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GPs in Scotland vote to accept new contract

BMJ 2018; 360 doi: https://doi.org/10.1136/sbmj.k297 (Published 22 January 2018) Cite this as: BMJ 2018;360:k297
  1. Bryan Christie
  1. Edinburgh

Scotland’s family doctors have voted by a large majority to accept a new contract that will radically change the way they work.

It will see GPs develop a new role as “expert medical generalists” working at the head of primary care teams to deliver integrated community services. It offers a guaranteed minimum income of just over £80 000 for GP partners, the end of GP responsibility for some services such as vaccinations, and a new funding formula that gives greater resources to practices with large numbers of elderly patients.

Although the contract has been described as offering a new future to general practice, and the Scottish government has promised that no practice will lose income as a result of the changes, it was rejected by 28% of GPs in a ballot conducted over the Christmas period. The strongest opposition came from doctors in rural and deprived areas who say the funding formula shifts money to urban practices with elderly patients.

Doctors’ leaders have responded to these criticisms by setting up a working group to ensure that the contract is delivered in a way that works for rural areas. It will also examine further ways to support rural general practice.

The chair of the BMA’s Scottish GP Committee, Alan McDevitt, said: “I believe that this contract offers stability and security of funding for practices in Scotland and will help to reduce the pressures of GP workload and improve GP recruitment and retention. This contract offers something to GP practices in every part of Scotland and I hope that young doctors will be encouraged by the direction we are going in to choose a career in general practice.”

At a conference examining the future of primary care in Scotland on 17 January, the day before the ballot result was announced, John Gillies, deputy director of the Scottish School of Primary Care, said that this was the first contract that attempted to integrate general practice with the wider primary care team. “There is a real opportunity to look at morale and retention and I believe it is a sound foundation for the future,” he said.

McDevitt told the same conference that it promised to make Scotland one of the most exciting places to work as a GP. He said it will take around three years before the new role for the GP will emerge but he warned that if other members of the primary care team do not co-operate with the changes, it will not work.

The conference, Priorities for Primary Care in Scotland, heard of a number of developments where integrated services are developing through shared responsibility among pharmacists, district numbers, occupational therapists, and third sector organisations.

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