The number of patients registered to each GP has increased at almost one third of practices across Scotland in the last three years, with some doubling or even quadrupling the number of people registered with a single doctor.
Some GPs told The Ferret they were being forced to work at “unsafe levels” as a result with duty doctors in average practices clocking up to 75 appointments in one day, three times the number suggested by British Medical Association (BMA) guidelines.
Data analysed by The Ferret from Public Health Scotland highlights what doctors claim is a deepening crisis in general practice. The BMA said GP services in Scotland are at “a tipping point”.
Patients said they were left feeling cut adrift with some claiming they no longer felt able to rely on accessing GP care. Meanwhile GPs told The Ferret about burn-out and exhaustion and some said they were seeing patients back-to-back for 13 hours at a time without having time to eat, drink or go to the toilet.
The figures – covering GP lists from October 2019 and October 2022 – reveal GPs in more than 100 practices are now responsible for more than 2,000 patients, with 17 practices now having more than 4,000 patients registered to see a single GP.
As of last October GPs at five practices across Scotland had over 5,000 patients, with one practice – Lanarkshire Medical Group in East Kilbride – having more than 18,000 patients listed for each of its two GP partners.
Lanarkshire Medical Group (LMG) is among practices that also offer patients access to a range of health professionals including practice nurses, mental health specialists, midwives and pharmacists along with doctors.
Temporary doctors known as locums are brought in by many practices to assist partner or salaried GPs. LMG said it employed locum GPs, taking the total number of doctors available to 16.
But across Scotland the number of doctors working on these temporary contracts in general practice is also shrinking, making it increasingly difficult to ensure adequate cover, The Ferret was told.
Practices under pressure
Earlier this month research by the Royal College of General Practitioners found that a third of GP practices were concerned that their practice was at risk of closure in coming months.
There have already been several high profile closures in recent months. They include Danderhall Medical Practice in east Edinburgh, where GPs announced it would hand the contract back to the NHS because they feared they were unable to provide a “safe” service. Its lists had grown by over 40 percent over a six year period.
However, The Ferret’s research found the lists of many GPs had grown far more dramatically. Boroughloch Medical Practice, in the south of Edinburgh, has only two GPs but its individual patient lists increased from 2,000 to 5,500 between October 2019 and 2022.
Meanwhile, Macduff Medical Practice, in Banff, has not increased its total list of about 12,000 patients. But the ratio of patients per GP has increased from over 2,000 to more than 4,000 because the number of doctors went from six to three in that period.
Valleyfield Medical Practice, Dunfermline, and Brechin Medical Practice, in Angus, more than trebled their lists over three years to over 4,000 patients per GP.
The size of the list for each of the three GPs at Dr Rai’s practice, in Wemyss Bay, increased by four times in the same period. Again, each GP had over 4,000 patients registered according to the data.
Patients told The Ferret they struggled even to get in touch with GPs.
One – Bee from Falkirk – provided phone records showing she had made hundreds of calls to her GP surgery’s number before finally being able to get through and make an appointment, due to a phone system that allows a limited number of calls in the queue at any one time.
Another – Peter from Glasgow – said he did not speak to his doctor about his depression even though he felt suicidal because the GP did not seem have the time to listen. He stopped trying to make appointments for a heart condition at the surgery and has attended A&E several times over the last year as a result.
Doctors said they desperately wanted more time to spend with patients that they simply did not have.
Dr Andrew Buist, chair of the BMA’s Scottish GP Committee, said patient demand was quite simply outstretching GP capacity. Scottish government figures from 2022 show the number of full time equivalent GPs down three per cent since 2019.
Buist claimed the number of GPs now at its lowest level since 2009, with a need for about 1,000 more full-time doctors.
“General practice is at a tipping point,” he added. “Last year 11 GP practices closed for good despite seeing an increase of 63,210 patient registrations across Scotland. Given the lack of GPs to provide services many practices are becoming unsustainable, and it should be little surprise on that basis that some practices are simply unable to continue.
“The stress caused by unmanageable workload pressures and the despair over patients struggling to get the care they need is seeing many GPs cutting hours, seeking to work outside Scotland or even leaving the profession entirely.
“We need an immediate direct injection of funding to practices to increase capacity, and we particularly need new practices to be built in areas with high levels of house construction like Lothian, Perth and Fife to provide the GP services they need.”
Jackie Baillie MSP, health spokesperson for Scottish Labour, blamed the crisis on political incompetence and cuts by the Scottish Government. She added: “As numbers of GPs reduce and the number of patients increase, GPs are doing more with less and this cannot continue.
“Enough is enough. Patients are being put in danger and GPs are at breaking point. We need the government to listen to GPs, invest in frontline services and get primary care back on track.”
Scottish Conservative health spokesperson and former GP, Dr Sandesh Gulhane MSP, said: “These stark findings are yet further proof of how overwhelmed GP practices are across Scotland.
“Successive SNP health secretaries’ dire workforce planning is at the heart of this. Their failures have meant that nowhere near enough GPs have been recruited to support patient demand.”
But a Scottish Government spokesperson said the government was “making good progress” on its commitment to deliver an additional 800 GPs by end 2027.
They added: “Despite the pandemic, we have also recruited 3,220 whole time equivalent healthcare professionals into multi-disciplinary teams to provide support to GPs and make it easier for patients to see the right person at the right time.
“We know the difficulties staff are facing and want to repeat our thanks to all those working across all health and social care services this winter to make sure people receive the care they need.”
Cover image thanks to artisticco/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.
The oversubscription rankings are interesting. Any reason why you’ve capped it at TOP20 instead of letting people check their current GP and try to move to a less oversubscribed alternative nearby?