Like all other NHS services, we do not have infinite capacity.
For many reasons outlined below, demand for appointments is now much larger than our capacity to provide them. This is despite our GPs and practice staff working more efficiently and harder, longer hours. As a practice we must consider guidance on safe working in order to protect the safety of our patients and the welfare of our staff.
Previously, when all appointments were filled, our GPs would see extra patients on top of their already full surgery and a ‘duty’ GP would have an open ended appointment list to take patient calls or see them in the practice. For years, this system provided flexibility and extra capacity in practices in the hope that the Scottish Government would make changes to ease Practice workload as all regulatory organisations have recommended. This has not happened and the result is that meeting the ever increasing demand has become an exhausting and often impossible task. Until recently, our GPs daily workload often included 60 patient appointments + home visits + prescriptions + letters + sicknotes + blood and scan results. The recommended BMA maximum is 25 patients per day. Due to the effect of this on the care we provide and on our family life and our physical and psychological wellbeing, we have now set limits on our daily tasks. These limits will however still be above the recommended maximum.
Setting workload limits is reasonable and is standard for other services within the NHS and jobs in other industries. Even with this, we are still working harder than other GPs in Europe. The alternative is GP burnout and sickness causing practices to close their lists or return their contracts to the Healthboard (12 in Lothian so far).
Issues impacting our appointment capacity:
Workload. Our workload has increased significantly over the years with no increase in funding or resources to reflect this. People now make many more appointments per year than ever before. GPs can treat many more conditions than previously and treatments are more complex. People are living longer and therefore have more conditions and more complex conditions. Secondary Care waiting lists are at record levels meaning GPs have extra work managing the patients and their conditions until they are seen in clinic or receive their operation.
Staffing. The total number of GPs in Scotland has increased but the increase has not been proportionate to the increase in population size or increase in demand for GP services. The actual number of fulltime equivalent GPs has decreased. Since 2013 Scotland’s GP workforce overall has fallen by 200 full-time doctors, the number of practices by 9 % but the number of patient’s has grown by 7 %. Poor working conditions for doctors has caused a significant proportion to emigrate abroad. All these factors make finding and recruiting GPs harder for the practice.
Funding cuts. GP Practices have suffered real-term funding cuts for years meaning that we are unable to invest in services, employ more staff and increase capacity. The Scottish Government is also no longer funding the yearly increase in pension contributions meaning that this is equivalent to a further yearly pay cut of several percent. Our funding per patient per year currently is only £110 (figure from 2023 for general medical services). If it is not self-evident as to why this amount is inadequate for running a GP practice, please watch this video from another practice here. (An English practice but the funding and service is broadly similar.)
Bills. Practices have to not only pay their staff but also the building electricity, gas and maintenance. This year (2024), NHS Lothian estates is raising practice bills by 200 % – 400 %. The bill for the Almond Group Practice is being raised by 400 %. The Scottish Government is unable to support practices with this increase and therefore this will mean a reduction to our services to meet this cost.
The GP Contract. In 2018 the Scottish Government and GPs agreed on a new contract to support practices. Unfortunately, the government has not yet fully implemented any of the promises with the exception of vaccinations. Please see the Almond Group Practice’s promised support compared to the actual support here.
All the GPs and other clinicians will continue to work hard and strive to do the best for our patients. We sincerely care for the towns of Kirkliston and Winchburgh. Most of our clinicians are from Edinburgh and West Lothian and one of our Partners was even born in Winchburgh and has friends and family living there to this day. Helping people is hugely satisfying and gives our jobs genuine meaning. We hope that this is appreciated and that you understand that the problem in General Practice is not one we are responsible for or able to solve. We will continue to work hard for you and the practice management will continue to increase practice efficiency. However these are all marginal gains where significant financial and structural change to primary care is what is necessary.
We hope this statement helps you understand why practices are unable to maintain current services, let alone expand them. If you feel General Practice is an important service that you would like adequately resourced and greater access to then please contact your local MSP.
Kirkliston and Ratho – Alex Cole-Hamilton
Winchburgh – Fiona Hyslop
We have already met both MSPs in the practice to discuss our concerns.