Watchdog issues warning over GP recruitment

Audit Scotland’s latest report on NHS workforce planning warns ’major policy changes’ are ’without a reliable basis’

Thursday 29th August 2019

The national public spending watchdog is today warning the Scottish Government will struggle to meet its commitment to recruit more people to work in GP surgeries.

Audit Scotland says ministers are likely to miss their target to boost GP numbers by 800, adding a ‘data gap’ is making it harder to plan what primary care staff are needed when and where.

Although training schemes are being expanded, the report calls into question the government’s goal of seeing more people cared for by teams of nurses, pharmacists and other professionals organised around GPs.

Caroline Gardner, the Auditor General for Scotland, said: “Scotland's primary care workforce is under pressure and operating in an uncertain climate. That makes detailed planning for the future even more important.”

“To date, the Scottish Government has introduced major policy changes without a reliable basis for its plans.

“It now needs to get a much clearer picture of the workforce and set out detailed plans addressing how its initiatives will improve patient care and deal with future demand on services."

There are around 6,200 healthcare workers in primary care, auditors say. GPs are the largest group, followed by nurses, support workers and pharmacy staff.

Recruiting more people into primary care – for many the first point of contact with the health service – is a key part of government plans to see more people cared for outside of hospital.

But the public sector auditors say planning for future recruitment needs is ‘fragmented’, with responsibility split across different national and local authorities. 

And although ministers have pledged to increase the number of GPs by 800 by 2027, analysis suggests numbers will in fact remain ‘broadly stable’ over the decade.  

This is mainly due to more people leaving the profession than joining. One in three family doctors and more than half of GP-surgery-based nurses are older than 50.

Changes to working patterns and European nationals leaving due to Brexit are also factors, with the government describing uncertainty around a ‘no deal’ Brexit as a continuing and significant threat for the whole of the health and social care sector "both in terms of the supply of medicines and critical goods and the impact which the loss of freedom of movement will have on the recruitment and retention of staff.”

Overall, auditors find primary care workforce numbers are on the rise but some areas of the country are experiencing very high vacancy rates.

In Shetland, one third of GP positions are empty because new doctors cannot be recruited.

A £15m series of recruitment initiatives including fast-track degree courses and financial bonuses for GPs in rural areas was found to have recruited just 39 GPs.

While training schemes for additional GPs, paramedics, nurses and midwives are ramping up, Audit Scotland says it is ‘not clear’ how many will end up in primary care.

In response, Health Secretary Jeane Freeman said: “Today’s report from Audit Scotland highlights the vital role primary care plays in delivering our long term vision of shifting the balance of care towards community and preventative care.

“As we work to address the challenges in this area we are seeking to build on our record number of GPs by at least 800 in the next ten years. This is backed by our substantial annual increases in primary care and general practice funding.

“The new GP contract and investment in multi-disciplinary teams is increasing capacity in primary care and helping patients to be seen at the right time by the right person. It will also help reduce GP workload, making the career even more attractive to new doctors."

At odds with the Health Secretary's comments, Andrew Cowie, deputy chair of the British Medical Association’s Scottish GP committee, said: “It is no secret that Scotland desperately needs more doctors in General Practice, and with not enough doctors choosing this as a career path, and more senior doctors retiring early or cutting down their working hours, it is difficult to see how the Scottish Government is going to meet its target of an additional 800 GPs to the current workforce.

“On that basis, it is worrying to see the level of work the Scottish Government needs to do on this.

“The delay in publishing the Workforce Plan – which was supposed to be published in late spring this year – is very concerning. To be clear – the commitment is very welcome, but the Audit Scotland report leaves little doubt that we need more details on the plans urgently.”

The Dundee doctor added: “Considering the future for GPs in general, we are now well into the second year of implementing the new GP contract in Scotland and starting to look towards the development of Phase 2.

“At this stage it is encouraging to see that progress has been made in certain areas. We are very clear that the GP contract has set Scotland on the right direction of travel and offers the best hope for sustainable general practice , however it is equally clear from this report that there is still a lot of work to be done, and the pace of change must increase over the next 20 months if we are to achieve the necessary transformation of primary care.”

In March of this year, the Rural GP Association of Scotland resigned from a Scottish Government working group set up to address rural doctors’ concerns about the new GP contract, claiming efforts to find solutions ‘had fallen by the wayside’.

“I understand the concerns raised by our rural GPs”, says Dr Cowie, “who are facing major recruitment and retention issues and a real struggle to get locums and replacements in some of the most remote communities.

“Our chair’s recent visit to rural practices highlighted the challenges we face to recruit and retain doctors in these areas, with a number of GPs over the age of 40. Our approach to rural areas does need to be flexible and we all need to keep working on appropriate solutions.”

“Indeed, across Scotland we need all partners – the Scottish Government, Health Boards, Integration Joint Boards and partnerships – to work together to meet their commitments to the contract in full. The core aim of the contract was – and remains – to restore hope to the profession and make becoming a GP an attractive career choice for young doctors, by lessening some of the burdens such as inappropriate excessive workloads, responsibility for employing a large practice-based team, and the risks associated with owning practice premises.

“Only then will we start to see an increase in the number of GPs in Scotland, and the future of primary care improved.”

Health services in Scotland are planning to increase staff numbers over the next year, with 2,000 new workers expected to be in post by March 2020, but questions have been raised over whether this will enable services to meet growing demand.

The Government is however confident its plans will suffice, with Health Secretary, Jeane Freeman, adding: “We are also taking action to build a workforce that can meet increasing demand. For 2019-20 we’ve increase nursing and midwifery student intakes by 7.6% - an extra 283 places. By 2020-21 we will have increased medical school places by 22% over 2016 levels, equivalent to an extra 190 places. We are also protecting free tuition for nursing and midwifery students and increasing their bursary to £8,100 this year and £10,000 next year.