Scotland has a similar problem with the recruitment and retention of GPs as the rest of the UK, but the remote and rural nature of much of the country meant the impact was felt earlier, prompting the influential RCGP policy paper Being Rural in August 2014.
‘We had the opportunity to look at recruitment from that angle, and much of the learning in that document is absolutely relevant to general practice elsewhere,’ Dr Mack says.
The emphasis now is on strengthening the ‘GP pipeline’, he adds. ‘We need to look at every stage of a doctor’s career, from training to retirement. We do some parts pretty well but in other parts we have serious issues.’
Medical schools need to promote general practice
A key problem for Scotland is the fact that half of the medical students in the country are not resident in Scotland at the time of selection: ‘We have excellent medical schools with great reputations and they are desirable places to study. But after training, people tend to go back to the areas they come from.’
Giving medical students early exposure to general practice is also seen as a priority, says Dr Mack, who will be speaking at the RCGP annual conference in Glasgow this week.
The Scottish medical school most active in the community can claim 40% of its undergraduates stating a first preference for general practice, compared with 18% in the least active medical school.
‘We need to make general practice a strong part of the undergraduate curriculum, so students are more inclined to work in the specialty after training – but that’s not always the case,’ says Dr Mack.
‘And doctors in the future will need skills across the specialties. We need generalists, not doctors who are limited to one specialty very early in their careers.’
In June this year, RCGP Scotland produced A Blueprint for Scottish General Practice, which made a strong case for greater investment in the service, as well as new ways of working.
New GP contract for Scotland in 2017
Scotland’s GP leaders are also negotiating a new GP contract for implementation in April 2017, which will see significant differences to the rest of the UK.
One major change could be the QOF being replaced with a new local system of quality and governance, in which groups of practices would form clusters covering 20,000 to 50,000 patients.
‘GPs will be asked to look at the core values of their practices and the healthcare needs of their local population, and from that, undertake quality improvement and audit to demonstrate that they are meeting the needs of their patients,’ says Dr Mack.
‘One of the big spin-offs is that it will facilitate the integration of care across organisations and between different health and care professionals, and improve the exchange of information.’
Mobile technology crucial for Scottish GPs
The upgrading of GP premises, practice IT systems, and the need for improved mobile phone reception and broadband in many areas of Scotland are also key points in the blueprint.
‘Mobile communication is a huge issue, not just for healthcare services, but for all parts of the rural economy,’ says Dr Mack. ‘It impacts on the patient being able to access care, the professionals needing patient information, and on recruitment, because families considering moving to these areas expect to be connected.’
Improvements in mobile technology are expected to be a key part of a report on the state of Scotland’s out-of-hours services by Professor Sir Lewis Ritchie, which is due out this month.
‘We have had a large input through the various consultation groups,’ says Dr Mack, ‘and we are expecting many of the recommendations to be congruent with what we believe should happen with general practice, in terms of IT, the measuring of quality, and new models of care.’
Dr Mack believes the Scottish government has taken on board many of the recommendations in the college blueprint: ‘What’s missing is adequate resources to make these things happen. We now need to ensure that what they have promised will be delivered as a matter of priority.
‘With a new contract being negotiated, we have a huge opportunity to change the way we work, but we still need strong and clear leadership to ensure general practice remains such a key and valuable part of the NHS.’