It’s worth reminding ourselves that the SNP have had complete control over Scotland’s Health Service for the past 13-and-a-half years, and that prior to becoming First Minister, Nicola Sturgeon was Health Secretary. In that time, the number of GP and consultant vacancies has increased dramatically.
As a GP, I have seen firsthand the effect of how the SNP’s chronic underfunding, higher taxation and lack of university spaces have combined to create desperate shortages in Scotland’s health service. Yet the SNP, distracted by constant agitation for a second referendum, and lacking competency, is simply not doing enough to improve the situation.
In recent years it has become very difficult for GP surgeries to replace outgoing GP partners. How has this happened?
In 2008, the British Medical Association warned that Scotland faced GP shortages. Nicola Sturgeon, who was the Health Secretary from 2007 to 2012, ignored the warning. The Royal College of General Practitioners (RCGP) now predicts a shortfall of 856 full-time equivalent GPs in Scotland by 2021.
The RCGP has long called for general practice to receive 11% of the health budget in order to provide an adequate service. In 2005 it was 9.8% but by 2019, under SNP control, it has dropped to 7.35%.
This underfunding had a detrimental impact on general practice – from 2013 to 2017 the number of full-time equivalent GPs in Scotland dropped by 160. In 2018, 25% of GP practices had an unfilled vacancy.
GP shortages have forced practices all over Scotland to close, including those in Dumfries and Galloway, Ayrshire, Edinburgh, West Lothian, 11 surgeries in Grampian, 14 in Highlands and Islands. Long established practices gone forever.
Many more practices are suffering. In 2019, 59 practices that felt unable to provide a safe service, returned their contracts to the health board to run using locums. Continuity of patient care has been lost and locums are expensive.
There are currently 500 vacancies for consultants in Scottish hospitals. Health boards have had to spend £102 million on medical agency locums in the last financial year alone to cover this shortfall, money that would pay for about 1000 permanent consultants.
I returned to Dumfries as a GP in 1998. At that time, the hospital was full of long-term permanent consultants. Now, this excellent new hospital, with excellent staff, has 22 consultant vacancies. It is spending £7 million a year on locums, an amount that would pay for 70 permanent consultants. But, if we did not have those locums, patient care would collapse.
There are many reasons for this: the after effects of the divisive referendum in 2014 dissuading applicants from the rest of the UK; higher tax rates in Scotland; uncertainty around a second vote on separation with the threat of currency turmoil, spending cuts and tax rises.
Significantly, the Distinction Awards budget was frozen by the SNP in 2010. This scheme gives awards to consultants for clinical excellence. While this scheme is still available in England and Wales, there are no new awards and no progression through the scheme in Scotland. Ambitious, highly motivated consultants from the rest of the UK are therefore deterred from coming to work in Scotland, while potential Scottish consultants move south.
The high level of consultant vacancies inevitably has an impact on care and helps explain why the Scottish NHS missed six out of eight national waiting time standards in 2018/19, including Child and Adolescent Mental Health Service referrals within 18 weeks and patients starting cancer treatment within 62 days.
This is not good enough. Young and old are suffering. We deserve better.
Discrimination against medical students from Scotland
1000 medical students graduate every year in Scotland, so why do we have a shortage of consultants and GPs? Why do they not stay and work in Scotland?
Research shows that medical students from Scotland are twice as likely to stay and work in Scotland after graduation, compared to students from elsewhere.
In 2000, 63% of medical students in Scotland were Scottish. In 2013, NHS Education for Scotland conducted a survey and found the following:
- In Northern Ireland 85% of medical students were Northern Irish
- In England 82% of medical students were English
- In Wales 30% of medical students were Welsh
- In Scotland 55% of medical students were Scottish
By 2016, the number of medical students in Scotland who were Scottish had dropped to 51%.
A major effect of Scotland’s free education system is that the number of Scottish domiciled medical students who can study at Scottish universities is capped by the Scottish Government. To make up the funding shortfall, Scottish universities take on fee-paying students from the rest of the UK or abroad. This results in fewer Scottish domiciled medical students studying medicine in Scotland.
Over the years, we have had enthusiastic local youngsters come to visit our Dumfries practice, desperate to study medicine. Their five As at Highers indicated that they would make excellent doctors, but they applied to Scottish medical schools and did not get in, simply because they were from Scotland.
This is an outrageous and historic failure with serious ramifications for the health service in Scotland.
Every moment the SNP continue to agitate for a second referendum is a time when they are not working to improve the health of Scottish patients. Isn’t it time we demanded better?
Dr Bruce Halliday is Health Spokesperson for Alliance for Unity. Follow him on Twitter @doonhamer1963
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