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More rural concern over new GP contract

Hillswick GP Susan Bowie.

A SHETLAND doctor has described a new contract for GPs in Scotland as a “disaster” amid continued concern over the impact it could have on rural practices.

Hillswick GP Susan Bowie took the opportunity to criticise the contract at Thursday’s meeting of Shetland’s Integration Joint Board (IJB).

She said figures suggest that the only health centre in Shetland that will benefit financially from a new funding formula will be Lerwick.

Bowie is due to meet Labour MSP Neil Findlay today (27 February) to discuss the issue.

A spokeswoman for the Scottish Government said that “no GP practice in Scotland – rural or otherwise – will experience a reduction in funding as a result of the new contract.”

Phase one of the contract has already been agreed upon following a vote late last year and it will come into force from April.

But Bowie told members of the IJB that 90 per cent of rural GPs voted against it and said they felt there was “no time to talk about it or digest it”, while the Rural GP Association of Scotland is also concerned.

The Scottish Government says the contract will bring in extra investment and allow GPs to spend more time with patients.

The contract was not up for discussion at the IJB meeting, but members had to agree to start developing a primary care improvement plan as required by the contract.

Bowie said the new contract had been designed to address “astonishing” workloads some practices in the central belt were facing, but it took into account patient numbers, which differs compared to rural areas.

She said the contract “fails to recognise” the unique kind of GP workload in rural areas, pointing to her Hillswick surgery dealing with issues like diabetes, asthma and cardiovascular problems on a scale akin to that of a practice three times its size.

Bowie said “there is a promise that the majority of practice funding will be protected for the duration of phase one, so if the work allocation formula (WAF) reduces funding, income support subsidy will compensate accordingly.”

“Sixty eight per cent of practices will receive an uplift in funding, but as rurality has been removed from the equation and more reliance is on population numbers, rural practices and deprived inner city practices whose patients do not survive into old age lose out,” she added.

The GP said she feared that the Hillswick health centre, which is one of two independently owned in Shetland along with Levenwick, could lose over 60 per cent of its funding under the proposed WAF formula.

“For five weeks I didn’t sleep, knowing that I would not be able to fund the extra doctor at my practice and therefore be able to perform my paediatric duties at the hospital,” Bowie said. “I thought we might have to lose staff.”

The doctor said she considered early retirement before the practice was given a special ’17C’ contract “negotiated locally with the health board”, adding that she hoped the new contract wouldn’t be enforced on the surgery.

Bowie said Deloitte, which assessed practices’ workloads, did not visit the Hillswick surgery or make contact over the phone.

The GP said the contract has been a “disaster” – and that its negotiators the Scottish British Medical Association, as well as the Scottish Government, may be starting to realise that too.

She also expressed concern about the retention and recruitment of staff, and health teams becoming “fragmented”.

Bowie said that the contract can “hopefully can be modified in the coming months to help both rural and deprived inner city practices and their patients.”

Third sector representative Catherine Hughson told the IJB meeting that Bowie’s words showed that decision-makers in the central belt were imposing a “blunt instrument” on the Highlands and Islands.

“I’m absolutely disgusted by it,” she said.

Primary care manager Lisa Watt said the IJB had to draw up a primary care improvement plan “that benefits Shetland” and suggested it gives an opportunity to “Shetlandise” things.

Chief community nurse Edna Mary Watson agreed and said: “It is incumbent on us to make the most out of it for Shetland.”

GPs, meanwhile, will vote again on ‘phase two’ of the GP contract in three to five years’ time, which Bowie said will introduce a GP pay scale and move to directly reimburse practice expenses.

The Scottish Government said in response that no practice will receive less funding as part of the new contract and claimed that Shetland will see a higher than average investment per patient.

“The new GP contract will ensure GPs can spend more time with patients and less time on bureaucracy, whilst helping to cut doctors’ workload and make general practice an even more attractive career,” a spokeswoman said.

“No GP practice in Scotland – rural or otherwise – will experience a reduction in funding as a result of the new contract.

“In 2018/19 we will invest £110 million to support the implementation of the new GP contract and wider primary care reform, including £850,000 in increased support to expand the remote and rural incentive scheme and relocation funds, which will have a positive impact for rural GP practices.

“Under the new workload formula and practice income guarantee, patients in Shetland will benefit from investment of £130 per patient compared to an average of £105 per patient in the whole of Scotland.”