Concerns raised over GP chains taking over practices

Health boards have stepped in to save dozens of Scottish GP practices from closure in the last six years, The Ferret has found, with more predicted to shut their doors in coming months.

In 2022, 11 practices across Scotland – including Alness Medical Practice in Ross and Cromarty, and the island-based Barra Medical Practice – were taken over by the health board because no GPs could be found to take over contracts after previous partners retired or quit.

Figures analysed by The Ferret showed that at least 60 practices had have health board involvement. 31 of the practices had been taken over by the NHS boards since 2016 with most of the others folding before October 2015 when the current data was first made available.

Two – the Edinburgh Access Practice and the Challenging Behaviour Practice in Edinburgh – are run by NHS Lothian. Glasgow’s homeless practice is run by NHS Greater Glasgow and Clyde.

Health boards are responsible for patient lists when practices shut their doors and seek to contract new GPs when practices are forced to close. The Ferret has found those willing to take over include a growing number of GP “chains”, who operate multiple practices.

These include Barclay Medical Group, which runs seven practices and Alba Medical Group which has taken over ten practices in the last five years. 

Alba Medical Group, which has two partners, currently has practices in Lanarkshire, Erskine, Dumfries and Galloway and Forth Valley. It operates under a variety of other names including Lanarkshire Medical Group and Forth Medical Group.

An additional partner is listed at Bargarran Medical Practice. Some of its practices employ a small number of salaried GPs, while others do not. However it operates a “multidisciplinary model” involving a wide range of healthcare professionals. In total, Alba Medical Group claims it hires 200 members of staff across its ten practices.

Among practices run by its two partners are those which form part of Lanarkshire Medical Group, which took over the contract from the Lanarkshire Health Board in 2018. It runs one surgery in Strathaven, two in East Kilbride and another in Lanark.

In total over 30,000 patients are listed at the practices. Only the two partner doctors are registered in holding the contract. They are currently looking for a salaried GP to provide unscheduled care, paid at a salary band of £99,000-£117,000 per year.

The multi-site practice says it has a “large multidisciplinary team” including nurse practitioners and physician associates – medically trained, generalist healthcare professionals, who work alongside doctors. It claims a total of 16 GPs work at the practices.

In a recent job advert Alba Medical Group  said it was working in “a different way from traditional General Practice”.

The Ferret has heard from people across Scotland who are struggling to access GP practices due to the acute shortage of doctors. But some politicians raised concerns about the model being operated by Alba Group Medical practices, including at practices run by Lanarkshire Medical Group.

Many complaints are from constituents who tell me they can’t get through on the phone at all and others say they cannot obtain a face- to-face appointment.

Dr Lisa Cameron, SNP MSP

Lanarkshire Medical Group said its model was “entirely in keeping with the Scottish Government vision for primary care” consisting of “expert medical practitioners leading multi-disciplinary health teams”.

Dr Lisa Cameron, SNP MP for East Kilbride, Strathaven and Lesmahagow, shared details of six letters she had written to Lanarkshire Health Board in connection to concerns about the practice dated between October 2020 and January 2023.

The Ferret has also seen a letter she wrote to cabinet secretary, Humza Yousaf, in July 2021 raising concerns about constituents struggling to access the practice.

Her constituency caseworker is currently dealing with complaints from 35 constituents.

The Ferret spoke to two patients of the practice who shared complaint letters raised about practices that are part of the Lanarkshire Medical Group. 

One progressed her complaint to the Scottish Ombudsman in August 2021. She received a reply a month later telling her the practice would now be in touch to discuss her complaint but has not heard anything since back. She said that while she was still unhappy about the service offered by her practice, she had “given up”.

Another claimed it was “almost impossible” to get through to the practice. She raised one complaint in 2022 and another this year due to repeated problems in getting repeat prescriptions, which she relies on for a range of health conditions.  

SNP MP Dr Lisa Cameron said “Many complaints are from constituents who tell me they can’t get through on the phone at all and others say they cannot obtain a face-to-face appointment.

