Media critic and retired academic Dr John Robertson challenges the Royal College’s view of GP services in Scotland compared to the rest of the UK
‘England now has the security of knowing that its general practice service is safe and will remain. To give Scotland, birthplace of the NHS model, comparable security, we would need to see £270 million more invested in general practice in 2020/21 than there was in 2014/15. This is a defining election issue, right at the heart of Scottish life.’ Dr Miles Mack, Royal College of General Practitioners Scotland (RCGP) in the Herald (April 23rd)
As we watch the English ‘NHS’ fall apart with, for example, repeated junior doctors’ strikes, appalling failures in health boards and attempts to privatise ambulance services, our first reaction to the Scottish RCGP’s suggestion (above) is likely to be disbelief. NHS Scotland is by no means perfect and, anyway, all such services are infinitely improvable, so a good idea from the English ‘NHS’ is always possible. Before, I go on to examine the case, why have I been writing ’NHS’ for the English system and NHS for the Scottish one? See this from the Independent of 10th March:
‘The NHS has actually been abolished. Now you may think that this is untrue. After all, you still go and see your GP or may be admitted to hospital and receive care free at the point of delivery. However, the Health & Social Care Act 2012 has abolished the NHS in legislative terms. It has achieved this through several mechanisms. It has axed the government’s responsibility for the NHS. It has devolved responsibility to Clinical Commissioning Groups (CCGs). The CCGs have no legal obligation to provide you with anything beyond emergency care – this may not be the case at present but it means that there is no legal guarantee that they will continue to do so.’
It’s another typical English newspaper article that forgets about devolution in the NHS, but the point is clear, for the ‘ENHS’. To return to the main topic here, what does the English GP reform plan for GPs involve? Well, actually, it’s really almost entirely about money and, in the process, protecting the elite status of GPs against other health-care staff:
‘NHS England has committed to raising the percentage spending given to GP services to ‘over 10%’ by 2020, outlining a raft of immediate, supportive measures designed to safeguard the service. The Chief Executive of NHS England, Simon Stevens, has said that NHS England is no longer ‘in denial’ about the state of general practice and its impact on patients and the rest of the health service.’ RCGP, 21st April 2016
The RCGP, a trades union remember, has ‘previous.’ Representing its members’ interests just as the NUM or the TGWU used to do, the RCGP campaigns tirelessly for ever-better salaries (In excess of £100 000), more-relaxed conditions and more funding for practices. See this from an STV report:
‘Royal College of General Practitioners say a decade of funding cuts is already impacting on patients. The Scottish Government says it is investing in primary care and is increasing the number of training places for GPs. In the past decade GPs have seen their share of funding fall every year and they say they’re suffering a recruitment crisis with patients waiting longer for appointments. Doctors fear the cuts are part of a wider strategy to limit the role of GPs.’ STV 26th January 2016
How representative are the claims made by the RCGP Scottish Region (as they call it on their website) of their members views? Remember the regular insinuations in the press, that the RMT, UNITE or UNISON are led by extremists whose real desire is to undermine governments? Surely the RCGP are more trustworthy? In December 2015, the well-respected Commonwealth Foundation of New York published a global comparatison study of primary-care, which suggested that, despite all the bad news we hear, the UK NHS performed pretty well by contrast with the rest of the world. After some time and a few arguments, I managed to get the breakdown of the data to enable comparison of NHS Scotland with other parts of the UK. It revealed the Scottish system to be in the best health of the five areas (England, London, Wales, N Ireland, Scotland) and sometimes by some way. My full collation of the Scottish data and discussion is here.
In particular, some of the data referred to GP satisfaction and stress levels. See these two tables from the above report:
Overall, how satisfied are you with practising/practicing medicine?
How stressful is your job as a general practitioner/primary care physician?
The difference between the Scottish and English figures, in both these tables, is well into the range of statistical significance, suggesting important differences in the management and funding by the Scottish Government, to the self-perceived betterment of Scottish GPs. The RCGP has published no credible, empirical, work to contradict these data. I have the raw data if you don’t trust me.
Further, on top of this important comparative evidence of the relative well-being of Scottish GPs, there is emerging evidence of the potential in the primary-care services, to make greater use of other health professionals to increase both efficiency and effectiveness without the need for additional funds. This is the current SNP Strategy, if worded more carefully, in the run-up the election.
A very quick search finds these:
‘Up to half of GP work could be done by another healthcare professional.’
The above claim is based on credible research by a GP-friendly online research agency.
Also from the British Heart Foundation and Parkinson’s UK:
‘And the evidence suggests it works. Research by the British Heart Foundation on heart failure specialist nurses has shown that they can reduce hospital admissions and consultant appointments, giving a saving of over £1,800 per patient.’
‘A specialist nurse saves over £200,000 a year in avoidable bed days, consultant appointments and unplanned admissions.’
The above are both from a BBC report.
Third, from Nursing Times:
‘The Cuckoo Lane Practice in Ealing is owned and run by nurses and was recently rated “outstanding” by the Care Quality Commission, making it one of only 3% of surgeries inspected so far to get the top rating.’
And, finally, though there is much, much, more out there:
‘Studies show that satisfaction with nurse practitioner care is high when compared with GPs. Clinical outcomes are similar. Nurse practitioners spend significantly longer on consultations. Nurse practitioners spent twice as long with their patients and both patients and clinicians spoke more in nurse consultations. Nurses talked significantly more than GPs about treatments and, within this, talked significantly more about how to apply or carry out treatments. Weaker evidence was found for differences in the direction of nurses being more likely to: discuss social and emotional aspects of patients’ lives; discuss the likely course of the patient’s condition and side effects of treatments; and to use humour.’
So, just as the NUM was accused of having a Soviet-backed agenda in the 1980s and as the RMT are often accused of having a supposedly ‘out-of-date’ socialist agenda today, dare I suggest that elements within the RCGP’s Scottish Region have a political agenda, which presents unrepresentative, anecdotal complaint, from a respected profession, uncritically reported by the Unionist media, to attack the Scottish Government’s evidence-based strategy? Does the fact that this strategy, based on the evidence above, will be more effective and less costly, explain the RCGP’s behaviour?
Youssef El Gingihy: Terrifyingly, according to the World Health Organisation definition the UK no longer has a NHS.http://www.independent.co.uk/voices/terrifyingly-according-to-the-world-health-organisation-definition-the-uk-no-longer-has-a-nhs-a6923126.html
RCGP: Scottish general practice calls for a commitment to fund its future