The local GP surgery is such a mainstay of every community that many of us never imagine it could disappear.
Eight thousand Aberdonians are the latest to learn that it can. Patients of Carden Medical Centre in the west end of the city have been told the practice is shuttering at the end of next month due to a lack of doctors. Surgeries in the area are being asked to take on patients two months away from having no registered GP.
It’s a nightmare scenario for most, and especially those with long-term health conditions or whose children are prone to pick up every bug on the go, but the situation isn’t all that unusual. In the last decade, the number of GP practices in Scotland has dropped from 1,019 to 928, a decrease of almost one in ten.
A survey conducted in October by the Scottish branch of the British Medical Association found that nearly three in ten surgeries had one or more GP vacancies while more than eight in ten reported being unable to meet demand for appointments. That demand ‘substantially exceeded capacity’ in four in ten surgeries.
In a country with such a pronounced aversion to the provision of publicly funded healthcare by private practitioners, the esteem in which GPs have been held stands out. They are the largest network of private healthcare providers in Britain, yet frequently praised in surveys of patient opinion as the best part of the NHS. The fact that they aren’t part of the NHS, and that most GPs are independent contractors whose services are retained by the state in the same way that multinationals retain entire law or accountancy firms, seems to escape most of their patients.
Where Aneurin Bevan was unable to persuade family doctors to become employees of his new NHS, patients have carried out a sentimental nationalisation all of their own, bringing GPs into public reverence if not public ownership.
Yet after 18 months in which the link between patient and practitioner has been severely strained, that connection is set to suffer another rough tug. From next Monday, Scottish Government guidelines will require surgeries to take patients through a nine-question survey either when they phone for an appointment or when they present at the surgery.
The rationale behind the questionnaire is to filter patients into respiratory and non-respiratory, a reasonable dividing line during a pandemic caused by a severe acute respiratory syndrome like Covid-19. The problem is that the process can take up to two minutes. This might sound fleeting but repeated for every call to every GP surgery in the country every day, it eats into the time doctors have to see patients.
Dr Andrew Buist, who is the head of the Scottish GP committee of the BMA, told BBC Scotland: 'We see one million patients each month face-to-face in our GP surgeries, I don't think we can maintain that if we're having to do this new process.
'The experts might tell us this is the right thing to do, in that case we need to tell the public. It shouldn't be me telling the public — a very senior person in the Scottish Government needs to explain to the public what is happening and why it will be more difficult to get an appointment with your GP.'
Dr Buist has been at this for a number of years but he sounds as though this is his first dealing with the Scottish Government. If anything, it's almost commendable that ministers didn't wait until the night before to publish the guidelines.
Nicola Sturgeon has undertaken to listen to GPs' concerns about the questionnaire and 'see whether that can be made any easier and whether there can be greater flexibility', but she says the survey is directed to 'trying to ensure that we keep Covid cases, as far as we can, out of GP practices' in order to 'keep GP practices open as much as possible'.
The implication that GP practices have been open until now is a novel interpretation of what has occurred since Covid-19 arrived in Scotland. The buildings may have been open and some of the GPs inside them but many patients have felt shut out of their community healthcare hub.
For a long time, face-to-face appointments were like winning lottery tickets and other services made available by GP practices, from nurses to mums 'n' tums groups, were off-limits. This caused serious dissatisfaction on top of the conditions that went undiagnosed as a result. The prospect of making in-person appointments a scarcity once more is sure to aggravate the discontent patients already feel.
Over the last 18 months, I’ve lost count of the number of (mostly older) people who have said the same thing to me: our old doctors would never have done this. They resent their local surgeries saran-wrapping themselves the moment Covid hit and, as they see it, leaving patients to fend for themselves. They are convinced, rightly or wrongly, that an earlier generation of family physicians would have moved Heaven and Earth to keep their doors open.
Many GPs would protest that it was imperative that Covid-19 not overwhelm the primary care system, but to some patients, especially those of a certain age and with chronic conditions, it feels as though their local surgery was overwhelmed anyway — by new practices that made it nigh-on impossible for them to see their GP in person.
It’s easy to be callous about this and say boomers should just learn how to work a smartphone, but virtual appointments were a very different proposition if you were already familiar with FaceTime, Skype and the rest. For those unversed in the rapidly-evolving video communications market, not only the technological hurdles but the prospect of describing or displaying medical complaints via video link was daunting.
GPs have as much interest as patients in resuming the status quo ante March 2020 because further weakening of the bonds between them and their patients will undermine their profession as much as it will the service afforded patients. Moves to shift more responsibilities onto pharmacies are already going to dislodge GPs from the centre of patients' healthcare experience.
Advances in artificial intelligence, though Scotland's reform-averse health bureaucracy may be reluctant to benefit from them, are also going to transform the profession in the coming years. Ironically, GPs have helped make the case for this by maintaining that primary healthcare could be adequately provided for the most part without physical contact.
The traditional, flesh-and-blood GP still has a crucial role to play in tending to patients' health and while reform can only be resisted so long, change need not mean a diminishing of the profession or the quality of healthcare it supplies. What is more likely to bring that about is GPs repeating the surgery lockdowns of 2020 and 2021 or allowing ministers to foist on them paperwork that makes it harder for them to see their patients. GP surgeries can vanish and so can the respect GPs have spent generations building up.
Here’s a brain-teaser to stump even political anoraks: Can you name the four women who have served as Liberal Democrat MSPs?
Yes, you read that right: in 22 years, the Lib Dems have had only four female MSPs. That’s the same number as the Scottish Socialist Party, which hasn’t had any MSPs since 2007. Since the Scottish party’s founding in 1988, there hasn’t been a single female leader and only one deputy (a two-year stint by Jo Swinson). In the party of proportional representation, only blokes are ever first past the post.
This situation was starting to look silly, what with it being 2021 and women being allowed to vote and ride bicycles unchaperoned, so the appointment of Wendy Chamberlain as deputy leader is progress. Alex Cole-Hamilton knows his party is in a bad way and in sore need of a purpose. It's up to him and Chamberlain to find one.
(Oh, and the answer: Alison McInnes, Nora Radcliffe, Margaret Smith and Beatrice Wishart.)
Originally published in the Scottish Daily Mail on December 6, 2021.
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