Thursday, 16 June 2016

Why any 'quick fix' for NHS Scotland's GP shortage is a nonsense.

I want to tell you the story of why there is a GP shortage not just in Scotland but across the UK.

In simple terms it is the result of the deal which brought the NHS into being in 1948 which ensured a ‘shortage’ to protect consultants and some GP’s private practices and get the BMA ducks into line.

By 1960 it was already clear the ‘deal’ was unsupportable but instead of increasing places at UK medical and dental schools, the government of the day decided to import doctors from Commonwealth countries instead. This created a shortfall in the Indian sub-continent and Africa from which they are only now recovering but that, in British Imperialist eyes, was ‘OK’. As late as 1970 a medical career was not a good option for many University students as is seen by a SCE Higher requirement of four B’s and a C getting you an entrance interview for Edinburgh. The entrance requirement is now five A’s, all in one sitting, but realistically if you do not have at least one A* you can forget it.

In the early 1980’s the Thatcher Government jumped on a manpower paper which suggested by 2000 the UK would see medical and dental graduate unemployment, then gleefully shut down three dental hospitals and reduced funding for medical places; this was in spite of the reality there were already shortages of GPs and DGPs across the UK which immigration was no longer filling. In 1985 the UK had the worst GP/DGP to patient ratios across the EU. The Tory answer was to impose NHS medical and dental contracts which increased work load on GP/GDPs but not the funding required to deliver treatment in real terms. William Waldegrave’s tactic, as Tory health minister, was described as screwing down the safety valve on the NHS pressure cooker to see what would happen. What happened was GDPs left NHS dental practice at an ever increasing rate from 1990 onwards and GP recruitment which was already weak, started collapsing. Of course when silly GDPs and GPs like myself tried to point this out to the UK’s general public we were labelled as ‘greedy’ and ‘protectionist’ by the Tory press of the day while folk inside the BMA and BDA tried to shut us up because we were ‘rocking the boat‘ and ‘upsetting relationships with government ministers and departments’. In much the same way as we have recently seen the current medical establishment in the form of the ‘Royal’ colleges and Tory media trying to demonise the junior doctors in their current, legitimate dispute with the DoH.

If we turn to Scotland, due to longstanding Uk Government under funding of medical and dental undergraduate courses from the 1980’s onwards the only answer the medical and dental schools had to meet the actual funding costs of the course was to encourage overseas students paying large tuition fees and UCCA applications from England. On most medical and dental undergraduate courses in Scotland 50% or less are Scots while over 50% are female who will, in all probability, take time out to have children and return to job share positions in their late 30’s early 40’s. This is not a rant against female doctors but simply to highlight further the recurring recruitment problems within any attempted resolution of the current lack of GPs in Scotland. In simple terms if you could double the current places at Scottish medical and dental schools and reserved the extra places only for graduates who would remain in Scotland for the whole of their working life (ignoring the human rights and freedom of contract issues such a move would create). Then if all these extra graduates had to become GPs; the reality is the current hole in GP recruitment and pressure on Scottish GPs will not see any real change for the good until 2026 at the earliest. The sting in the tail is the final tranche of ‘baby boom’ generation GPs and GDPs are reaching retirement age over the next ten years on top of the current shortage of NHS GPs and GDPs.

The idea that the SNP or any devolved government can simply wave some magic wand and reduce the massive shortfall of trained medical personnel caused by insufficient undergraduate training places over the last 70 years is a nonsense. This is a problem the UK has had for a long time and has created for itself through UK Government indifference and public ignorance. The NHS managed its first personnel crisis in the 1960’s by importing crates of doctors and nurses from Commonwealth countries and then carried on regardless assuming folk would always want to work in the NHS, no matter what.  This assumption is now on the point of collapse as UK trained doctors and dentists emigrate in increasing numbers and it gets harder and harder to import replacements from Eastern Europe or the Far East.

There is only one place the blame can be laid for the collapsing NHS GP services across the UK and that is on the UK Parliament at Westminster.

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