Grampian LMC Open Letter to patients
GRAMPIAN LMC OPEN LETTER TO PATIENTS
We wish to highlight to all patients this open letter which explains why GP practices are unable to do everything they once were able to do. This has been provided to all GP Practices in Grampian by Grampian Local Medical Committee (LMC) who are the representative body for GPs in Aberdeen City, Aberdeenshire and Moray.
WHY IS YOUR GP PRACTICE NOW UNABLE TO DO EVERYTHING THEY ONCE WERE?
Many GP practices in Grampian are faced with unmanageable workloads coupled with a rapidly shrinking and exhausted workforce. The COVID-19 pandemic has generated a vast backlog of care which is so far largely unmeasured in General Practice. It is exerting increasing pressure on a wider system that is already at breaking point. Grampian LMC’s GPAS (General Practice Alert State) has consistently reported Amber 2 (equivalent to NHS Grampian’s G-OPES 3) since launch. Amber is defined as “moderate to severe working pressure, sustainable only in the medium term”. This worrying alert state forewarns of a General Practice in crisis. How did we get here? In 2017, the Scottish Government, after negotiation with the SGPC, introduced a new contract starting in 2018 and to be fully implemented within three years. At the time, the then Health Secretary Shona Robison MSP said, “We equally recognise the fundamental challenges faced by General Practice, not least growing workload and increasing risk.” We have experienced particular challenges with the recruitment of the Multi-Disciplinary Team to deliver the contract in Grampian, likely linked to our geography. Unfortunately, in past years when Health Boards haven’t been able to spend the money that they were given to employ additional Pharmacists and other professionals to support General Practice, the money has been clawed back by Scottish Government rather than being able to be spent supporting your local Practice to fund covering the significant gaps in services left through non-delivery of the contract. Scottish Government committed to the payment of transitionary payments to Practices whilst the contract was in the process of being delivered, however withdrew this commitment in March 2023, despite the contract having only been partially delivered and with significant gaps in service still being covered by General Practice. This left GPs in a position where they were being asked to carry out work that was no longer contractual, and no longer funded. There have been many further challenges since then:
• Funding for Practices comes through a national formula and doesn’t reflect how many times patients are seen. Practices are paid the same whether you are seen once or a hundred times per year. The average patient used to contact their practice 3-4 times per year. This has increased to 6-7 but funding and therefore staffing in General Practice has not increased proportionally to this. Furthermore, the annual funding uplifts for General Practice have been consistently and substantially below inflation since 2017. GPs see over 90% of all patient contacts in the NHS yet are allocated less than 6% of the national NHS budget. This is not sustainable.
• The reasons for increased patient contacts are multiple and include an ageing population, patients with more severe, complex and often multiple illnesses, and the huge mental health fallout from the COVID-19 pandemic across all age groups. The growing hospital waiting lists have also had a big impact, with a significant proportion of GP appointments being taken by patients suffering from progressing physical and psychological symptoms whilst waiting to be seen in secondary care.
• In March 2023, Scottish Government transferred the responsibility for the provision of routine blood tests, many nursing tasks and ‘non-essential’ Pharmacotherapy work to NHS Grampian from GP Practices. Significant gaps still exist in NHS Grampian’s delivery of these services through community hubs or by health boards in Practices, but they have decided not to provide transitionary payments to Practices to cover these gaps. Ongoing involvement in these activities by your Practice may now be limited to only what is required by GP Practice contracts.
• We all know how much energy costs have risen over the last couple of years and for GPs who own their own buildings there is no additional funding to cover this increase. Money spent on rising energy bills means less funds going into services Practices wish to offer their patients.
• Part of the funding which comes from Government every year is earmarked to uplift the pay of non-GP staff e.g. receptionists, nursing staff, and Practice Managers. This has always matched what was given to staff working elsewhere in the NHS, e.g. in the hospital. But for the first time last year, the Scottish Government decided to break this link. As a result of Scottish Government’s actions, many Practices had to fund this shortfall in pay themselves or risk losing staff to other services. Again, funds used to cover this shortfall means less funds going into the provision of patient services.
