Scottish LMCs conference: chairman's speech in full

GPC Scotland chairman Dr Alan McDevitt told delegates at the 2013 Scottish LMCs conference on Friday that he fears politicians 'have lost sight of the point of general practice'. Read his conference speech in full.

GPC Scotland chairman Dr Alan McDevitt
GPC Scotland chairman Dr Alan McDevitt

Good morning conference, let me start with a simple question. General practice - what’s it about?

Is it about caring for the sick? Is it keeping people healthy and well? Is it to improve and protect public health?

Or is it just about delivering targets? Well if it’s not just about that, then sometimes that’s how it feels.

It should be about having time for the patient. Time to listen, time to explain, time to help the patient decide what to do and how the NHS can help. But most of all – time to care.

In the drive by governments to squeeze as much out of the contract as possible, I fear that politicians have lost sight of the point of general practice and that is to provide care for our patients when they are unwell.

You know what it’s like in consultation. Before you even speak to the patient, you face a barrage of questions and reminders from your computer. There are so many things that must be checked in order for you to have achieved the target.

In a 10-minute consultation, where does this leave time for the patient? My time, your time, should be for the patient and we have gone too far in bringing other agendas to the consultation.

We need to take a step back, reconsider and remember the purpose of general practice and focus on our patients.

All too often we find ourselves bogged down by the processes, filling in forms, ticking boxes; being micromanaged through an increasingly bureaucratic process. Is this what you imagined when you dreamt of a career as a GP?

'Fast food' general practice

There are those who think that general practice can be broken into a series of menus like a fast-food restaurant giving the patient a limited choice of options always delivered exactly the same way. I can say now that that's not the way to deliver complex personalised humane care.

As your chairman, it is my intention to refocus the government back towards the patient. We know that times are hard, the lives of our patients as described to us in the surgery make that quite clear. When you sit at the sharp end of the NHS you need to know that you have the support of the NHS and the government behind you in dealing with what patients require.

We must be aware of the needs of the population and we do have to use the country’s resources wisely but if you feel undermined and undervalued you cannot deliver the care patients deserve and maintain the values and aspirations of NHS.

So don't let's make the mistake of deconstructing general practice. General practice is a curious hybrid of public service and independent contractor yet that is what makes it responsive and flexible and able to absorb the health challenges that the country faces.

The general practice way of doing things is the right one for the future health needs of Scotland.

In these straightened times it is important that we deliver value for money and the best way we can do that is to ensure that our patients get the best possible care either from us in general practice or from specialist services that we refer our patients to.

Rising workload

Workload is increasing – there’s no doubt about that. 

Shifting the balance of care has resulted in more work undertaken in primary care settings without the associated shift of resource. Instead of dumping work on general practice, NHS managers should look, with us, at the patient journey, consider the right place to treat patients and ensure investment in a service that provides the quality of care that our patients rightly expect. This is not just the most sensible approach; it’s likely to be the most effective.

It’s not just the government’s policy of shifting the balance of care that is adding to our workload. 

The UK government’s flawed approach to benefits reform and changes to the work capability assessments are flooding GP practices across Scotland with additional avoidable work, and are driving patients to us seeking support for appeals, which the government does not fund.

GPs are being criticised for the failures of this new process but I want to make it absolutely clear today that GPs have been dragged into this process because of badly thought out policy and poorly designed systems which are impacting on general practice and having a serious effect on our patients and our relationship with our patients. The damage is immeasurable. I hope that government will listen to our debate on this issue today and take steps to alter the reforms.

It is clear to all of us in this room that the rising workload just isn’t sustainable. I’ve seen the work piling up – we all have – but what I don’t see are the resources to sustain this workload.

Yes, these are tasks that general practice can do. Yes, some of these tasks can help the NHS run more efficiently. But without additional support and resource general practice does not have the capacity to provide these services in addition to those we already carry out. Something’s got to give and I do not want our patients to suffer because general practice has reached saturation point.

We need more GPs, more practice staff, better facilities and increased funding to ensure that we can do the thing we do best – make our patients' health better.

Conference, this is my first year as SGPC chairman – and it has been quite a year – I have many people to thank...

In the past year, we’ve seen the best and worst of the Scottish government – At its best when they worked with us to negotiate a fairer deal for Scotland’s GPs, but at its worst when it refused to act independently of Westminster on the issue of our pensions.

Contract negotiations

The contract negotiations were, as you know, a response by the Scottish government to the hard-headed approach by the DH in England. Alex Neil made it very clear that he preferred to reach an agreed conclusion rather than forcing an imposition on GPs in Scotland. He, like us, also agreed that the DH’s proposed changes were not good for patients. It was in that context that we entered into negotiations on an agreement to the changes for the contract. It clearly shows what we can achieve if we work together.

I know that the contract changes aren’t perfect and that we need to keep working to improve the situation. But what we managed to negotiate was immeasurably better than the destructive changes that are being imposed on our colleagues in England and Northern Ireland. I don’t want to dwell on the situation in the other nations but it is right for me to send a message of support to our colleagues in the rest of the UK, for we may have diverging health systems but we still share the ideals and hopes for the future of the NHS in the UK.

Let me be clear. This agreement is within the context of the UK contract. This is not a Scottish contract, but it is clearly a ‘more’ Scottish contract and is, perhaps a reflection of the requirement for flexibility in the contract to meet the needs of our increasingly different health services within the UK. Again, I look forward to you debating this issue later this morning.

There will be many more opportunities for us to work with the Scottish government in the coming months and I am pleased that the cabinet secretary has taken the time to come and speak to us here today. We have made some progress, but there is still much to be done to ensure a fair deal for our members and for our patients.

And so I say to the government, look at what we can achieve when we work together in Scotland. We are not the problem; we can be part of the solution. Work with us, listen to us and engage with us to ensure a better future for general practice in Scotland.

In the next few months, the Scottish government will publish its legislation for the integration of health and social care. This policy is, for many of us, already tarnished with the chequered history of previous attempts to create, or force, joint working between the NHS and social care services.

But it is not helpful for us to dwell on the past, instead we should learn from these mistakes. It is clear that one of the main reasons CHPs weren’t successful was the failure to engage local GPs. But the increasingly aging population means that we need, this time, to do something that works. I urge each one of you here today to ensure that GPs across Scotland have their voices heard.

Not everyone is able to have great involvement in health and social care partnerships, many of us haven’t the time or the enthusiasm, but we, as advocates for our patients, should have the opportunity to have a say on how services should be organised and run. And so it is essential that we have people representing us on these bodies, ensuring that our voices are heard. We don’t have to lead these partnerships but we do need to influence them. This is how we can help bring about change. We can’t sit on the side-lines and expect to be listened to. We must ensure our place on the team.

Colleagues, this past year has been quite an incredible learning experience for me and I have been proud to represent you. Scottish general practice is essential to the future of the NHS. We are privileged to have the trust of our patients and we should never take this for granted. It is important that we stand up for ourselves and our patients.

We have the opportunity to engage in developing policy and to lead and influence the debate on the future of general practice in Scotland.

It's what our patients deserve so let’s make sure it is time for the patient.

Conference, thank you.

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