MSP extremely concerned about GP Contract after resignation from working body

19th March 2019

Highlands and Islands Labour MSP Rhoda Grant is extremely concerned for the future of remote GPs' practices after a prominent figure from the Rural GP Association of Scotland (RGPAS) resigned from a key working group.

Dr David Hogg, Vice-Chair of RGPAS, says that the short life Remote and Rural General Practice Working Group, set up by the Scottish Government in the wake of the New GP Contract, appears to have "fallen by the wayside" when it comes to finding ways to ensure the contract is implemented successfully in rural areas.

Moreover, Mr Hogg says he has become "increasing despondent about us seeing any pragmatic, realistic proposals to reverse the damaging effects of the new GP Contract in rural Scotland". There is also no-one to take over RGPAS's representation on the working group because Dr Hogg's says his colleagues are occupied "trying to safe-guard local services from the threats of the new contract".

"This doesn't bode well for the future of rural health care when GPs are stressing that what's on the table with the new contract is an urban model and this just doesn't suit remote and rural areas," said Mrs Grant.

"A recent survey carried out by RGPAS highlighted that 82% of members believed the outlook for rural healthcare was worse under the contract, 88% of members voted to reject the new contract at the time of implementation, while 92% said they would vote to reject the contract based on their experience so far.

"GPs are worried it will cause poor continuity of care for patients and that procedures, currently performed at surgeries, are being centralised - for instance for blood tests or vaccinations. This will inevitably inconvenience patients and worsen health outcomes by raising barriers to care.

“My reading for Dr Hogg’s resignation is that the working group is turning a deaf ear to very serious concerns being raised by rural GPs across Scotland and the Highlands and Islands. He’s tried but he can’t try anymore and the process appears to be painfully slow.

“I will again contact Health Secretary Jean Freeman about this new development asking that she does not brush off the problems suffered by rural GPs, only to hear the views of urban GPs."

In January Mrs Grant met Ms Freeman in Holyrood alongside Dingwall GP Miles Mack and Inverness GP Phil Wilson, also a Professor of Primary Care and Rural Health at the University of Aberdeen, to discuss the challenges faced by rural and remote practices under the new contract. The issue had been raised with her and with her Labour MSP colleague David Stewart.

GPs have told the MSPs that the new contract fails to recognise the unique workload in rural areas where surgeries deal with a far greater range of medical problems - including emergencies that would be dealt with in hospitals in urban areas.

The contract states that other health care professionals will be employed to deal with extra tasks such as blood tests or vaccinations but Mrs Grant argues there must be flexibility for GPs to retain the old system of care. The new contract’s funding formula has been based, under this new system, on the number of appointments and does not take account of issues in rural areas such as patient and doctor travel.

The short life Remote and Rural General Practice Working Group (RRGPWG) remit is working to support rural areas to deliver the first phase of the new contract. The group members include the BMA, Royal College of General Practitioners, Scottish Rural Medicine Collaborative, Scottish Government, NHS Boards, integration authorities and patient representation.

Letter of resignation by Dr David Hogg to -

Prof Sir Lewis Ritchie

Rural Short Life Working Group

Primary Care Division

Scottish Government

St Andrew’s House

Regent Road

Edinburgh

EH1 3DG

12th March 2019

Dear Lewis

Rural Short Life Working Group - resignation

It is with disappointment that I wish to advise you of my resignation from the rural Short Life Working Group.

This is a pivotal time for the future of rural practice in Scotland. The concerns of the RGPAS Committee and our members have been well documented since the new GP contract was first proposed. The promise of an effective SLWG to address these concerns, and specifically, to find ways to ensure that the contract could be implemented successfully to rural communities, seems to have fallen by the wayside.

I am obviously constrained in this letter to maintain confidentiality about the nature of recent conversations at the SLWG, and so I have refrained from citing specific recent discussions and topics covered. I would of course be willing to discuss this in more detail if that would be helpful. However, I am concerned that SLWG work is being distracted from urgent issues raised by implementation of the contract, to wider aspects of rural health in general that are outwith the remit and capacity of the SLWG.

