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FIFE LOCAL MEDICAL COMMITTEE LIMITED

Why are your GP practices now unable to do everything they once were?

 General Practice across the Country has been struggling for years.  However it has now reached a critical situation with less money, less doctors and less staff to meet the growing needs of the Scottish population. So how did we get here?

In 2017, the Scottish Government recognised this and promised to introduce a new Contract, starting in 2018 and to be fully implemented within 3 years. At the time, the then Health Secretary Shona Robison MSP said “We equally recognised the fundamental challenges faced by general practice, not least growing workload and increasing risk”.

Unfortunately, for the first time in the history of the NHS, large parts of this contract have not been implemented. Even worse, 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 had to be returned to Scottish Government rather than being able to be spent supporting your local practice.

Scottish Government promised transitional payments to Practices to recognise the non-delivery of this contract, but then withdrew that funding, even after some practices had already used the money for additional cover.

There have been many further challenges both local and National since then.  Many Practices in Fife are facing increasing bills for their building costs such as mortgages, rent payments and utility bills. Without any additional funding coming into practices, their financial situations will deteriorate and it’s likely this will lead to reduced staffing, with fewer appointments and longer waits to be seen.

All Practices in Fife are impacted by Scottish Government not funding an increase in compulsory pension contributions. This is only occurring in General Practice in Scotland; the English and Welsh Governments have already committed to paying this, and there is funding in place for all staff in hospitals. Therefore, these payments come out of the funding available to Practices to pay for administrative staff, nurses and doctors.

Many people don’t know that the 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. In 2017, the Scottish Government recognised that it wasn’t sufficient and promised to move towards a new funding model. This still hasn’t happened, and the funding uplifts have been substantially below inflation since then.

The average patient used to contact their Practice 3-4 times per year. This has increased to 6-7. The reasons for this are multiple and include an increasing elderly population, more people with illness (often multiple) and more available treatment options. The large growth in waiting lists has also had a big impact, with GP appointments being taken up with ongoing management whilst awaiting hospital investigations and procedures.

GPs are in demand. There are many roles and jobs that require the skills of a GP, so the GP that you see in your practice will likely be working “full time” hours across fewer, longer days with other days spent in these other roles or undertaking caring responsibilities for their families.

Part of the funding which comes from Government every year is earmarked for non-GP staff pay rises e.g. receptionists, nursing staff, practice managers. This has always matched what was given to staff working elsewhere in the NHS. For the first time last year, the Scottish Government decided to break this link, meaning practices had to fund the shortfall or risk losing staff.

The number of GPs in Scotland is falling. As part of the 2017 contract the Scottish Government promised that 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 whole time equivalent GPs. In that same time period, the number of practices has fallen by 9%, average practice 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 20 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, and this reflects the falling share of the NHS budget spent in General 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 working out of buildings no longer fit for purpose. Scottish Government has also withdrawn sustainability loans, a scheme to reduce the risk for GPs who own their building. This leads to financial loss which again impacts on the services they can deliver.

With less staff and more work, better IT would help improve efficiency. Our IT is cumbersome and unreliable which often impacts on the care of our patients, increasing inefficiency and damaging 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 we need time to learn and develop. We used to receive regular half days 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, although our local health board have tried to reintroduce this recently.

 Incredibly, despite all that we have just described, your Practice remains absolutely committed to provide the best service that it can.

However, if you’re not satisfied with the service you receive, look beyond the Practice and instead hold those with the power to improve matters 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

Fife LMC

June 2024

PRACTICE POLICIES

Confidentiality, Medical Records, and Freedom of Information

Locked blue folderThe practice complies with the Freedom of Information Act 2000, the General Data Protection Regulation and the Access to Health Records Act 1990.

Information required for disclosure under Freedom of Information in respect of the Practice and the General Practioners can be made available to the public. All requests for such information should be made to the practice manager.

In accordance with the Access to Health Records and the GDPR acts, patients may request to see their medical records. Such requests should be made through the practice staff and may be subject to an administration charge. No information will be released without the patient's consent unless we are legally obliged to do so.

Reception and administration staff require access to your medical records in order to do their jobs. These members of staff are bound by the same rules of confidentiality as the medical staff.

Identifiable information about you will be shared with others in the following circumstances:

    • To provide further medical treatment for you, for example, from district nurses and hospital services.

    • To help you get other services, for example, from the social work department (this would require your explicit consent)

    • When we have a duty to others, for example, in child protection cases. Additionally, anonymised patient information will also be used at local and national level to help the Health Board and Government plan specific services e.g. for diabetic care.

If you do not wish anonymous information about you to be used in such a way, please let us know.

See more detailed information about how GDPR affects you

 Duty of Candour

We share a common purpose with our partners in health and social care – and that is to provide high quality care and ensure the best possible outcomes for the people who use our services. Promoting improvement is at the heart of what we do. We know that we deliver exceptional care on a daily basis but sometimes things go wrong and it’s how we deal with these incidents that is important.

What it means for you

What Happens When Things Go Wrong

Further information about Duty of Candour

Duty of Candour - Healthcare standards - gov.scot

Chaperone Policy

The St Brycedale Surgery is committed to providing a safe, comfortable environment where patients and staff can be confident that best practice is being followed at all times and the safety of everyone is of paramount importance.

This Chaperone Policy adheres to local and national guidance and policy i.e. the ‘NCGST Guidance on the role and effective use of chaperones in Primary and Community Care settings’.

The Chaperone Policy is clearly advertised through patient information leaflets, website (when available) and can be read at the Practice upon request. A poster is also displayed in the practice waiting area and all clinical rooms.

All patients are entitled to have a chaperone present for any consultation, examination or procedure where they consider one is required. The chaperone may be a family member or friend, but on occasions a formal chaperone may be preferred.

Patients are advised at the time of booking an appointment that they should ask for a chaperone if they require one, so that arrangements can be made and the appointment is not delayed in any way. The Healthcare Professional may also require a chaperone to be present for certain consultations.

All staff are aware of and have received appropriate information in relation to this Chaperone Policy.

All trained chaperones understand their role and responsibilities and are competent to perform that role.

There is no common definition of a chaperone and their role varies considerably depending on the needs of the patient, the healthcare professional and the examination being carried out.

Their role can be considered in any of the following areas:

  • Emotional comfort and reassurance to patients.
  • Assist in examination.
  • Assist in undressing.
  • Act as interpreter.
  • Protection to the healthcare professional against allegations/attack.

Complaints Policy

Customer service form

We strive to provide the best service we possibly can, and we therefore welcome constructive criticism. If you have a problem we hope that you will make use of our practice complaints procedure so that we can improve.

A new complaints procedure was introduced in April 2017.  We hope most complaints can be resolved within 5 working days under Stage 1, but if not, under Stage 2 with a full investigation and a response within 20 working days.

Please ask to speak with the Practice Manager, Office Manager or a GP.

Written complaints should be addressed to the Practice Manager. 

If you are complaining on behalf or someone else, we will need their consent in writing.

We are aware that things can go wrong resulting in a patient feeling that they have a genuine cause for complaint. If this is so, we would wish for the matter to be settled as quickly, and as amicably, as possible.

Further written information regarding the complaints procedure is available from reception.

Violence Policy

The NHS operate a zero tolerance policy with regard to violence and abuse and the practice has the right to remove violent patients from the list with immediate effect in order to safeguard practice staff, patients and other persons. Violence in this context includes actual or threatened physical violence or verbal abuse which leads to fear for a person’s safety. In this situation we will notify the patient in writing of their removal from the list and record in the patient’s medical records the fact of the removal and the circumstances leading to it.



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