Hard times ahead for Scottish GPs

The invisible line separating England and Scotland is all that determines whether a GP is contending with the biggest NHS reorganisation in history or experiencing a much more considered approach to change.

LMC delegates voted against scrapping the UK-wide contract, but GPC Scotland chairman Dr Dean Marshall is clear that the disquiet will not go away.

He says if politicians in England press ahead with their plans for NHS reform a 'massive gulf' will be created between England and the Celtic countries, prompting a disintegration of the UK-wide contract by 2016.

It is not just a divergence in health policy that sets the countries apart, but also the governments' differing relationships with general practice.

After an initial stutter, the Health Bill in England appears to be going ahead against a backdrop of widespread concern from the profession.

On the same page
But Dr Marshall says the Scottish government and GP leaders north of the border are largely on the same page about NHS reform. 'The BMA and the Scottish government are not hugely ideologically apart on where we want to go,' he says. 'The arguments are over how to get to that point.'

In particular, Dr Marshall says the Scottish government has been hugely receptive to BMA Scotland's Way Ahead report, published in early 2010.

The wide-ranging report set out changes needed across six key areas, including access, out-of-hours care, health inequalities and infrastructure.

A review of progress on the Way Ahead objectives is due early next year, but Dr Marshall says on the whole the report has been a success.

'The report is now regularly quoted in government communication with the profession and it has been very successful from that point of view,' he says.

'I'm not aware of any other document that has had that impact, certainly not a BMA one.'

Dr Marshall says progress is being made on a number of areas highlighted in the report, most markedly on health inequalities. Progress on premises improvement has been limited, but he adds: 'That's hardly surprising in the current financial climate.'

This relatively harmonious relationship could come under pressure in future, however, as Dr Marshall suggests GPs in Scotland face tougher times.

Speaking in Edinburgh on 30 November, as millions of public sector workers in the city and across the UK protested against cuts to NHS pensions, Dr Marshall is unflinching in his criticism of the Scottish government's handling of the issue.

The Scottish government can decide not to implement the changes, but in doing so would forfeit £400 million each year for three years running of the funding it receives from the UK government.

But Dr Marshall says the Scottish government's claim that its hands are tied because it cannot afford the bill for breaking away from the UK pension scheme is 'just an excuse'.

He says: 'The government in Scotland has the opportunity to do something different and has chosen instead just to blame the UK government. It has taken the easy option and I don't think it has seriously looked at the alternatives.'

Revalidation
Dr Marshall is equally scathing about the government's position on revalidation. Earlier this year the GMC hinted that revalidation could be rolled out first in the Celtic countries as they were better prepared.

But Dr Marshall says any progress that had been made has now stalled. He says a working group set up to thrash out issues specific to revalidation for GPs has now been replaced by an 'overarching group for all doctors'.

'I think in Scotland we were doing very well, but unfortunately actions taken by the Scottish government and those in charge of revalidation in Scotland are having an adverse effect on GP revalidation.

'We think GPs have particular issues and that a separate group is a far more sensible way to go.'

Dr Marshall says issues still remain on how sessional GPs will be revalidated and warns that unless these are resolved Scotland will not be implementing revalidation first.

'Unfortunately there is a view that Scotland wants to be leading the way, but we are not going to agree anything that puts Scottish doctors in a worse position than their UK colleagues,' he warns.

GPs in Scotland, along with those across the UK, will therefore have a lot to contend with in 2012. But beyond June, Dr Marshall will be stepping down after five years at the helm.

It is clear that while GPs in Scotland do not have to contend with the NHS reforms their English counterparts are experiencing, they are not completely insulated against NHS change.

Whoever takes over the reins from Dr Marshall will have their work cut out to help steer the profession through these tough times ahead.