Measures introduced in 2018 to ease pressures faced by GPs were not having the intended effect three years after the changes were first put in place, according to findings from research by Public Health Scotland.

A series of reforms introduced in the GMS (GP) 2018 contract set out to expand multidisciplinary teams within primary care to support GPs by taking away their direct role in vaccination, medicines management and mental health support.

However feedback collected in 2021/22 from GPs in nine health boards shows that many did not think the reforms had provided their practice with access to phlebotomists, pharmacy staff or community link workers staff as promised. 

Though nearly all the respondents believed there was at least some potential for the new staff to make a positive difference to GPs, concerns over funding and recruitment were seen as key barriers.

Even in practices that had had access to new staff teams, the prevailing view among GP respondents was that there were too few additional staff to make a meaningful difference to the needs of either GPs or patients.

Just 14% of the one in five eligible GPs surveyed said their patients had sufficient access to a mental health practitioner, while 59% reported they had no access at all to urgent care staff.

Pharmacy and mental health practitioners were seen by respondents as the staff groups most likely to make a significant difference to GPs workload.

While 83% of surveyed GPs said the additional staff had helped ease their workload to some extent, only 6% said this had translated into them being able to offer longer appointments.

 

2023 challenges in primary care improvement

Since the period covered by the survey just published by Public Health Scotland, implementation of the primary care improvement programme has continued to prove challenging, with cuts to funding, issues with recruitment and what GPs have described as a lack of commitment from health boards to deliver these core services.

The first three priorities of the contract – vaccination, pharmacotherapy and chronic disease monitoring – transferred across to health boards in April 2022.

Despite this, a progress report published earlier this year shows that, as of March 2023, around one in four GPs still did not have access to poly pharmacy review services, while 44% had no access to chronic disease monitoring.

April 2023 guidance now confirms medicines management and phlebotomy are no longer the responsibility of GPs, with health boards now having to pay practices directly for filling any gaps in these services.

Meanwhile, plans to create 1,000 new staff posts including community link workers and mental health nurses, backed by annual funding of £10m, were shelved after the budget for primary care improvements was cut last year.

Speaking to healthandcare.scot earlier this year, Dr Patricia Moultire, Medical Director at Glasgow Local Medical Committee, said insufficient funding is derailing the full delivery of the GMS contract.

Most recently, the Scottish government was forced to step in and fund the next three years of Glasgow’s community link worker service, after local funding challenges threatened cuts of more than a third.

BMA Scotland said earlier this year that ministers’ continued failure to issue enforceable directions setting out exactly what health boards are expected to provide, has created a ‘considerable contractual gap’ in the provision of key services which could lead to patients waiting longer to be seen.

 

Read more: GP contract changes too slow to fix ‘unfolding crisis’; Glasgow link workers protected for three more years

 

 

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