Viewpoint: The challenges faced by the NHS in Scotland

In his last guest editorial of the year, RCGP Scotland chair Dr John Gillies looks at the future challenges faced by the NHS in Scotland.

Dr Gillies: 'While hospital stays are getting shorter, I haven’t seen much evidence of an increase in the resources in primary and community care'

In terms of getting round my practice, things are better than last year; we have no significant snow or ice so far. Trying to be prepared, I’ve put snow tyres on my car but haven’t used them in anger yet. Also, we have no flu epidemic, at least not yet.

However there are some worrying developments. A recent report tells us that there are 1,500 fewer nurses and midwives in the NHS in Scotland than last year. 

It’s not clear how many of these losses are in primary care but at a time when our population is getting steadily older and we wish to ensure person-centred care for all patients, this is a concern.

While hospital stays are getting shorter, I haven’t seen much evidence of an increase in the resources in primary and community care to deal with the increasing demand on district nursing services.

We know that in many areas of Scotland, these services are being reconfigured. I’m sure that practices will be keeping a careful eye on the situation to ensure that our patients are properly supported.

In England the new guidance on support for clinical commissioning groups (CCGs) seems designed to move new players into the field - social and private enterprises - which may limit the freedom of CCGs to determine how to commission care.

These proposals are still in draft form but don’t seem at first sight positive to me. The Health and Social Care Bill (England) is still being examined by the Lords, who are certainly fulfilling their democratic duty in subjecting it to a forensic examination.

However, I think the degree of disruption caused by such a major change must have a serious effect on the service during the transition. I can’t see either how the proposed cost savings are realistically to be achieved.

More positive by far, I thought, was the launch of the Scottish Partnership for Palliative Care’s new website, Good life, good death, good grief.

The partnership aims to help us all - GPs, NHS staff and organisations, patients' relatives and the public - to talk more openly about death and dying. It would make a great subject for group work for GP trainees and is a practical and thought-provoking resource for all of us.

I hope that the flu and the snow stay away. Have a great Christmas and New Year.

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