Dr Alan McDevitt interview: Building a new world for Scotland's GPs

From 2017, GPs in Scotland will operate under a 'substantially different' model from their English counterparts, Dr Alan McDevitt tells David Millett.

Scotland may have voted no to independence last September, but Scottish GPs could soon be living 'in a different world' to GPs in the rest of the UK, says Dr Alan McDevitt.

The Scottish GPC (SGPC) chairman promises Scotland 'will have a substantially different way of contracting GP services' when the current contract is renegotiated.

The fact that no changes will take effect until April 2017 reflects how things are already working differently for GPs in Scotland.

Scotland implemented a three-year rolling GP contract in August last year. The deal means the QOF and enhanced services will remain unchanged for the next two years.

GP contract

The new approach began at last year's Scottish LMCs conference, after Dr McDevitt asked delegates to vote for a split from the UK deal. The SGPC announced its fixed contract just five months later.

Although the 2015 Scottish LMCs conference is scheduled rather ominously for Friday 13 March, Dr McDevitt has no intention of slowing the pace this year.

'If we are to deliver by April 2017, we have to have written the contract by the end of summer 2016,' he says.

'By the time the next conference comes around, we should be well on our way to describing the practicalities of bringing it in - so this is the conference for us to debate the issues and get people's views and votes.'

The current contract is not wholly unrecognisable from its UK origins. Dr McDevitt says it is similar, 'but without some of the bad things' and with 'some changes for the positive'. It has kept the MPIG correction factor, which is in the middle of a seven-year phasing out process in England.

'That is causing clear problems in England,' he says. 'Quite a number of practices in Scotland would have had to close if we changed MPIG. So we haven't had that destabilisation.'

Scotland has also kept up seniority payments, which Dr McDevitt believes has convinced 'valued' older GPs to stay in the profession.

'Keeping these GPs is vital. Workforce shortages are the greatest threat to the future of Scottish general practice,' he says. The latest data show applications for GP trainee posts fell 10% last year, more than the 6% drop observed in England.

'Our rural colleagues are often the first barometer of our problems, and they've had at least a year of significant recruitment problems,' Dr McDevitt says.

'That's in the Highlands, Grampian, the Islands, Dumfries and Galloway. But we're seeing practices in the central belt - Forth Valley and even Edinburgh - having discussions on what they'll do when there are no GPs to fill their vacancies.'

That even Edinburgh is approaching crisis point confirms 'just how serious the problem is', Dr McDevitt says. He and his team have their work cut out to find a way around these problems in contract talks.

It is no secret that GPs are struggling with rocketing workloads as the workforce dwindles. Workload increases can also be attributed to demographic change, with patients living longer and requiring more complex care.

'If GPs need to focus on complex care, that will take up more time. So we have to change the rest of what we're doing,' Dr McDevitt says.

The future Scottish contract is likely to see general practice become embedded in wider 'primary healthcare teams' incorporating pharmacists and nurses with expanded roles - with GPs as the senior clinical decision-makers.

'The contract will allow GPs to focus on providing expert clinical generalist advice to patients,' he explains. 'The difference from the current contract is that we will move away from the idea of providing much broader services to providing expert clinical advice to patients as part of a much wider team.'

The plan seems to bear some resemblance to NHS England's proposals in its Five Year Forward View. Perhaps the key difference, though, is that Scotland already has its government on side.

The SGPC is visiting all LMCs and health boards in Scotland to discuss how to make general practice viable and sustainable in the future. About half have been visited so far.

Dr McDevitt is keen to get feedback from everyone. Next month will take him to Shetland, Orkney and the Western Isles. 'This is a unique process where we're visiting the LMCs around Scotland with Scottish government negotiating colleagues. And they're inviting us to their meetings with health boards.'

Meeting needs

Dr McDevitt says there are three things GPs will concentrate their time on under the new contract.

They will see patients with undifferentiated needs that cannot be met by other clinicians, and patients who require complex care, and provide expert generalist medical advice to other members of the primary healthcare team.

Services such as vaccinations will be carried out by health and social care partnerships, and GPs will no longer be running those services.

'We also think every GP will need time away from patients to get involved in quality education and management training. We should start to find time in the contract for that.'

In short, he says, it is about allowing GPs to be GPs again. 'We're hoping the contract will pave the way for GPs to be expert clinical generalists doing expert clinical generalist work, with a practice list of patients they know over a long period of time.

'I love being a GP; it just has some severe problems with volume and intensity. If we fix that, I think it's a fantastic job,' he adds.

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