This is a rehash of the Scotsman and the Herald in April platforming uncritically a trade union convenor as useful idiot to attack the SNP in government:
According to the Scotsman on April 3:
A top medic has warned “no practice is safe” after one of Scotland’s largest GP surgeries folded – warning it is “a tipping point which could spread across the country” and lead to the collapse of NHS Scotland.https://www.scotsman.com/health/gp-practice-closures-could-lead-to-the-collapse-of-nhs-scotland-warns-top-medic-4089414
Let’s deal with the ‘folded’ practice. It hasn’t. From NHS Grampian before the Scotsman piece was published:
Alex Pirrie, Partnership Manager for Central Aberdeenshire, said: “Inverurie Medical Practice has unfortunately, like many others across the country, found itself in the position of being unable to recruit new, permanent GPs and as a result the Partners have taken the very difficult decision to hand back their contract to us.
“We will be working closely with the Practice and all other partners to secure a robust, sustainable, future focused Primary Care service for everyone registered with the Practice.
“I appreciate that this is an uncertain time for those registered with the practice, however the Practice will continue as normal over the next six months and there is no need for patients to change their practice, or take any other action, at this time.
“I would also like to reassure patients that we will keep them informed throughout the process and whilst I fully understand that this is an unsettling time, I can promise that we are doing all we can to make the process as smooth as possible. There is no need for any patients of the practice to take any action as the practice will continue operating as normal over the coming months and I would ask the community to refrain from contacting the practice with queries around this but rather if they have any questions, please get in touch with us.”https://www.nhsgrampian.org/news/2023/march/inverurie-medical-practice-to-end-contract-with-nhs-grampian/
Why did the partners in this business give up? Might it be that they could not make enough profits to satisfy them because they couldn’t employ enough cheap, new, doctors at the rate they want to pay?
And in the Herald on April 23:
Today, the Herald allows this claim, unchallenged:
Even by their standards, the brass-necked cheek of that claim stated as if it was a fact, with no source, not even the a GP union shoddy survey.
What research is there, either way?
From the Health Foundation in February 2023 and oh so easy to access by even a Herald journalist:
Some acute NHS trusts are now acquiring general practices and employing GPs – for example, to staff urgent treatment centres. What is proving more controversial is hospitals employing GPs to deliver a fuller range of GP services, such as the Royal Wolverhampton NHS Trust, Northumbria Healthcare NHS Foundation Trust and others.10 Some have suggested this might be an organisational and employment model for the future11 and the idea appears to have some political support from senior Conservative MPs.12 The Labour party has also proposed scrapping the independent contractor model, with GPs becoming salaried NHS staff13 – and one option for doing this could involve NHS trusts employing GPs.
This is not a purely UK phenomenon. Similar merging of some general practice and community services with hospital care has happened in Spain, the US, New Zealand and Denmark.14,15,16,17 The stated rationale includes improving collaboration between services, better management of the population’s health needs, sharing back-office support such as premises and IT, making general practices more sustainable and accommodating changing career paths and GP training preferences.
The Royal Wolverhampton NHS Trust, a large acute and community health services provider, currently has eight directly integrated general practices, governed by a designated division in the trust comprised of primary care clinicians and secondary care managers. The trust has established links between its community health services and GP practices, creating a rapid intervention team intended to improve health in the area and reduce unnecessary demand for emergency care services. Work is under way to establish a ‘command centre’ that handles calls to all practices. GP practices owned by the trust also have access to a live dataset showing their patients’ contacts with acute, primary and community services.18
In their conclusions:
UK studies of vertical integration of acute trusts and general practice are limited, but research is starting to emerge.20,21 Early evidence on the professional and management effects of these new models21 points to a mix of potential challenges, such as:
- fear of loss of GP and practice autonomy
- increased bureaucracy associated with larger NHS bodies
- a reduction in local patient and community attachment to their practice
- potential damage to relationships with other local GP practices
- threats to existing multidisciplinary team working
- staff leaving if they feel ‘taken over’.
But the research also identified potential advantages of these new ways of working, including:
- better links between GPs and secondary care services and colleagues
- less management and regulatory pressure for GPs
- more training and development opportunities and resources for all in the primary care team
- new career pathways for practice managers
- greater potential for service innovation.