I have valued your discussion to date on the practicalities and realistic potential of the SLWG to implement effective measures that have been so clearly lacking from the outset of contract implementation. It is incumbent of me to represent the views of our committee and members, and I feel it is no longer sustainable to do this with the present direction of the SLWG.

We recently carried out a survey of our members to hear their current experiences of contract implementation. This was offered to the SLWG for distribution and consideration by its members, and I understand that that is still being considered by the team.

I summarise some of the results below as I think they are important in highlighting the current perspective of Scotland’s rural GPs.

• 80 survey invitations gathered a 63% response rate within seven days.

• 82% of our members believe that the outlook for rural healthcare is worse under the contract (18% believe it is much the same, none believe it is better).

• In the vote to accept or reject the new contract, 88% of our members voted to reject the new contract. 92% report that they would reject the contract if given an opportunity to vote now, based on their experience so far.

• 50% are not sure how effective the rural SLWG has been in addressing the concerns raised to date. 47% believe that the rural SLWG has been ineffective or very ineffective so far. I think this offers important feedback about the need for better engagement and feedback with rural GPs in Scotland.

• 31% of our members are anticipating that services will need to be curtailed as a result of the current contract making for unsustainable conditions.

• Our members are particularly concerned about vaccination programmes (including to children), appropriate contingencies for when the promised MDT-provision is not provided in rural areas, and losing the economies of generalist service provision - both in terms of financial value-for-money and in the provision of effective, joined-up primary care services.

At the last meeting, I was asked again what RGPAS members wish to see improved as part of the roll-out of the new GP contract to rural areas. Again, I am disappointed that despite providing Scottish Government in November 2017 with very detailed and fair concerns (‘Looking at the Right Map?’), along with specific proposed solutions to these challenges, there has still been no effective response to these, and there remains an ongoing reliance on rural GPs to fix the problems caused by lack of appropriate rural-proofing in our national contract.

98% of Scotland’s land mass is considered rural. 20% of the Scottish population live in a rural area. I have become increasingly despondent about us seeing any pragmatic, realistic proposals to reverse the damaging effects of the new GP contract in rural Scotland. Integrated Joint Boards and Health & Social Care Partnerships across Scotland seem to be increasingly expectant of the rural SLWG to guide them on how to implement the new contract successfully, however this guidance seems a long way off. The SLWG terms are also constrained in being unable to tackle some core challenges relating to the new contract: particularly the disparity of resource allocation via the new SWAF.

Much detail has been provided to the SLWG, Scottish Government officers and the Cabinet Secretaries already in relation to this particular point. In addition, there seems to have been no attempt so far to define a framework of additional services that are already provided by rural GPs, but which are being threatened by the new contract. Again, this is one of the key solutions proposed by our ‘Right Map’ document submitted in 2017.

I have discussed the present situation with our RGPAS committee, and it is a committee decision that I should resign from the SLWG, and for RGPAS to withdraw from further SLWG work. There is no capacity from any others to take on the role of SLWG meetings, mainly as most of my colleagues have found themselves increasingly occupied trying to safeguard local services from the threats created by the new contract. We also need to see more tangible and convincing commitment to addressing the issues affecting our members and our rural communities in Scotland

before we can consider the rural SLWG as an effective mechanism to address our members’ concerns.

For these reasons, I cannot nominate any other representative of RGPAS to take my place.

Thank you for the opportunity to serve on the rural SLWG. I sincerely hope that a successful direction can be found to safeguard the future of rural practice.

With kind regards,

Dr David Hogg BSc(MedSci) MBChB DCH FRCGP

Vice-Chair - vicechair@ruralgp.scot

RURAL GP ASSOCIATION OF SCOTLAND (RGPAS)

Web site - https://ruralgp.scot/