A Holyrood committee says the current delivery methods and models in Scottish primary care are ‘financially unsustainable’ and ‘have not kept pace with modern living’.
In a hard-hitting report published today, the Scottish Parliament’s Health and Sport Committee says primary care requires ‘a radical revision to ensure citizens receive the primary care they want, need and require for the next generation and beyond’.
MSPs are calling for a ‘fundamental shift’ in general practice, recommending that the ‘days of the 9-to-5 service, five days a week in primary care should be consigned to history’.
They say it should be replaced with a new patient-focused model shaped around users’ needs, adding that the NHS must also embrace technology, enabling better data sharing and monitoring.
In response, the doctors’ organisation, the BMA, says, while it agrees with much of the report, it is ‘simply wrong’ to characterise primary care as being only 9-to-5 on weekdays.
In echoes of the committee’s previous criticism of family doctors following their inquiry into supply and demand for medicines, today’s report says the focus ‘should shift towards prevention and away from the automatic provision of a prescription’, adding that patients must take more responsibility for their own help supported by social prescribing, which should become ‘much more of the norm across the board’.
Committee Convener Lewis Macdonald MSP says their inquiry highlighted the growing costs and demands on the health service of an ageing population and more complex health needs, an obesity epidemic and stark health inequalities in Scotland’s most deprived areas:
“It is clear that when it comes to primary care the status quo is no longer an option. Existing ways of delivering care are not only financially unsustainable but have failed to keep pace with modern life.
“We need to radically rethink primary care so that we can ensure our citizens receive the best possible care for generations to come.
“We must move away from the automatic provision of prescriptions and towards social prescribing. There must be widespread adoption of a preventative model of delivering care and the health service must fully embrace new technology.”
Mr Macdonald added: “A fundamental shift is also required in how the public and health professionals view general practice. Instead of GPs being seen as the provider of all services, a new approach should be adopted where other health professionals, who are often better placed and equipped to help and support people can do so.”
Dr Andrew Buist, Chair of the BMA’s Scottish GP Committee, said the report will require careful consideration, and includes many things doctors have been calling for:
“We completely agree that GP services need to be patient focussed – but suggesting this is simply about GP surgery opening hours reflects neither the complexity of the system, nor the huge pressures already on the GPs themselves.
“Primary care – including GPs and pharmacy services – operates 24/7 with out of hours services running through the night and on weekends. Community care teams, who are a core part of the primary care workforce in Scotland, also carry out patient-facing work on weekends – daytime general practice is available 8-6 pm so it is simply wrong for the report to say primary care needs to move away from a 9-5 five days a week approach.”
The report is the second and final publication following a two-year inquiry into the future shape of primary care, which the Committee says was centred around the views of members of the public.
Their investigation looked in detail at the changing role of doctors, the increasing importance of multidisciplinary professional teams and difficulties in measuring activity within primary care.
The report suggests the government should think again about its commitment to increase GP numbers in the light of the much greater emphasis now being placed on multidisciplinary team working, of doctors alongside allied health professionals, pharmacists, nurses, dentists and optometrists.
MSPs express frustration that there continue to be divisions which mean sharing health data within the NHS continues to be a significant problem. The Committee concludes:
‘The health service must now embrace new technology, stop talking about what they are going to do and start delivering a 21st century system to patients.’
The BMA said it welcome’s the Committee’s focus on prevention and improved technology and IT to allow better data sharing – and that it is clear that the wider delivery of primary care is held back by an excessive dependency on paper-based systems that are not fit for purpose.
However, Dr Buist said the proposal to revisit previous commitments on GP recruitment is very dispiriting:
“It also seems contradictory to propose GPs work longer hours to meet demand, while also suggesting reconsidering plans to recruit extra GPs.
“Radically expanding the teams of all professionals working in primary care is at the heart of the contract we negotiated in 2018 , so this isn’t about picking between one or the other. We can and must do both – the Scottish government recognised we are short of GPs and has committed to expanding primary care funding, and providing an additional 800 GPs by 2027, and both of these commitments must be realised.
“Across Scotland, GPs are stretched to the limit, working as hard as possible to meet ever rising demand. They face having to deal with complex issues in short appointments and without the time to truly provide the care every patient needs.
“Simply suggesting that they need to work longer hours to meet this demand will be very dispiriting to the profession currently on the frontline of dealing with covid-19.”
The Committee repeats its call for 5% of health and social care partnership budgets to be spent on social prescribing, suggesting that the role and status of the third sector and private sector as partners in the integration of health and social care, including the delivery of primary care services, is not being fully recognised and recommends that the capacity of the third sector must be taken into account in primary care workforce planning.
The Royal College of GPs (RCGP) however, says that while it agrees with the Committee that improvements can be made, MSPs have failed to understand the range of services already available outside of normal office hours.
Dr David Shackles, Joint Chair of RCGP Scotland, said: “GPs and the wider multidisciplinary primary care teamwork exceptionally hard day in, day out, to meet the varied and complex needs of their patients.
“While we agree that improvements can and should be made to ensure that primary care can deliver patient-centred care now and in the future, it is simply not the case that this will be achieved by extending the opening times of GP surgeries.
“This recommendation by the Committee also does not reflect the hard work of our colleagues in the out of hours service who ensure that primary care in Scotland is available to patients 24 hours a day, seven days a week.
On data sharing and the use of technology in primary care, the College has welcomed the Committee’s suggestions that better data sharing and moving away from burdensome paper-based systems will be key to meeting patients’ needs.
‘These are areas that we have been calling for action to be taken for many years,’ the College said in a statement.
‘Improving the IT systems that primary care teams use will bring huge benefits for patients and increase efficiency within the NHS.
‘For many years, we have been calling for a national conversation to take place with the public on what the NHS can reasonably and sustainably deliver in the modern age.
‘We have also been calling for a campaign to improve patients’ understanding of what changes to the delivery of primary care will mean for them.
‘We are pleased to see these recommendations included in the Committee’s report and stand ready to work with all partners, including Health and Sport Committee members to make this a reality.’