• The number of GPs in Scotland is falling. As part of the 2018 contract the Scottish Government promised that GP numbers would rise by 800. However, when doctors in training are excluded from the figures, the numbers are actually reducing! Since 2013, the GP WTE (whole time equivalent) workforce has fallen by 5.35% - a fall of 196.7 WTE GPs. In that same period, the number of practices has fallen by 9%, average patient list sizes have increased by 18% and the total patient population has increased by 7%. 42% of practices in Scotland report at least one GP vacancy. The number of GP Partners has reduced by 14% between 2012 and 2022. In the last twenty years the ratio of GPs to hospital consultants has halved, despite many things which used to be done in hospital now commonly being done in Practice.
• In many areas, Practice buildings are too small and are outdated. Unfortunately, Scottish Government has now cancelled all funding for new builds, leaving many GPs working out of buildings that are no longer fit for purpose. Scottish Government has also suspended sustainability loans, a scheme introduced to mitigate the risks for GPs who own their building. This leads to increased financial liability which again impacts on the services they can deliver to their patients.
• With fewer staff and more work, better IT solutions would help improve efficiency. Our IT is outdated, cumbersome and unreliable which often impacts detrimentally on the care of our patients and is damaging for staff morale. We are the only country in Britain still using paper prescriptions – this alone costs a huge amount of clinical, administrative and patient time.
• In order to make systems better and to keep our medical knowledge up to date, we need time to learn and develop. We used to receive ten half days per year of Protected Learning Time (PLT) to work with our teams on making Practices better for everyone. The support for this was withdrawn by NHS24 and Scottish Government have done very little to reintroduce any form of reliable support. Incredibly, despite all that we have just described, your GP Practice remains absolutely committed to providing the best service that it can with the available staff and resource. However, if you’re not satisfied with the service you receive, look beyond the Practice, and instead hold those in positions of power to account. Scottish Government needs to do more to directly support General Practice, the bedrock of the NHS. Please contact your MSP. Their contact details can be found at Members of the Scottish Parliament (MSPs) | Scottish Parliament Website.
Grampian Local Medical Committee 18 July 2024
RSV Vaccine
Respiratory Syncytial virus (RSV) Vaccine
Did you know there's a vaccine that helps protect against RSV?
RSV is a common and highly infectious respiratory virus that affects the breathing system. While most RSV infections are usually mild, it can cause severe illness for older adults and in babies under one year of age. For those at greatest risk, RSV can cause pneumonia and bronchiolitis, leading to complications and hospitalisation.
The NHS in Scotland recommends you have the RSV vaccine if you are:
- turning 75 years old on and between 1 August 2025 and 31 July 2026
- pregnant.
Older adults who are turning 75 years old between 1 August 2025 and 31 July 2026 will be sent an appointment letter. Pregnant women are encouraged to speak to their midwife about getting the vaccine from 28 weeks of their pregnancy.
Those aged 76-79 who have previously not received the RSV vaccine are also eligible for vaccination. Contact your local immunisation team for further information.
For more information please visit www.nhsinform.scot/rsv-adult or www.nhsinform.scot/rsv-baby
NHS 24 & Healthier Scotland Facebook page provides lots of usefuls information
Diabetes in Grampian
The Healthier Futures Diabetes Working Group have set up a Diabetes in Grampian Facebook page with the purpose of raising awareness of the help and support that is available to those in Grampian living with diabetes and their carers, and providing information for healthcare professionals.
Benefits of cutting back
Has #AlcoholAwarenessWeek made you think about how the effect of alcohol on you and those around you?
Cutting back on alcohol use comes with many benefits:
better sleep
improved mental health
more energy
more productivity
Other useful information and links:-
Health advice for patients with Asthma
Coping with Stress
Helping Children cope with stress
Information & Support
Inchgarth Community Centre Support
Inchgarth Community Centre are offering useful information and support to residents in the local area. For more information please see their information booklet or visit http://www.inchgarth.org
Norovirus (Winter vomiting bug) campaign
The key message of this campaign is to advise the public to stay at home for 48 hours after their norovirus symptoms have stopped to avoid spreading it further. For further information please visit
http://www.nhsinform.scot/norovirus
Seasonal Affective Disorder
We’ve all heard of the “winter blues.” A dreary sort of feeling when summer and autumn are over, and you’ve got several months of darker, colder days ahead. While some people love the winter months, others aren’t big fans. In fact, some people struggle with the winter months so severely that they have what’s known as seasonal affective disorder, or SAD. Let’s talk a little about how SAD affects people, and what solutions are out there.
For more information on Seasonal Affective Disorder (SAD) please click here
For 5 top tips for those living with SAD, please click here