4. Improving GP Workload
4.1 In November 2016 we made clear our view that in addition to
increasing the numbers of
GPs available we
will redesign the services
GPs deliver so that
GPs can become
clinical leaders of expanded teams of health professionals working
in the community.
4.2 We are also working with Health and Social Care partnerships ( HSCPs) and Health Boards to see which services currently provided by GPs would be better transferred to the wider healthcare system. This work is underway and we are considering carefully the balance in the new contract between GPs fulfilling a critical role and as providers of services.
4.3 We have established an advisory group with representation from Chief Officers of Health and Social Care Partnerships to provide advice and recommendations to the Scottish Government and SGPC on how best to deliver services within Primary Care.
4.4 Our shared goal in reducing workload is to meet patients' needs in the best way by reconfiguring services to make best use of the mix of skills in primary care. To this end, we are starting a programme of work to review and transform how we deliver vaccinations. Our intention is to move away from the current position of GP practices being the preferred provider of programmes on the basis of national agreements.
4.5 We want to find ways to enable other parts of the system to be responsible for the delivery of vaccination programmes, and we want to work with GPs and Board colleagues to do that. We recognise that solutions will be different in different areas depending on local circumstances, and factors such as geography.
4.6 Be reassured, we have been clear in the joint Memorandum outlining our shared Vision that historically associated funding will stay in practices. This is not about reducing GMS, but re-focusing GMS so it funds the new role of the GP - in complex care; in managing uncertainty; and in quality, education and local medical leadership.
4.7 The Vaccination Transformation Programme will draw in expertise from across the NHS and will take around 3 years to complete. This is a complex piece of work impacting every person in Scotland. It will require engagement from us all to ensure that Scottish vaccination programmes continue to be delivered to the same high standard as they are now. Transition to the new model will be incremental, and changes will be made only when there is an agreed process and the new model can be shown to be operating safely and sustainably.
4.8 We accept that general practice is facing challenges here and now. GP capacity and supply are critical elements of successful service delivery in the day to day running of a practice and we know that even a single GP's unexpected absence through illness or injury can have a significant impact on workloads for other GPs and healthcare staff in the practice.
4.9 It is also clear that the workforce is changing, with more GPs working part time or flexible hours, and that existing arrangements for sickness payments should be improved to provide better support to those working at the frontline of primary care.
4.10 That is why we have agreed to raise the maximum amount of sickness pay that can be claimed for locum cover due to a GP absence from illness or injury from £982.92 to £1,734.18 per week, matching the payments for maternity leave.
4.11 We can now announce that this new rate will be backdated to 1 April 2017. The updated 2017/18 Scottish Statement of Financial Entitlements ( SFE) will refer to the new higher payment amount.
4.12 We will also simplify the discretionary rules around eligibility for payments. They will no longer be linked to the number of remaining GPs or the GP/Patient ratio and will no longer be discretionary. Payments will be made to all practices who claim for GP performers absent for over two weeks. The payments will still be tied to the 52 week cycle within which a GP Performer can claim the maximum rate for 26 weeks and half the rate for a further 26 weeks. The 2017/18 SFE will provide full details of the new eligibility arrangements.
4.13 These new sickness payment arrangements are made in recognition of the new workforce landscape in Primary Care. The increased rate and simplified eligibility helps us to get more of the basics right and will improve the health and wellbeing of GPs and practice staff as we work towards our shared vision.
4.14 We also recognise the amount of time and effort that GPs put into completing their annual appraisal. While the appraisal is an important tool for improving learning within the profession and is required as part of the revalidation process, we appreciate that the time and resources required to prepare and carry out the appraisal takes time away from patient care.
4.15 We are investing a further £200,000 into Appraisal payments paid through the Global Sum to reflect the real-terms increase in the costs of completing appraisals. Appraisal payments for Principal GPs has been included in the global sum payments since 2004 and the value has been increased as the global sum amount has been increased over time. This year an additional £200,000 has been added to the global sum to specifically increase the payments to practices. This will mean that GP Partners will receive an average of £390 for appraisals included in their practice income. Sessional GPs will also receive the additional payment by claiming in the present manner through the SOAR system.
Review of 4-Day Services
4.16 There were conference motions and questions from delegates on the Review of Health and Care Public Holiday Services. The Cabinet Secretary made clear that working on public holidays will not be made mandatory for GPs in Scotland. The review is being carried out in partnership with the Academy of Royal Colleges and other professional bodies, NHS leaders and Integration Joint Boards and will look at availability of services over public holiday weekends, and how hospital, community and social care services could be coordinated more effectively. We are expecting the review to report recommendations in the summer for implementation next Christmas.
4.17 Its approach will be in line with our work on seven day services, where from the outset we have been clear that sustainability would be the cornerstone of our programme and we would not be spreading services more thinly to achieve additional services for the sake of it. Instead we will focus on areas which we believe will improve patient care and clinical outcomes rather than take a "blanket" approach.
Email: Joseph McKeown
Phone: 0300 244 4000 – Central Enquiry Unit
The Scottish Government
St Andrew's House