The doctors’ organisation, BMA Scotland, says it has concerns about the future of general practice under government proposals to create a National Care Service.

The BMA is describing as not a ‘viable or acceptable option’ a proposal that GPs will no longer work for their local NHS boards.

Under the plans they would instead sign a contract with the new National Care Service (NCS) – effectively taking them out of the NHS.

The suggestions are prompting confusion among GPs, who are questioning what such a shift would mean to them.

But the government told healthandcare.scot GPs will remain ‘an integral part of Scotland’s NHS’.

A Scottish government consultation document says integration of health and social care has not worked well in some areas due to ‘a lack of collaborative leadership', stating:

‘As the GP contract is a nationally negotiated contract there are limits to the ability of the Integration Joint Board to influence GP service delivery.’

One of the solutions the government has put forward is that NCS Community Health and Social Care Boards (CHSCBs) – replacements for integration joint boards (IJBs) – should take over management of GPs’ contractual arrangements.

Currently, GP practices that operate as independent contractors sign a contract with their health board, working within a framework set by a national agreement: the General Medical Services (GMS) contract.

Dr Andrew Buist, chair of the BMA’s Scottish GP Committee, told healthandcare.scot:

“While we will provide full and detailed input on this consultation in due course, essentially we believe GPs are an integral part of the NHS.

“It has been said many times by politicians that general practice is the backbone of Scotland’s NHS, so to effectively remove it from the NHS would not be a viable, or acceptable option.”

In its consultation document, the Scottish government says that moving the contract across to the new CHSCBs meets a recommendation of the Independent Review of Adult Social Care.

The man who headed up the review, Derek Feeley, was asked about the change at the Scottish Parliament Health, Social Care and Sport Committee.

Scottish Conservative Health and Social Care Spokesperson, Dr Sandesh Gulhane – himself still working part-time as a GP – asked if the aim was to change the status of general practitioners from contractors to employees.

Mr Feeley said his group had not been proposing any change in their status:

“We do not envisage there being a significant change in the current arrangements.

“It is much more about ensuring that, in this spirit of integration, integration joint boards have the facility and the capacity to oversee GP contracts…

“We do not envisage there being a massive shift in the current arrangements; it is much more about tidying up.”

Judith Proctor, the chief officer of Edinburgh integration joint board and chair of the chief officer group at Health and Social Care Scotland, told the committee that she believed neither the Feeley report nor NCS consultation proposals will make a “big practical difference” on the ground:

“In practice, IJBs or health and social care partnerships are effectively managing much of the engagement and relationship with GPs in relation to the contract through our primary care teams. The work on primary care improvement plans is locally driven in health and social care partnerships.

“Under the contract, 2C practices in which GPs are employed – that accounts for a small number of general practices that usually have a specific set of circumstances – are managed by the health and social care partnerships, which all have, through their IJBs, clinical directors and lead GPs for that. Therefore, that management is already happening.

“Derek Feeley’s report on the NCS talks about oversight of the overall contract moving from those boards to the new community health and social care boards.”

Dr Andrew Buist says the BMA has a number of concerns about the impact of the changes being proposed:

“Many GPs have already flagged that they are worried about exactly what being locally managed by CHSCBs would mean.

“A considerable focus of the 2018 [GMS] contract was for IJBs and health boards to establish themselves as alternative service providers in primary care – for example in vaccinations and pharmacotherapy – thus allowing GPs to use their skills, training and experience as expert medical generalists to focus on complex care and whole system quality improvement and clinical leadership, among other priorities.

“We are concerned this proposal could have unintended consequences such as negatively impacting on GP recruitment.

“We see the way forward for GPs to influence the shape of local services is through the established local Quality Clusters and existing advisory and representative structures.”

A Scottish government spokesperson said ministers were committed to delivering a National Care Service:

“We have launched a consultation to seek views on what should be included and how the National Care Service should work. We have heard about the problems people face in the current system, now we want everyone’s help to build a better approach.

“As part of this consultation, we look forward to receiving the views of the medical profession on the contractual arrangements proposals and in particular to hear from the Scottish General Practitioners Committee of the BMA and the Royal College of General Practitioners. The points raised will be fully considered as part of our analysis of the consultation responses.

“Our GPs and primary care staff are, and will continue to be, an integral part of Scotland’s NHS.”

 

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