There is some early evidence of impact on quality and service use associated with the integration of general practice with hospital trusts in the UK. A quantitative study found a modest reduction in emergency hospital admissions or readmissions for patients of vertically integrated practices compared with a ‘synthetic control’ group of non-integrated practices, perhaps due to the removal of some barriers to more effective coordination.20 The authors note the similarity of their findings with those of a study of vertical integration in Portugal.22
More opportunities than disasters ahead?
Talking-up Scotland 'Albatraz' 
“Get yer retaliation (scare stories) in first”.
(Mighty Mouse or Willie John)?
This time its a Brit Nit frightener for weans.
By the usual suspects.
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Doctors are retiring. NewDoctors are qualifying. Increased numbers at Medical schools. Medical schools are over subscribed.
The settlement of the Doctors claim in Scotland will maintain Doctors numbers. Brexit has been the cause of a loss of Doctors. Tory policy again. Tory underfunding the NHS. Spending £1000Billion but cannot support an adequate NHS service. Underfunded the NHS for 10 years. Cut funding from 2015 to 2020.
The Tories wasting £Billions, They have not got a clue. Wasting money on HS2, illegal wars, Trident, Hickley Point, decommissioning nuclear. The list is endless. Not funding the NHS. Westminster borrowing and spending what they want. Scotland has to pay the debt repayments on monies not borrowed or spent in Scotland. Scotland raises £74Billion+ but has to make repayments on debt not borrowed or spent in Scotland.
Revenues raised in the UK £732Billion+. Revenues raised in the rest of the UK £658Billion. £732Billion+ – £74Billion+. = £658Billion+. Westminster is spending £1000Billion. Scotland has to pay £Billions in loan repayments on monies not borrowed or spent in Scotland. A total mismanagement of Scotland’s revenues.
Scotland loses £Billions to Westminster unionist mismanagement and lies. £3Billion tax evasion. £3Billion loan repayments on monies not borrowed or spent in Scotland. HS2, Hickley Point. £1Billion on Trident/redundant weaponry. £Billions being lost because of Brexit. Scotland cannot borrow £6Billion paid for by growth. £Billions lost to Scotland because of Westminster unionist poor bad policies and decisions.
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UK Gov whole accounts 2021/22. – Published July 2023.
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Regarding the Inverurie Medical Practice referred to above and in the Scotsman article from 3 April, it’s good to know it’s still operating. And the website states: ‘WE ACCEPT NEW PATIENTS who will be permanently resident in our practice area for more than three months.’
And by the way, just in case The Scotsman – and BMA Scotland’s spokesperson – fails to inform you, what follows is from an announcement made by the Partners on 22 May 2023:
‘.. the Inverurie Medical Group, which operates and manages the Inverurie Medical Practice, HAS DECIDED TO REMAIN AS THE CONTRACT HOLDERS for General Medical Services for the populations of Rhynie, Kintore and Inverurie. (my emphasis)
‘Originally the GP Partnership had felt that they would be unable to continue to deliver the contract for General Medical Services due to national difficulties in recruiting new GPs. However, Partners at the practice have been INVESTIGATING NEW MODELS OF CARE AND WAYS OF WORKING over the last few months and believe that they are in a unique position to be able to ensure continuity of care to patients whilst also DEVELOPING THE PRACTICE TO ENSURE ITS SUSTAINABILITY.’
‘Dr Sheeja Kolangara, Partner at Inverurie Medical Practice, said: “.. WE HAVE COME TO REALISE THAT THERE IS SO MUCH MORE THAT WE CAN DO. We have DEVELOPED A NEW BUSINESS PLAN FOR THE PRACTICE WHICH will see us FURTHER DEVELOP OUR MULTIDISCIPLINARY TEAM and IMPROVE OUR INTERNAL WORKING PRACTICES to ensure continued and sustainable, excellent care for our patients. Whilst GP recruitment will remain challenging, we believe that MAKING THE CHANGES WE HAVE IDENTIFIED WE WILL BE IN A GOOD POSITION TO CONTINUE INTO THE FUTURE”
And: ‘Dr Chris Wilkins, Partner at Inverurie Medical Practice, said: “.. the last few months have ACTED AS A CATALYST FOR ALL OF US PARTNERS TO TAKE A LONG HARD LOOK AT HOW WE ARE WORKING and how we might change to ensure that we can continue to deliver high quality care to our patients LONG INTO THE FUTURE. I can honestly say that I, ALONG WITH MY PARTNERS, AM REALLY EXCITED AND LOOKING FORWARD TO THE FUTURE.”
