Doctors warn of ‘full-blown crisis’ in general practice

Senior doctors have warned of a “full-blown crisis” in general practice, with new figures showing Scotland has lost nearly 90 surgeries in the last decade – with almost one in 10 having closed their lists to new patients.

The British Medical Association (BMA) Scotland highlighted what it described as “extremely worrying trends”, with the number of GP surgeries in Scotland down from 994 in 2013 to 905 in 2023 – a decrease of 89.

Demanding action from the Scottish Government, Dr Andrew Buist, chair of the BMA’s Scottish GP committee, said: “I cannot be any clearer when I say that intervention is needed now.”

Falling practice numbers mean there are now an average of 1,687 patients for every whole-time equivalent (WTE) GP, up from 1,499, the BMA said.

Currently 9% of practices in Scotland have formally closed their lists to new patients, it added.

Meanwhile there are eight practices where doctors have indicated they plan to hand their contracts back to the health board in 2023 – which could see them close altogether, further increasing pressure on remaining surgeries.

A total of 245,193 more patients were registered with a GP in 2022 than was the case in 2012, BMA Scotland noted – adding the country’s aging population meant more funding is needed for GPs to provide the same level of care.

Orkney is the only part of Scotland seeing the average number of patients per GP fall, Dr Buist said, adding: “Everywhere else is reporting increasing patient numbers with fewer GPs and fewer practices overall.”

He raised the issue ahead of a meeting with Health Secretary Michael Matheson on Wednesday, saying he hopes the Scottish Government “finally addresses the full-blown crisis it has on its hands and acts”.

Speaking about the situation facing family doctors, Dr Buist said: “Workload demands keep increasing, and the profession is rapidly losing any remaining faith that our political leaders have the will to deliver either the support and solutions needed.

“In 2017, the Scottish Government pledged an additional 800 GPs by 2027, but six years down the line only 113 new GPs have been recruited and the WTE has actually decreased by 3.4% since 2019.

“While we may be training more GPs, they are barely keeping pace with the premature losses the profession is suffering due to failure to retain – the bucket we are filling has a large hole in it and levels will continue to drop until that is repaired.”

Branding the situation “simply unsustainable”, Dr Buist said some GP practices have closed their lists to patients over the past few years “because they would be unable to safely provide the level of care required if they continued to take on new patients”.

He added: “This year alone at least eight practices have indicated their intention to hand back their contract to their local health board.

“If the health boards are not in a position to take over the running of those practices, they will close completely, and all of their patients will be dispersed to other practices – further increasing pressures elsewhere and leading to a domino effect of practice closures.”

Dr Buist said this is “a cause of great worry for GPs, who want to continue giving their patients the best care possible”.

He added it is also “very concerning for patients, particularly older and more vulnerable patients”.

Dr Buist warned: “I am desperately worried for the future of general practice in Scotland.

“It is clear to me – and has been for some time – that unless there is a change of policy within Scottish Government, almost no practice can consider themselves safe from falling over in this crisis.”

Scottish Labour health spokeswoman Jackie Baillie said: “The very existence of primary care in Scotland is hanging in the balance.

“Years of SNP cuts and inaction have left Scotland’s GPs unsupported with soaring demand and collapsing capacity.

“Without action now, we risk a full-blown primary care crisis in Scotland, with thousands of Scots and whole communities without access to their GP.”

Scottish Liberal Democrat leader Alex Cole-Hamilton said: “The Scottish Government need to increase the number of trained GPs in Scotland and embed more nurses, mental health professionals and physiotherapists in practices so that people can get a wider range of diagnoses, treatments and follow-up care within their community.”

Health Secretary Michael Matheson said he had a “constructive” meeting with Dr Buist, adding: “We are clear that patients who need to see a GP should always be seen.

“We have already 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 GPs, we have recruited over 3,220 healthcare professionals into multi-disciplinary teams. We are committed to investing £170 million a year to help grow these teams and to further increase the number of GPs in Scotland.

“A £20,000 bursary is offered as an incentive to GPs to increase rural and other hard to fill vacancies and trainee recruitment last year was the most successful year of any of the last five, with 99% of GP training posts filled.”