GPs will have to cut services without major investment, doctors warn

GPs in Scotland will be forced to cut their services unless they receive a huge and sustained injection of cash, doctors have warned.

BMA Scotland sounded the alarm over the state of local health services as an Audit Scotland report found the Scottish Government is failing to deliver on its key missions for the sector.

The watchdog said despite a deal in 2018 with GPs to improve services, the number of family doctors has fallen, the pressure on them has increased, and patients are finding it more difficult to access care.

The union representing doctors said GPs have been left “angry and demoralised” as they claim promises from ministers have failed to materialise.

Dr Iain Morrison, chairman of the BMA’s Scottish General Practitioners Committee, said the Auditor General’s report “demonstrates in forensic detail exactly why so many practices across Scotland are struggling to meet demand and the enormous pressures so many GPs are having to work under”.

Thursday’s report found spending on general practice as a proportion of overall NHS spending has fallen in recent years.

Between 2021/22 and 2023/24, spending decreased by 6% in real terms, which the Auditor General said had put further pressure on GP practices.

The BMA said this level of spending is nowhere near enough to cope with rising demand, which is being compounded by longer hospital waits.

Dr Morrison said: “The failure to invest in general practice and plan effectively to recruit GPs is taking its inevitable toll.

“After seven years, the 2018 GP contract has failed to create anywhere near the services and capacity promised to the profession by the Scottish Government.

“Given the rising demand from a growing and ageing population, with more complex health conditions, it means GPs are simply unable to provide the best possible service to their patients and the community.”

He said it is “clear we desperately need more GPs in Scotland”.

However, Audit Scotland said the Scottish Government’s target to hire 800 more GPs by 2027 is unlikely to be met. The BMA said this number, even if it is met, may not be enough.

Dr Morrison said: “BMA Scotland has been warning of the lack of progress on this target for some time and there is a clear need to step up action, not only recruit more GPs but to retain the existing workforce.

“Central to that must be to invest directly in GPs, which the 2018 contract failed to do.

“That left substantial sums being channelled through the improvement fund which simply is not delivering as it should.

“As a result, GP practices across the country are having to look at reducing services to balance their books and newly qualified GPs are struggling for work as practices simply cannot afford to employ the doctors which are desperately needed.

“The situation has become paradoxical.”

He said ministers must “urgently address the shocking situation” facing medics as Audit Scotland found the Government has failed to set out how it will invest in general practice over the medium term.

BMA Scotland said the “only solution” is for the Scottish Government to invest directly in GP services.

It wants to see GP spend as a proportion of the NHS budget rapidly rise from the current 6.5% share to 15%, which it said would see an extra 1,800 whole-time equivalent GPs in Scotland.

Dr Morrison said that would allow GPs to “massively improve patient access, bringing huge benefits across the NHS”.

He added: “A properly resourced general practice can offer so much to the health and wellbeing of Scotland, but the dire predicament we are in now – as illustrated by Audit Scotland – means we need immediate action to safeguard the bedrock of the NHS.”

Auditor General Stephen Boyle said: “The pandemic pushed back plans for general practice.

“But the new delivery deadlines that were put in place were missed and there’s not been enough transparency about progress since then.

“The Scottish Government needs to clarify its plan for general practice and set out the actions, timescales and costs to deliver it.”

Scottish Conservative health spokesman Dr Sandesh Gulhane, who is also a GP, described the report as “damning” and said it “lays bare a catalogue of SNP broken promises in failing to support Scotland’s GPs”.

He added: “Their shocking failures have left communities up and down Scotland, particularly in rural and our most deprived areas, dangerously short of the GPs they need.

“It is scarcely believable that the SNP have cut the proportion of funding going to primary care when patients are trying desperately to get GP appointments.

“The SNP’s failure to deliver these appointments is forcing patients to go elsewhere to receive the healthcare they need, placing further strain on our already overstretched hospitals.

“Seven years have now passed since this contract was agreed, yet in typical SNP fashion, there is a total lack of transparency over whether it will ever be fully implemented.

“General practice has been abandoned by the SNP and I have seen the devastating effects on patients first-hand.

“(Health Secretary) Neil Gray must finally stop short-changing GPs and ensure money gets to frontline care, rather than being wasted on pointless bureaucracy.”

Gray said: “I thank Audit Scotland for their report. Many of its recommendations are already in progress and we are committed to working with the BMA to support general practice and to meet our commitment to deliver 800 additional GPs by 2027.

“The First Minster and I have been clear that we know too many people have had issues with seeing their GP and we have set out a plan to improve access, with a greater proportion of new NHS funding going to primary and community care so that GPs and services in the community have the resources to play a greater role in our health system.

“This financial year we have invested an additional £73.2m in general practice, including £13.6m to support GPs, and the 2025-26 Budget includes over £2.2bn investment in primary care which will help to make it easier for people to see their GP.”