Helen McArdle: If there are more GPs than ever, why is workload increasing – and appointments harder to get?

A WEEK ago, Health Secretary Jeane Freeman told a conference of Scotland’s GP leaders that they were the “bedrock of the NHS”.

For the health service to function efficiently, general practice must be able to perform its role as gatekeeper: sifting the patients whose symptoms require an onward referral for tests, scans or a specialist consultants from those whose ailments are minor and can be tackled through primary care services.

This is not easy when GP workload has been soaring while the total number of GPs in Scotland has remained almost static by comparison.

READ MORE: GPs vote to take back control for hiring practice staff 

Between 2009 and 2019, the overall GP headcount (partners, salaried GPs, locums and trainees) grew by just 3%, from 4902 to 5049.

At the same time, the number of patients registered per GP practice has swelled 15% and become considerably older, bringing with it an increasing volume of patients living with multiple long-term illnesses.

Doctors on the frontline also tell poignant stories of elderly patients who will turn up at their GP surgery several times a week simply because they are lonely and want to talk to someone.

For every GP in Scotland today, there are 209 patients aged 65 or older – up 17% from 178 per GP a decade ago.

Measuring GPs by headcount gives an overly optimistic picture compared to the reality on the ground, however.

Part-time working has become increasingly common, partly because a majority of the profession (61%) now are women more likely to juggle work with childcare, but also because more GPs are reducing their hours for a better work-life balance.

The result is that when the GP workforce is counted by ‘full-time equivalent’ (FTE), there were only 3,575 in 2017 (the last year that data is available). That was a decline from 3,735 in 2013, and it is a downward trend expected to continue when the next data set is published in 2020.

That translates as an increasing – and increasingly unmanageable – workload for GPs, but also longer waiting times for patients as same-day (or even same-week) appointments become harder and harder to secure.

READ MORE: Jeane Freeman admits mistakes in how new GP contract affected rural practices 

While the Scottish Government has pledged an extra 800 GPs by 2027, it has so far refused to commit to that being anything other than an increase in headcount.

Meanwhile, statistics this week showed that the number of GP partners in Scotland has fallen to a record low.

Partners now account for just 66% of the GP workforce, compared to 85% in 2004, increasing the risk that surgeries will run out of GPs to own and run them and will have to close, merge or be taken over by health boards instead (a costly alternative).

The bedrock of the our NHS is on shaky ground.

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