Scottish GPs back new contract making them “expert medical generalists”

Authors: Bryan Christie 

Publication date:  04 Dec 2017

The proposed new contract for family doctors in Scotland has been backed at a special conference of local medical committees where the Scottish government announced plans to recruit an additional 800 GPs over the next 10 years.

LMC leaders were asked for their views on the potential of the new contract to reduce workloads, make the service more sustainable and attractive, and reduce the risks to GPs associated with owning premises and employing staff. In each case there was a majority in agreement, with the conference registering votes of between 79% and 85% in favour of the new contract.

The new deal, which has been agreed between the BMA and the Scottish government, seeks to establish GPs as “expert medical generalists” who lead expanded community multidisciplinary teams. It allows for responsibility for some services (such as vaccinations) to be transferred to health boards without loss of funding. Practices in deprived areas and with high proportions of elderly patients will benefit, and a guaranteed minimum income of just over £80 000 is offered for GP partners. Interest free loans will be made available to help with premises as part of a long term move towards relieving GPs of the need to own their own practices.

The positive reaction of the LMC conference contrasts with opposition that has been voiced elsewhere, especially through social media. An online poll conducted in Highland LMC found that 72% of respondents were opposed to the new contract, with only 11% in favour. The Rural GP Association of Scotland has warned that the new funding formula being used in the contract would see a massive shift of funding from rural to urban areas.

Concern was also expressed at the conference that the new contract marked the start of a “salaried service by stealth,” a possible loss of autonomy, and undervaluation of rural general practice. There were also worries that the plans could fail if the money to support extended community teams did not filter down from health boards.

The chair of the BMA’s Scottish GP committee, Alan McDevitt, rejected those criticisms. He said that although the funding formula was changing, income was being protected for every practice in Scotland, with no time limit on the guarantee. The Scottish government and the profession remained committed to the independent contractor status, he said, and the contract’s implementation would be monitored closely to ensure that it was delivered appropriately.

He said that GPs faced a choice between a contract that offered £250m of extra funding, together with practical solutions to current problems, and a status quo that has produced workload and financial pressures and recruitment and retention problems.

“This is a contract for the whole of general practice in Scotland,” McDevitt said. “It offers solutions, and it provides much needed additional resources. It will give us more time with our patients and will make sure they have access to a wide range of professionals more quickly and more locally.

“I truly believe it will deliver a brighter and more sustainable future.”

Speaking to the conference, Scotland’s health secretary, Shona Robison, announced plans to recruit an additional 800 GPs over the next 10 years. As part of this initiative £7.5m is to be spent in 2018-19 on extending financial incentives to all 160 rural practices in Scotland. “Golden hellos” of £10 000 will be on offer, in addition to £5000 relocation packages.

GPs in Scotland will be asked to vote on the contract in a poll that opens on 7 December and runs until 4 January. The final decision will be taken by the BMA’s Scottish GP committee on 18 January.

Bryan Christie Glasgow

Cite this as BMJ Careers ; doi: