The 2018 Scottish GP Contract document suggests “Generalism, by definition, is a form of care that is person- not disease- centred.” However, the fundamental thought processes behind this contract remain largely unchanged from every contract in the history of medicine. It continues to be driven by a system- not person-centred focus and resourcing. This sets the whole profession up for yet another decade of living in the deluded belief that we can improve the quality and safety of healthcare by just tweaking the delivery a little bit. Primary Care resourcing will continue to be defined by what the system thinks it can provide rather than what the people and communities truly need. Whilst SGPC have acknowledged that a formula is not a good way to allocate resources across such a complex, heterogeneous system, yet another formula (the Workload Allocation Formula, WAF) has been devised and sold as a ‘methological improvement’ over the previous 2004 allocation formula. This continues despite clear indications from the widely publicised allocation map(1), basic comparisons between practice WAF calculations and SIMP deprivation data(2), and concerns from both Rural and Deep-End GP groups, that the WAF rewards demand, not need, and will further reinforce the inverse care law from the outset of Phase 1 of the new contract.
SGPC have continuously repeated that “... no practice in Scotland will see any reduction in nationally agreed funding as a result of this contract “(3). On the surface that sounds great, but in reality a freeze in income translates to a loss when tax changes and inflation are taken in to account. The new formula takes even less account of the very real higher costs of providing core GP services in geographically challenging and widely dispersed practice areas. This includes higher fuel usage and prices, acquisition (delivery surcharges), locum and permanent GP recruitment, and much more. Even the costs of a basic CPD course sky rockets when you factor in ferries, fuel, flights, hotels, and extra cover for the additional travel time needed.
And then, if you were looking for a partnership, would you be more likely to go for a practice with an income boost or income protection? Essentially it has a similar psychological effect as a landlord comparing tenants in paid work vs on social security. So what will that do for recruitment and retention? It widens the gap and makes it harder to recruit to some of the hardest areas to recruit to already.
These are all very real prospects for Remote and Rural GP practices and their communities, right from day 1 of Phase 1. They need to be addressed now, or many rural areas may lose their medical services before Phase 2 ever emerges out of the negotiating chambers.
Rapid Response:
Re: GPs in Scotland vote to accept new contract
The 2018 Scottish GP Contract document suggests “Generalism, by definition, is a form of care that is person- not disease- centred.” However, the fundamental thought processes behind this contract remain largely unchanged from every contract in the history of medicine. It continues to be driven by a system- not person-centred focus and resourcing. This sets the whole profession up for yet another decade of living in the deluded belief that we can improve the quality and safety of healthcare by just tweaking the delivery a little bit. Primary Care resourcing will continue to be defined by what the system thinks it can provide rather than what the people and communities truly need. Whilst SGPC have acknowledged that a formula is not a good way to allocate resources across such a complex, heterogeneous system, yet another formula (the Workload Allocation Formula, WAF) has been devised and sold as a ‘methological improvement’ over the previous 2004 allocation formula. This continues despite clear indications from the widely publicised allocation map(1), basic comparisons between practice WAF calculations and SIMP deprivation data(2), and concerns from both Rural and Deep-End GP groups, that the WAF rewards demand, not need, and will further reinforce the inverse care law from the outset of Phase 1 of the new contract.
SGPC have continuously repeated that “... no practice in Scotland will see any reduction in nationally agreed funding as a result of this contract “(3). On the surface that sounds great, but in reality a freeze in income translates to a loss when tax changes and inflation are taken in to account. The new formula takes even less account of the very real higher costs of providing core GP services in geographically challenging and widely dispersed practice areas. This includes higher fuel usage and prices, acquisition (delivery surcharges), locum and permanent GP recruitment, and much more. Even the costs of a basic CPD course sky rockets when you factor in ferries, fuel, flights, hotels, and extra cover for the additional travel time needed.
And then, if you were looking for a partnership, would you be more likely to go for a practice with an income boost or income protection? Essentially it has a similar psychological effect as a landlord comparing tenants in paid work vs on social security. So what will that do for recruitment and retention? It widens the gap and makes it harder to recruit to some of the hardest areas to recruit to already.
These are all very real prospects for Remote and Rural GP practices and their communities, right from day 1 of Phase 1. They need to be addressed now, or many rural areas may lose their medical services before Phase 2 ever emerges out of the negotiating chambers.
1) New GP contract uplift heatmap. Available at: https://fusiontables.google.com/DataSource?docid=13SLV8fjU8S5LvhiMcmbUWp...
2) Scottish Index of Multiple Deprivation (SIMD) 2016 Map. Available at: https://jamestrimble.github.io/imdmaps/simd2016/
3) A. McDevitt, BMA SGPC Chair. Proposed GMS contract and its impact on remote and rural areas. Letter, undated. Available on https://www.bma.org.uk/-/media/files/pdfs/collective%20voice/committees/...
Competing interests: No competing interests