Where GPs cannot be found to run a practice in some area, it is always presented as some kind of failure and, often, used to accuse the Scottish Government of something.

In 2017, there were 52 health board run surgeries out of a total of more than 1 000 in Scotland.

Intuitively, I’d have thought that being run by a health board with all its expertise and quality control mechanisms might be a safer bet for the patients than the risk implicit in control by a small number of individuals for whom the profit motive is a factor.

I see, for example:

Figures obtained by the General Medical Council show 104 doctors in Scotland have convictions but are still allowed to practise.


Might that be less acceptable to a health board?

Further, is the strong gatekeeper role in the UK always for the best? We all have experience of waiting to see a GP and then waiting again to be referred to a specialist but this is different in other places:

For example, in areas such as eastern Europe, and to an extent north America, first-contact care is provided by specialists. The polyclinics in the former communist countries were the places where specialists gathered together to provide first-contact care. The gatekeeper role of GPs is also particularly strong in the UK. It is almost impossible to see a specialist in the UK without going through your GP, whereas in countries like France it is normal for people to see a specialist as the clinician of first contact.


Don’t sneer at the Eastern Europe reference, the East German model was highly respected and some of its features are resurfacing today in Germany:

State owned health centres (policlinics) were one component of primary health care in former East Germany, housing general and specialist doctors and dentists. This integrated model was efficient and cost saving: facilities and laboratories were shared, alternative treatment and prevention strategies were coordinated, and referrals to specialists were well monitored, as well as each patient’s case.