the workload and the risk of burnout is very high, both for GPs and other doctors.

"I think a lot of clinicians are looking for a better balance and there's no doubt that working in the private sector you're far more in control of your workload, and you get longer with patients.

"The quality of care you can deliver, because you've got more time, improves as a result."

Dr Ali said many of the patients coming to him privately said they "have to fight for a GP appointment" on the NHS.

He added: "These are often patients who are ill, vulnerable, with mental health issues, and this idea that there is a fight to get an NHS appointment is really disappointing.

"Having seen it from both sides, there's absolutely no doubt that the workload in general practice - especially as a partner - has increased astronomically, and they're so constrained for time.

"We talk about general practice being a fire-fighting service: you come in at the start of the day and you just want to get through the crisis patients and actually, the patients with the chronic conditions, who maybe don't need to be seen immediately, they are the ones who maybe don't get the care they want."

In 2013, partners made up 84% of the GP workforce in NHS Scotland but that had dwindled to just 71.4% by 2023 as a growing number opt to work on a salaried basis instead.

This has has resulted in a string of practices collapsing, merging, or being taken over by health boards - a much costlier option for taxpayers.

GP partners ('performers') make up a declining share of the general practice workforce in Scotland, leaving many practices in a precarious position (Image: PHS)

Campaign group, Rebuild General Practice, has been lobbying governments across the UK for a fairer share of health spending to improve GP retention and make the existing independent contractor model more sustainable. 

Dr Nora Murray-Cavanagh, a member of Rebuild in Scotland and a GP in Wester Hailes - one of Scotland's most deprived communities - said urgent action is needed to ensure that patients "are able to see a GP when they need to free of charge".

She added: "As the NHS GP workforce shrinks and patient need grows, we are witnessing a deepening of health inequalities - between those who can afford private care and those who cannot.

"This is a huge issue for patients such as mine who simply cannot afford private care.

"That’s why Government must pay attention to the growing number of private practices and collect the necessary data to inform a strategy that re-establishes quality health care for all.”

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Scottish Labour's health spokeswoman, Jackie Baillie, said it was "disgraceful" to see patients "pushed into the private sector". 

She added: “It is vital that the expansion of private primary care is recorded and monitored properly.

“We need action now to properly support and resource NHS primary care to help GPs and the patients that they serve.”

Scottish Conservative health spokesman, Dr Sandesh Gulhane - a GP in Glasgow - called on the Scottish Government to be "transparent about the true scale of patients going private and take urgent action to stop it escalating further".

He added: “The SNP’s cuts to primary care and dire workforce planning mean GPs like myself simply cannot meet demand from patients, meaning they have to shell out money – during a cost-of-living crisis – for treatment."

A Scottish Government spokeswoman said: “Everyone in Scotland can register with a GP practice.

"GPs are essential to the delivery of high quality, sustainable general practice and the Scottish Government is fully committed to increasing the number of GPs in Scotland.

"It is our current ambition to add 800 new GPs by the end of 2027 and there are currently just over 1,200 trainee GPs in Scotland.

“We have expanded GP Speciality Training, adding 35 places last academic year and a further 35 places this year.

"On top of this we are also investing over £1 million per annum in a range of recruitment and retention initiatives so that becoming a GP remains an attractive career choice.”