Rural GP association warns Scottish Government that practices are in “jeopardy”

RGPAS chair Alida McGregor has said that it is “deeply unfair that rural practice has not seen an equitable investment.”

The Rural GP Association of Scotland believes that rural general practice faces problems of the “utmost gravity” which it says could place its future in “jeopardy”.

In a letter sent last week to Professor Sir Lewis Ritchie, the RGPAS committee highlighted serious concerns about proposals outlined in the Scottish Government’s ‘Shaping the Future Together’ report which was published in January.

The RGPAS committee also argued that a funding shortfall for rural practices should be resolved and backdated to April 2018 when the General Medical Services Contract (GP contract) was introduced.

The ‘Shaping the Future Together’ report is the product of work undertaken by the Remote and Rural General Practice working group which is chaired by Professor Ritchie. Its 12 key recommendations seek to meet the challenges of implementing the 2018 GP contract in a remote and rural context and support rural GPs with any future contractual developments. However, the RGPAS committee said the recommendations were “insufficient to address the acute problems facing the general rural practice in Scotland.”

Writing on behalf of the RGPAS, the committee chair Dr Alida MacGregor stated: “These problems are of the utmost gravity: we are witnessing an unprecedented decline in rural GP contractor numbers to the detriment of patient care. Furthermore, our ability to provide medical students with exposure to rural practice is under threat, and this places the overall future sustainability of rural general practice in jeopardy.”

Dr MacGregor argued that the recommendations in the report lacked “specificity and a sense of urgency”. She said that there should be an option for rural GPs to continue offering services such as immunisation, which they currently deliver, and be remunerated at the total costs which health boards would have to pay. She said that the option should be “offered now” on a “sustainable long-term basis for rural practices”.

Commenting on the funding arrangements in the GP contract, Dr MacGregor stated that it was “deeply unfair that rural practice has not seen an equitable investment” and that the committee does not believe it to be “fair or acceptable for funding for rural practice to be delayed any further” She added that any funding uplift should be backdated to the 1st April 2018 – when the GP contract was implemented – to match when other GPs received their funding increase.

The RGPAS committee chair also contended that by compelling all practices to reduce the scope of their workload, the 2018 GP contract made rural practice – with its “uniquely broad remit” – a much less appealing prospect for young doctors than it had been in the past.

RGPAS committee member Dr David Hogg resigned from the rural and remote working group in April 2019.

She went on to add that the Remote and Rural General Practice working group was not representative of rural patients as RGPAS had not been formally involved since Dr David Hogg, the then chair of RGPAS resigned from the group with the backing of the committee in April 2019.

The 66-page Shaping the Future Together’ report recommends that the Scottish Government and British Medical Association should state their unequivocal commitment to maintaining the income and expenses guarantee under current contractual and funding arrangements; ensure that new terms and conditions clearly recognise the diversity of remote and rural general practice, and provide a long-term sustainable footing for rural practices and their local communities.

The report also acknowledges that significant concerns were raised which highlighted that the 2018 GP contract did not “fully appreciate the nature of the rural GP role and differences to delivering general practice in rural communities.”

The Cabinet Secretary for Health, Jeane Freeman said the report aims to “enhance primary care across remote, rural and island communities by ensuring stability for rural GP incomes alongside other measures that support innovative approaches to the use of IT and physical infrastructure, as well as recruitment and retention practices.”

Article by Adam Gordon