Scots doctors appeal for help as funding and recruitment crisis sabotage care

A SURGERY treating some of Scotland’s sickest patients has been pushed to the 
brink as their GPs warn of a funding crisis.

Doctors there are the latest to voice fears that Scotland’s GP service is in a state of emergency.

Yesterday the practice partner at Balmore Surgery in Glasgow’s 
Possilpark, Lynsay Crawford, said 
they cannot survive without 
extra funding.

She said unmanageable workloads, a colleague quitting because of stress and shortfalls in funding have pushed the surgery – which has the third 
sickest patient list Scotland – to the brink of closure.

The Balmore GPs have now written to their health board asking for 
emergency help and Dr Crawford said: “There is no denying the crisis in general practice. We need to stop talking about it and actually do something.

“It is a measure of the pressure we are under that we have swallowed our pride and asked for help. Simply put, we cannot 
continue without it.”

Some health boards have already been forced to step in and take over ailing 
practices – particularly in Forth Valley – because of a recruitment crisis as 
newly qualified doctors shun family practice and older GPs retire.

Now Dr Crawford fears the Balmore surgery could become the first in the west of 
Scotland to be taken over by NHS Greater Glasgow and Clyde.

Some patients at the clinic have had to wait up to three weeks to see their doctor. Others spoke of the difficulty of getting an appointment within 48 hours.

Dr Crawford approached the health board in February after what she describes as a “horrific winter”.

She warned that the clinic would have to close their list and not take on any new patients. But they were told they would lose £30,000 in funding if they closed their list to new patients.

Dr Crawford said: “We told them that was deeply unfair. They said by not taking on any new patients 
we are not doing the things to 
generate money.”

The clinic, which has two other GP partners, was thrown further into turmoil when another partner – 
Alyson Hee – resigned last month 
after the pressures of the job took 
their toll.

Dr Crawford added: “We warned that we are close to resigning due to stress. That has come partially true. Alyson told us at the beginning of 
July that she is resigning due to 
work-related stress and an impossible workload.

“The prospect of finding someone to cover her work is daunting and impossible. But if we cannot find locum cover or a new partner then the 
practice will fail and terminate its contract with the board.”

The clinic are seeking funding for an extra GP to try and cope with the soaring demands.

They have a patient list of 3500 but the complex health needs of their patients – living in one of the most deprived postcodes in Scotland – means the work generated is the equivalent of around 5000 patients.

The average patient list for an 
individual GP within a practice in Scotland is 1500.

Dr Crawford said her role and that 
of her colleagues have changed “immeasurably”. She added: “All GPs will have noted that. Huge amounts of work that was historically dealt with in 
secondary care has been transferred.

“For example, routine care for Type 2 diabetes – following up discharged patients – no longer seems to get done by routine clinics.

“It has been professionally 
demoralising and frustrating to 
note the emphasis on protecting 
secondary care over the last few years at the expense of primary care.”

In Balmore, seven per cent of patients have diabetes. That is double the national average. Some 13 per cent have hypertension, four per cent have chronic respiratory problems and five per cent have heart disease. Added to that are the high levels of illiteracy amongst patients, who need help filling in 
benefits forms.

The prevalence of cancer, obesity, heart disease, diabetes and mental ill health is higher than the averages for Glasgow and Scotland as a whole.

Dr Crawford added: “What those 
figures do not show is the increased workload they generate. To achieve targets to generate payments, we all have to work much harder.

“We have increased our nurses’ hours to combat workload and help with chronic diseases management.

“Our nurses are magnificent. But they too are feeling the strain. Apparently having two full-time nurses in a 
practice of our size is unusual, 
perhaps that speaks volumes about practice demand.”

Despite the concerns voiced by 
doctors and opposition politicians, health secretary Shona Robison said she does not believe there is a crisis in general practice.

However, in June, she announced that £50million will be invested to address immediate issues, including recruiting up to 140 pharmacists to work with GPs and a £2.5million fund to help with GP recruitment and retention.

But the Royal College of General 
Practitioners in Scotland say they have reservations about how much the plans will help. And Dr Crawford is also unconvinced.

She said: “We undertook an analysis of how we work. It looked at each patient appointment for both GPs and nurses and whether the consultation was 
necessary or whether it could have 
been dealt with by someone else.

“The results were clear – 99 per cent of the GP consultations needed a 
face-to-face GP appointment. The nurses’ results were similar.”

Traditionally, a full-time GP worked nine sessions per week, or four-and-a-half days.

Now, with the burden of secondary care falling on doctors, few can manage nine sessions of primary care and seven has become the new full-time.

Dr Crawford said: “That means we need more GPs to cover all the work, but there are none.

“This problem also means that there is a huge shortage of locum GPs who work independently and cover GP 
partners’ holidays and so on.

“Balmore Surgery is in urgent need of support. The clinical need is there but not the cash. We cannot advertise for a new partner until the concerns we 
have are addressed.”

A spokesperson for Glasgow 
Community Health Partnership, 
part of NHS Greater Glasgow said: “We have agreed to provide interim 
support to allow us to work with the practice to gain an understanding of what might need to be done, to ensure the needs of patients continue to be met in the longer term.”

Doctor: Why I'm resigning

Alyson Hee, 36, joined the Balmore practice in 2012 but has told the partners she is leaving.

Deciding to leave the practice was difficult. There were many tears. It is a practical decision but I do it with a heavy heart.

I am working when I am not supposed to be working. I was logging on at night time when I was at home. I have a young daughter now and I feel I need time with her too.

GP work has changed all over and especially for me in the practice. In the past two years, it has become more difficult.

We are a good practice and we have good results and patient satisfaction. It’s a real shame when the doctors are feeling
the strain.

It’s sad to leave and I have built up a great relationship with patients.

I do worry about general practice. There aren’t as many medical students and general practice is not as attractive as other specialities.

Patients: We're scrambling to see a doctor and don't get enough time when we do

Patients at the Balmore surgery yesterday told how they struggle to get an appointment as the number of those seeking treatment grows.

And they say they are also worried about the limited amount of time they get with their doctor.

Margaret Chatterton, 82, has recently been released from hospital and was in for a follow-up.

The great-grandmother said: “I’ve lived in the area since I was seven and 
I’ve always come to this surgery. I’ve seen it get busier. I waited three weeks to see the doctor. I think it’s a scandal.

“Maybe they are 
taking on too many patients. Maybe they need another doctor. I don’t think 10 minutes is long enough with the doctor. I think 20 minutes would be better.”

Her concerns are echoed by Catherine Dayer, 53, who was at the surgery with her mother Hester Campbell, 72.

She said: “It’s really hard to get an appointment. I don’t get to see my own doctor and I like to be able to see the same doctor. I phone at 8am and I can’t 
get through. By the time 
I get through, all the 
appointments are gone.

“We are here a lot at the moment. It seems there’s an awful lot more patients now.”

Jess Muirhead, 67, and her husband Jim, 70, have both struggled with anxiety.

Jess said: “I struggled to speak to anyone about my problems. But Dr Crawford is really brilliant.

“I do like to see my own doctor but I’ve never had a problem with any of them. I’ve never heard anyone complain about any of the staff here. But it is very busy.”

Jim added: “I struggled with anxiety after I retired. Dr Crawford was fantastic.”