Now why is this not newsworthy? – ‘GP PRACTICE IN SCOTLAND “EXCITED AND LOOKING FORWARD TO THE FUTURE” BY EMBRACING INNOVATION’
Source https://www.inveruriemedicalpractice.scot.nhs.uk/2023/05/22/inverurie-medical-group-to-remain-contract-holders-at-inverurie-medical-practice/
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It seems as if EVERY time one looks into negative stuff in the mainstream news media about a public service in Scotland something can be unearthed to change the picture painted!
On GP practices, a BBC News website article published on 13 December 2022 had this headline: ‘Scottish GP numbers drop and fewer working full-time’. (https://www.bbc.co.uk/news/uk-scotland-63955169 )
Lisa Summers, the BBC Scotland health expert, provided an ‘analysis’: ‘I visited a surgery in Scone had (sic) that 30 years ago had 6000 patients. Now it has 17,000.’
We learn this about the Scone surgery in Perthshire: ‘Dr David Shackles, who has worked at that practice for 29 years, said there were not enough GPs. Headcount is often meaningless. It is how many GPs you have got working in the surgeries day-in day-out and how many you have got in the out of hours service.
‘Dr Shackles, who is joint chair RCGP Scotland, said there were shortages in other services linked to general practice such as pharmacists and district nurses.’
This is the website of the Practice in question, the Perth & Scone Medical Group: https://www.perthandscone.co.uk/#!
On 31 March 2023, the website reported this: ‘After 29 years of dedicated service Dr David Shackles has retired as a partner at the practice and Dr Catriona McGregor is moving on after 9 years with the team.’ But also this: ‘We expect that two new GP partners will join the practice later in the year and we will share their names when the time comes.’
The Perth & Scone Medical Group currently has 10 GP Partners and one salaried GP who work a variety of full and part-time hours. In addition the website lists:
– four Advanced Nurse Practitioners, noting: ‘In December 2019, the practice embarked on a journey to expand the clinical team at the practice to include Advanced Practitioners. Advanced Practitioners are professionals who have undertaken additional Advanced Clinical Skills and Assessment training and are often able to prescribe certain medications to patients, where appropriate. They are also able to request tests and can refer onto specialist colleagues in secondary care if required, IN THE SAME WAY AS DOCTORS AT THE PRACTICE can.’ (my emphasis)
The site also lists: 4 practice nurses and 2 health care assistants; an ‘attached’ team of district nurses and health visitors; a practice pharmacist plus a practice manager, and a reception and admin team of c. seven staff.
According to the practice website it has 16,250 patients. Split amongst 11 GPs gives a ratio of one GP to 1,477 patients. But of course some of the GPs work part-time.
For the sake of argument, let’s say none of the GPs work full-time. Let’s say they all only work 75% of the time, i.e. assume the practice has just 8.25 Full Time Equivalent GPs. This gives a ratio of one GP to 1,970 patients. (And that’s before factoring in the contributions from Advanced Nurse Practitioners who now do work comparable to that done only by the GPs pre-2019!)
According to recent BMA figures, in England the average number of patients per fully qualified FTE GP is 2,304 and in Wales it is one FTE GP to 2,210 patients. So the Perth & Scone example chosen by Lisa Summers back in December – to make some ‘point’ – probably has a GP to patient ratio better, perhaps substantially better, than the average in England and Wales!
The House of Commons Library recently (25 July, 2023) published a research briefing entitled ‘How to spot spin and inappropriate use of statistics’. Amongst the many wise and useful things it stated were these:
– ‘the three essential questions to ask yourself when looking at statistics are: Compared to what? Since when? Says who?’
And – ‘Context is vital in interpreting any statistic. It is highly unlikely that you can conclude anything meaningful from a single statistic without any background or context. Without context, an author can put their ‘spin’ on a statistic, for example, by claiming it is particularly big or small, high or low, without answering the question, compared to what?’
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Aye, Buist was also interviewed by the Sunday Show where he was predicting a rise in private healthcare as a possible future, without once explaining where these additional doctors would come from who cannot solve their current dilemma….
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