Scots defend essence of GP role

General practice north of the border is 'vibrant', RCGP Scotland chairman Dr Ken Lawton tells Colin Cooper.

Dr Ken Lawton: A lot of what Scots GPs have been doing for six or seven years will fit well into revalidation
Dr Ken Lawton: A lot of what Scots GPs have been doing for six or seven years will fit well into revalidation

Ten years since devolution, and GPs in Scotland are now facing a markedly different future to that of their colleagues in England, Wales and Northern Ireland.

Whether it is revalidation, the quality agenda, private providers or health inequalities, the Scots are forging their own way ahead.

With a population of 5.2 million, Scotland is the size of an average SHA in England. But there is wide diversity, with the south central urban and inner city areas balanced by more than a third of patients living in rural and remote communities.

RCGP Scotland's chairman Dr Ken Lawton says it is a 'vibrant' part of the college.

He says the quality of general practice is higher north of the border: 'We have an average list size of 1,600 per GP, which gives us more time and allows more concentration on quality.'

Tackling deprivation
But some practices in deprived areas are struggling. In September the RCGP invited GPs from the 100 most deprived practices in Scotland to a conference aimed at addressing their specific needs.

'We worked with GPs to look at their issues and the potential solutions,' says Dr Lawton.

A report from the conference will provide a strategy to tackle health inequalities. 'The health inequalities agenda is very big here. If we can get the most effective care for the money available we will be going a long way to addressing the overall problem.'

The conference was jointly funded by the RCGP and the Scottish government, underlining their strong working relationship.

'Scotland is a small nation with a small number of politicians, civil servants and GP politicians, which helps to get things done,' he says.

This relationship means that Scottish GPs are unlikely to face the same burden of regulation under the new Public Services Reform Bill as those south of the border expect from the Care Quality Commission.

Dr Lawton says: 'I accept the need for these bodies because we have to ensure that the quality of care is the same wherever you are in the UK. But I am concerned that the bureaucracy could be quite burdensome in England, whereas I do not think it will be in Scotland.'

So how will the Scots fare under revalidation, given that they will be working under the same system as England?

'A lot of what Scots GPs have been doing in appraisal for six to seven years now will fit well into revalidation. Scotland and Wales are well ahead of the game on this.'

But there have to be adequate remediation and occupational health services in place for revalidation to work, and the workload involved must be 'similar' for all GPs taking part, including those in remote areas and locums.

Resisting privatisation
The difference between Scotland and England that has really hit the headlines in recent months is the Scottish government's plan to ban private providers from holding primary care contracts.

'The health systems are diverging. England is very much a market-based economy whereas Scotland has no private provision within primary care,' says Dr Lawton.

'The SNP has been very cautious about allowing in private providers that are run for profit, and, personally, I am never convinced that all the money going to these providers is being directed to patient care.'

That is not to say Scotland will be immune from the funding problems ahead for the whole of the NHS, and difficult decisions will need to be made. But Dr Lawton believes general practice can compete with anyone, and provide solutions to the funding crisis, if it is allowed to do so.

'We can offer services and care at considerably lower costs than the hospital sector or private providers because of the way that we are set up.'

The problem in England, of course, is that general practice is not being given a fair chance. Dr Lawton warns that Darzi centres and walk-in centres herald 'the loss of continuity of care throughout life, from a doctor you can trust within your own community'.

'These new centres may well be addressing a need - and general practice has to look at itself and ask why people are using them - but a lot of it is political expediency. My fear is that they result in many areas ending up under-doctored, not over-doctored.'

Future vision
In Scotland, Dr Lawton is hoping that a major document being prepared by the RCGP's Scottish council for 2010 will set out a vision for the profession north of the border, that aims to define and protect the essence of general practice.

'We want to tie all the different strands together and see what general practice will look like here in the next five to 10 years, embedded with the values of the college around quality, education and the universality of access.

'We will work with the BMA and the government on this, and if they feel able to sign up to the document it will put general practice in a very strong position in Scotland.'

It sounds like a document that politicians from all parties, in all parts of the UK, should put at the top of their reading lists.

NHS differences between scotland and England
  •  Private providers are banned from running primary care services in Scotland.
  •  England's competitive, market-based approach to the NHS has been rejected in Scotland in favour of a collaborative model.
  •  List size per GP is lower in Scotland.
  •  Scottish appraisal model, like that in Wales, is better developed than in England.
  •  Rural deprived areas are a key issue for GPs in Scotland.
  •  Average life expectancy in Scotland is lower than anywhere else in the UK.
Colin Cooper

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