What the New GP Contract Will Mean for Dumfries and Galloway

A NATIONAL ballot has seen Scottish GPs vote to accept a new contract – but what does it mean for Dumfries and Galloway?

The new contract is aimed at allowing general practitioners to focus their attention on providing care for the patients most in need, as responsibility for delivering services such as blood tests, repeat prescriptions and dealing with minor ailments is instead taken on by the Health and Social Care partnerships across Scotland.

Dr Grecy Bell is the region’s Associate Medical Director for Primary Care, as well as being a working GP in Annan, and she says the contract could be ‘transformational’ for Dumfries and Galloway as a new approach to services is introduced over the next three years.

Addressing the 2018 contracts, Dr Bell said: “We want to focus on patients that need us the most, people that really would benefit from our care. At the moment we feel that we are doing far too many other things that perhaps are not really providing the benefit to patients who need it the most. This contract will allow GPs to focus on what they do best, which is working with patients and their communities.”

Addressing the particular challenges in Dumfries and Galloway, Dr Bell added:

“Being a very rural area is one of the factors that we need to take into consideration when thinking about delivering the services, ensuring that GPs in Dumfries and Galloway can provide the care and support that our patients need.

“Our GP workforce in Dumfries and Galloway is getting older, and nationally we are training less GPs because we are not getting trainees to choose general practice. Meanwhile, the number of people over 65 in our region is increasing – adding to that existing GP workload.

“So we need to think about how we are going to be able to provide the service that the patients need in a way that we are able to offer extra help to the people that need it most.

“And it’s realising that there are other professionals within our Health and Social Care teams such as nurses, pharmacists and paramedics who, with support and extra training, can extend their professional remit to take on responsibilities and authority at the top of their licences.”

The decision by GPs to accept the new contract means a Primary Care Improvement Plan must be created for Dumfries and Galloway, to ensure the changes are in place in three years’ time – by 2021.

This will mean working with GPs, GP practices, other medical and social care professionals, patients and representative groups to develop the best approach for Dumfries and Galloway. It will involve looking at how and where services are delivered, but with the transformation set to take place gradually and carefully.

Dr Bell said: “We want to ensure that services are delivered as closely to GP practices as possible, but as part of the ongoing integration of health and social care we have the opportunity to work with the NHS, council and voluntary and independent sectors as partners to determine what the best options and points of delivery might be.”

Responsibilities taken over by Dumfries and Galloway Health and Social Care Partnership include:

• Repeat prescribing, and the monitoring and reviewing of prescriptions.
• Taking bloods, with nursing support being provided to practices.
• Vaccination services.
• Urgent care services including some home visits, with the potential for a greater role for paramedics as already seen in a six-month pilot scheme in the region’s Out of Hours service.
• Community treatment and care services.
• Some physiotherapy services, community mental health services and community link worker services.

The new contract developed by The Scottish Government and the British Medical Association (BMA) will standardise GP incomes and create the potential for a better work/life balance, encouraging more doctors to choose general practice.

As a GP herself, working two days a week at the Greencroft Medical Centre (South) in Annan, Dr Bell added:  “We’re integrating, we’re offering support to practices, and we’re letting GPs focus on being the expert generalist.

“And this is huge change, because it’s not only a contract – it’s a vision. It’s a vision that is shared by GPs by saying yes to the contract and saying, ‘This is the vision for the future’.

“It’s transformational, because this is allowing GPs to focus on dealing with patients rather than the multiple things that we have been doing, and that is going to make the workload more manageable.”

Dr Bernard Jones is one of two GPs who staffs the Glenkens Medical Practice in New Galloway, and is also the clinical lead for the Stewartry area.

Dr Jones said: “The board will now be required to carry out health care activities which traditionally would have fallen to the GP practices. It’s something that GPs will have to get their heads round as well.

“The aim is that GPs will also take the lead in shaping how the health board delivers the other services. So it’s a different role. GPs will still be seeing patients, but it’ll be focused on those with complex needs and who have conditions which are perhaps not easily diagnosed.”

Dr Jones added: “The overarching aim of the contract is to reduce the overall workload of individual practices, which I think the contract will do – allowing GPs to concentrate primarily on being clinicians. The way work is going to be reduced is by other health board employed staff taking on tasks such as repeat prescribing and vaccinations.

“It was certainly quite a surprise for me to read in the contract that repeat prescribing, amongst other tasks would no longer be our responsibility, thinking ‘Who’s going to do this?’ However, it is not dissimilar to 2004 when the previous contract came in, and GPs were no longer obliged to do on-call work. I couldn’t believe that this would ever come to fruition. At that time I couldn’t see how that would work, but it came to pass and a new approach to providing out of hours care was adopted.

“So in the same way there are things now where one may think, ‘How will that work?’. However, it probably will come to pass, and new ways of providing primary care services will, in time, become adopted and established, although it would be unwise not to understate the challenges that lie ahead, particularly around some of the smaller, more remote practices in quite how it will pan out.”

June Watters is the Wigtownshire locality manager for Dumfries and Galloway Health and Social Care.

June said: “The new GP contract is welcomed and provides both opportunities and challenges operationally to implement. 

“I think everyone is now more aware of the challenges general practice continues to face across Scotland. These are magnified across Wigtownshire due to the rurality of the area. 

“Increased workload, increased risk of available staff and premises, recruitment and retention are all factors in the challenge to deliver sustainable local general practitioner services.

“General practice requires a team approach relying on clinical and non-clinical staff including medical, nursing, healthcare assistant and practice management. 

“The approach we are using across Wigtownshire is to extend this core practice-based team to include additional professionals. Initially this will be pharmacy and mental health professionals and advanced nurse practitioners. 

“This is in line with the new GP contract and is expected to free up GPs to enable them to focus on more complex care and provide more clinical leadership.

“As a locality manager I am now focussing on better understanding the impact of the contract on how we support the public in accessing the appropriate professional which will not always be the GP.

“At the same time I am ascertaining the numbers of professionals currently available to deliver the new services and how we continue to develop the new workforce required to enable us to deliver the support outlined in the contract to GPs within the current budgets.”

GP facts for Dumfries and Galloway

There are 33 GP practices across Dumfries and Galloway.

There are 115 full time and part time GPs across Dumfries and Galloway (April 2017)

This equates to 91.7 Whole Time Equivalent (WTE) GPs across the region.

There are approximately 150,000 people living in Dumfries and Galloway.

On average, for every 1 whole time equivalent GP there are 1670 people

In 2011 there were 23,300 people aged 0-14 years, 95,000 people aged 15-64 years and 33,000 people aged 65+ years .

By 2037 it is expected there will be 20,800 people aged 0-14 years, 72,600 people aged 15-64 years and 48,200 people aged 65+ years.

Approximately 25% of remaining GPs are aged over 55 years and could retire soon.

95% of visits to a GP practice are managed within general practice. 5% of visits result in a referral to hospital based care.