New GP contract hampering efforts to retain rural Scottish workforce

GP contract reforms introduced last year in Scotland are hampering efforts to retain rural doctors, the former chair of the Rural GP Association of Scotland (RGPAS) has warned.

Scottish parliament: MSPs warned over rural GPs (Photo: RollingEarth/Getty Images)
Scottish parliament: MSPs warned over rural GPs (Photo: RollingEarth/Getty Images)

Speaking at a Scottish parliament health and sports committee meeting last week, East Lothian locum GP Dr David Hogg revealed that clinicians working in rural parts of the country had been left feeling ‘devalued’ by the terms of the new GP contract. He said this was because the contract underestimated their worklaod, affecting how much they could earn.

Although Dr Hogg said it was positive to see a recruitment drive to attract doctors into rural practice, he argued that a focus on retaining the rural workforce by improving the terms of the contract would be more effective.

The new GP contract took effect in Scotland in April 2018 and saw the introduction of a new funding formula, which aims to reflect practice workload better through increased weighting for older patients and deprivation.

Extinction of rural GPs

But rural GPs warned the contract could lead to the ‘extinction’ of rural practice in Scotland because it failed to regonise the needs of rural practitioners and could potentially strip away as much as two-thirds of their core income.

Almost a year and a half into the contract, Dr Hogg said a lack of ‘rural proofing’, which would have helped to protect the interests of rural GPs, was affecting the retention of this group of clinicians.  

‘There’s a lot being said just now about recruitment to rural areas and it’s great to see some of these innovations, but the real view being expressed is that the best mechanism for increasing recruitment is retention,' he told MSPs.

‘This is why Australia and New Zealand have been historically so attractive for [rural GPs] because they see happy, supported GPs in these areas.

‘We are in a situation where rural GPs are feeling very fragile about what’s happening - they’ve seen their workload estimates, or a measure of the work they are doing fall by 82% - in some cases - over what they are actually delivering, so there’s a real problem that GPs are feeling devalued.’

Rural proofing

Given Scotland’s geographical makeup - with one fifth of the population in remote communities - Dr Hogg expressed his disappointment that more was not being done to look after rural practice. Dr Hogg resigned from the Scottish government's Rural Short Life Working Group (SLWG) due to a lack of action.

‘Surely we should be aspiring to a stage where in many policies, not just in healthcare, there is a mechanism by which policies and decisions go through a rural proofing process, just like Canada does, just like Australia does.’

Reacting to Dr Hogg’s comments, chair of BMA Scotland’s GP committee Dr Andrew Buist felt it was equally important to focus on recruitment as well as retention to improve the health of the rural GP workforce: ‘There are a lot of GPs approaching retirement age, who have spent and fulfilled careers in remote and rural areas,' he said.

‘However, we know from speaking to newly qualified GPs that attracting them to remote rural areas, taking them away from the busy urban centres within Scotland, can be difficult - even though they also report that once they have step in that direction, they enjoy and build their lives in the communities that they serve.

GP recruitment

‘To fully tackle the recruitment challenge we face, we have to ensure that general practice is fully funded so that GPs have the resources and support that they need to make sure that they can forge a career in remote and rural areas.

In August, an Audit Scotland report projected that the total GP workforce in Scotland would increase by just 19 GPs by 2027, despite a recruitment drive. The report, which estimated that the workforce would grow from the current total of 4,398 to 4,417 by 2027 pointed to an ageing workforce and problems with recruitment and retention as major issues to boosting this number.

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