“Those who have been offered an appointment after persistence, appear to often be told they have to see another practitioner, like a practice nurse, despite requesting and wanting to see a GP”.

She added: “The level of complaints indicate constituent concerns that are systemic and ongoing. NHS Lanarkshire do not appear to have adequately addressed this, despite my raising it repeatedly and I believe the same medical group have subsequently taken on more and more practices.

“I was told by NHS Lanarkshire managers, this is the way forward because the practice is multidisciplinary but my experience is constituents often can’t see a GP when they feel they need to clinically, which is extremely concerning to me.”

Satisfaction rating

In last year’s health and care experience survey just 21 percent of respondents gave Lanarkshire Medical Group a positive rating, the second lowest in the country.

Lanarkshire Medical Group said that it would expect its rating to be low as it had taken over failing practices.

It said there were “significant underlying problems including a serious and significant backlog of clinical letters”, when it took over. A spokesperson added: “ It would be unrealistic to believe that such shortcomings and failures would be resolved immediately, but we have established a patient participation group to improve delivery and address any concerns.”

Concerns about two practices in Moffat and Lockerbie – also run by Alba Medical Group – were raised by local MSP Oliver Mundell last year. In a question in the Scottish Parliament on 29 September last year he said he had “been inundated with concerns from constituents in Moffat and Lockerbie who are struggling to access GP appointments”.

In parliament he continued: “They report that there are frequently times when no GP is available to see anyone face to face and that they offered telephone consultations only, which forces people towards accident and emergency departments.

“I and other local representatives, including the chair of Lockerbie community council, who is in the public gallery, have raised concerns with the health board, but it refuses to intervene.”

Alba Medical has since confirmed it will withdraw from the contract.

A spokesperson said: “Alba Medical Group is structured to ensure the highest quality healthcare provision. We provide a care model that is GP-led at each location and uses a mix of Allied Health Professionals (AHPs) to meet the needs of local patients. The model includes GP partners supported by a Senior Management Team responsible for the effective operation of the practices.

“The GP-led multidisciplinary team includes a mix of advanced clinical nurse and paramedic practitioners, practice nurses, clinical pharmacists, physician associates, mental health workers and lifestyle advisors such as social prescribers. 

“The utilisation of our wider teams and clinical hubs in Lanarkshire and Forth Valley supports the whole organisation by provision of back-up clinical and admin support, ensuring greater resilience in care delivery. All complaints are investigated to address patient concerns and enhance improved delivery.”

In April 2020 Forth Medical Group, which is also run by the same two doctors, took over three practices – Kersiebank in Grangemouth, Hallpark in Sauchie, and Bannockburn Medical Practice in Bannockburn, which had previously been run by Forth Valley NHS.

NHS Dumfries and Galloway said it could not discuss complaints due to patient confidentiality. But they added:  “We take all patient complaints extremely seriously. The tendering process for both practices has been under way since Alba Medical Group informed NHS Dumfries and Galloway of its intention to vacate its contract, and no final decision has been announced regarding either practice.”

NHS Forth Valley said: “Any complaints regarding primary care contractors, including GP Practices, would be dealt with via the practice’s complaints procedure to enable them to respond direct to any patient complaints or concerns individually.

“If patients remain dissatisfied with the outcome of their complaint they can also contact the Scottish Public Services Ombudsman and ask for an independent review.”

A Scottish Government spokesperson said: “Patients who need to see a GP should always be seen and the Health Secretary has written to all GP practices to encourage them to ensure there is an appropriate mix of pre-booked, same day, face to face and remote appointments.

“We aware of the specific situation with Lockerbie and Moffat. We are in discussion with NHS Dumfries & Galloway and expect all necessary arrangements are made to ensure patient disruption is minimised.

Cover image thanks to fizkes/iStock

GPs in Crisis is an investigation by The Ferret examining the pressure on doctors and patients at the frontline of community healthcare. Support our journalism by becoming a member for £5 a month at theferret.scot/subscribe.

This story is part of our Health Gap project, funded by the European Journalism Centre, through the Solutions Journalism Accelerator. The fund is supported by the Bill & Melinda Gates Foundation.