Possibility of bespoke rural GP solution

Remote and rural GPs could be removed from controversial new GP contract if solution cannot be found, Health Secretary says

Thursday 9th May 2019

General practitioners working in Scotland’s remote and rural areas could be excluded from the new GP contract, which critics say skews funding away from countryside practices to urban areas, if the new agreement cannot be made to work, the Health Secretary has said.

Jeane Freeman said the move, which the Scottish Government had previously decided against because did not want to appear to “marginalise” rural and remote GPs, could be reconsidered after the first part of the contract has been put into practice.

The new contract, which sets out GP rates of pay and how much cash is allocated to each practice, was approved by 72% of voting GPs on a turnout of just under 40%.

It came into force in 2018 and will be implemented in two phases.

But opponents say the formula used in the contract to allocate the money underestimates the challenges a doctor in a remote community faces and shifts cash to cities instead.

In March, the Rural GP Association of Scotland resigned from a Scottish Government group in protest over the new contract.

Vice chair Dr David Hogg said the body did not have enough powers to change the contract and had failed to come up with any ‘pragmatic, realistic proposals.’ 

More than 90% of the association’s members were opposed to the contract, he added.

Speaking to MSPs on the Scottish Parliament’s Petitions Committee today, Ms Freeman opened the door to removing rural and remote GPs from the contract and finding a bespoke solution, if the formula cannot be amended.

She admitted more needed to be done to ensure the agreement “adequately reflects the needs of all our communities.”

She told the SNP’s Angus MacDonald: “Now, whether or not that means you then remove rural and remote practices from the formula or whether you find other ways to adequately address that diversity is part of discussion that goes on at stage two…

“What we have at the moment clearly isn’t perfect. There are issues that need to be addressed, we need to see how best to address them to do that. Do we do that by removing remote and rural? That question will be returned to. There may be alternatives to doing that and we have to have that discussion and see.”

During the evidence session Ms Freeman also insisted the short life working group for remote and rural practices would have “direct input” into the second phase of negotiations.

Its chair, leading doctor Sir Lewis Ritchie, said it was currently at a ‘diagnostic phase’ and would soon move to a ‘treatment phase’.

The former GP, who previously headed a review of out-of-hours health services, said he wanted it to better reflect the unique role of a rural or remote community doctor.

“A GP in a remote and rural area can be a nurse if the nurse is sick, can be a paramedic if the ambulance is out of area, attend to a road traffic accident,” he said.

The diversity is quite stark at times. For example, in a very remote island he might work all day to keep a sick patient at home, avoiding an air evacuation….no formula will account for that.

“Therefore, we need to be more sophisticated at looking at what are rural colleagues do – the diversity of what they do, how well they do it; that needs to be resourced and supported. And as I see it, I would like to shed a little light on that with my group.”