Demand to boost general practice investment

The leader of Scotland’s GPs is calling on the Scottish Government to take urgent action to invest directly in general practice – or risk further harm to the ‘bedrock of the NHS’.

Iain Morrison, chair of the BMA Scottish GPs committee, said the failure to invest in general practice and recruit enough GPs was ‘taking its inevitable toll’.

He was speaking as a report from Audit Scotland laid bare the challenges facing general practice since the introduction of the new Scottish GP contract in 2018.

According to the watchdog report, seven years on, the estimated number of WTE (whole-time equivalent) GPs has fallen, pressure on general practice has increased, people are finding it more difficult to access care, and proposals to support GP teams with more nurses and other health professionals have moved more slowly than planned.

The report also warns that national data for general practice remains inadequate, so there is a lack of robust information about demand, access and quality of care. And it says that spending on general practice as an overall share of health service funding has fallen slightly, and that spending had in any case fallen by 6 per cent in real terms between 2021/22 and 2023/24.

Dr Morrison said: ‘This Audit Scotland report demonstrates in forensic detail exactly why so many practices across Scotland are struggling to meet demand and the enormous pressures so many GPs are having to work under which has left them angry and demoralised.

‘Given the rising demand from a growing and ageing population, with more complex health conditions, it means GPs are simply unable to provide the best possible service to their patients and the community.’

The Audit Scotland report warns that the Scottish Government’s commitment to increase the number of GPs working in Scotland by at least 800 by 2027 was unlikely to be met, and that in any case might not be enough to meet the health needs of the population.

‘BMA Scotland has been warning of the lack of progress on this target for some time and there is a clear need to step up action not only recruit more GPs but to retain the existing workforce,’ Dr Morrison said.

The 2018 contract led to substantial sums being channelled through an ‘improvement fund’, which wasn’t delivering for general practice, he added.

‘As a result, GP practices across the country are having to look at reducing services to balance their books and newly qualified GPs are struggling for work as practices simply cannot afford to employ the doctors which are desperately needed. The situation has become paradoxical.’

He said that increasing the proportion of the NHS budget which goes to general practice to 15 per cent would mean an extra 1,800 WTE GPs across Scotland, allowing GPs to improve patient access, bringing huge benefits across the NHS.

‘A properly resourced general practice can offer so much to the health and wellbeing of Scotland but the dire predicament we are in now – as illustrated by Audit Scotland – means we need immediate action to safeguard the bedrock of the NHS.’

Stephen Boyle, auditor general for Scotland, also called for action. ‘The pandemic pushed back plans for general practice. But the new delivery deadlines that were put in place were missed, and there has not been enough transparency about progress since then. 

‘The Scottish Government needs to clarify its plan for general practice and set out the actions, timescales and costs to deliver it.’

Health secretary Neil Gray thanked Audit Scotland for the report. He said: 'Many of its recommendations are already in progress and we are committed to working with the BMA to support general practice and to meet our commitment to deliver 800 additional GPs by 2027.

'The first minster and I have been clear that we know too many people have had issues with seeing their GP and we have set out a plan to improve access, with a greater proportion of new NHS funding going to primary and community care so that GPs and services in the community have the resources to play a greater role in our health system.

'This financial year have invested an additional £73.2m in general practice, including £13.6m to support GPs and the 2025/26 budget includes over £2.2bn investment in primary care, which will help to make it easier for people to see their GP.'