Scotland’s health secretary Neil Gray acknowledged the need to expand GP practice premises to accommodate a larger workforce, in comments at the Scottish LMCs conference in Aberdeen.
He condemned the current use of temporary buildings to deliver care, but added that he could not make ‘any promises’ on increased premises funding given an ‘incredibly pressured’ health budget.
Mr Gray also reiterated the government’s stance that plans to introduce 15 new walk-in centres are not intended to displace general practice but to help ease pressure on the rest of the NHS. He added that GPs will be involved in the design of the walk-in centres.
Premises issues
The health secretary’s conference speech comes just a month after the BMA Scotland GP committee ended its dispute with the Scottish government after agreeing a three-year deal that will increase GP funding by more than £500m from a current total of around £1.3bn a year. Committee chair Dr Iain Morrison told the conference this was a ‘pivotal’ moment for GPs in Scotland and an opportunity the profession must seize.
Tayside LMC joint medical director Dr Amy Stewart said she welcomed the government’s recent funding commitment to general practice, but raised concerns that extra staff would struggle to fit in current premises. She asked Mr Gray how he would address the ‘critical lack of adequate premises’.
Mr Gray said: ‘I’ve seen some of that, where services are being delivered in temporary structures [and it] is not what I want to see. The three-year deal is on the employment of GPs – that’s deliberate because we want to expand capacity.’ He acknowledged a debate at the conference highlighting ‘the importance of ensuring that you all have facilities to be able to put people [in]’.
He added: ‘I am looking at every possible option that I can explore in advance of the budget…and the infrastructure investment plan around how we can reopen health capital projects and look to come forward with a primary care investment program that allows for the physical practical implementation of what we’ve done from a policy perspective around shifting the balance of care.’
GP involvement
Mr Gray added: ‘I will be doing all I can, because I recognise having seen too many practices operating in unsuitable and unsustainable situations. For us to expand, we not only need to repair some of those facilities, but we also need to expand in order to allow for the GPs that we want to see employed. To have places to stay, rather than hot desking.’
Lothian LMC medical director Dr Neil MacRitchie said many GPs were ‘surprised and somewhat dismayed’ about government plans to open walk-in centres. He warned that other initiatives elsewhere in the UK have suggested that the centres widen health access inequalities. He asked the health secretary what success for the centres would look like and whether plans would change if they are found to not work.
Mr Gray said the government is committed to the current general practice model. He added: ‘I do not see walk-in clinics as being a challenge to that. They are in no way linked to the [funding] deal. The deal and walk-in clinics are separate policy processes. I in no way wish to see displacement [of general practice]. This is about providing additional flexibility for patients.’
The health secretary said he believed walk-in centres will help ease the pressure of A&E and GP practices’ 8am telephone rush, which is why the centres have been designed to ‘straddle in-hours and out-of-hours’.
He added: ‘In terms of our criteria it is about relieving pressure on all parts of the system. It is about reducing health inequalities. I do want to learn from where this has been trialled elsewhere, and where it has not worked and make sure we don’t repeat those same mistakes. Health boards and GPs will not just inform but will be part of the design of the walk-in clinics.
‘This is not about displacement. This is not about challenging the general practice model. This is about providing additionality and it is a pilot that we will be learning from.’