General practice in Scotland is in a sustainability crisis, with almost a quarter of a million more patients than 10 years ago, and almost 90 fewer GP practices, BMA Scotland said today.

A new sustainability dashboard revealed that while the number of GP practices in Scotland is falling, the average number of patients per WTE GP has increased from 1499 to 1687.

The dashboard also highlights:

• Between 2013 and 2023, the number of GP practices in Scotland dropped from 994 to 905.
• Greater Glasgow and Clyde has 17 fewer GP practices in 2023 than it did a decade ago.
• Eight practices have indicated they plan to hand their GMS contracts back to the health board in 2023.
• Almost one in ten – 9% – of practices in Scotland have formally closed their lists to new patients.
• Practice list sizes have increased in most of Scotland, with the practice population of Lothian rocketing by 8.16% in just five years.

Dr Andrew Buist, chair of the BMA’s Scottish GP committee said: “These are extremely worrying trends and the data on the dashboard indicates that nowhere is safe or sustainable for general practice currently. The only area we are seeing a decrease in the average number of patients per WTE GP is Orkney – everywhere else is reporting increasing patient numbers with fewer GPs and fewer practices overall.

“It is simply unsustainable, and we are seeing that now in the numbers of GP practices which have closed their lists to patients over the past few years because they would be unable to safely provide the level of care required if they continued to take on new patients. This year alone at least eight practices have indicated their intention to hand back their contract to their local health board – if the health boards are not in a position to take over the running of those practices, they will close completely, and all of their patients will be dispersed to other practices – further increasing pressures elsewhere and leading to a domino effect of practice closures.

“This is a cause of great worry for GPs, who want to continue giving their patients the best care possible but due to issues around retention, recruitment and funding are unable to meet the level of demand – but not only this, it is very concerning for patients, particularly older and more vulnerable patients who will be left wondering where they go from here, faced with the prospect of a practice that is unfamiliar to them and GPs who do not know their history.

“Workload demands keep increasing, and the profession is rapidly losing any remaining faith that our political leaders have the will to deliver either the support and solutions needed – in 2017 the Scottish government pledged an additional 800 GPs by 2027, but six years down the line only 113 new GPs have been recruited and the WTE has actually decreased by 3.4% since 2019. While we may be training more GPs they are barely keeping pace with the premature losses the profession is suffering due to failure to retain – the bucket we are filling has a large hole in it and levels will continue to drop until that is repaired.

“Most GP practices certainly have the workload and demand for an extra GP (or more) – but the trouble is that funding has not been provided to pay for additional GPs. Worryingly, I predict that without the additional resources to fund extra GPs, the WTE numbers will continue to slowly decline. I am desperately worried for the future of general practice in Scotland.

“It is clear to me – and has been for some time – that unless there is a change of policy within Scottish government, almost no practice can consider themselves safe from falling over in this crisis. I cannot be any clearer when I say that intervention is needed now. I am meeting with the new health Secretary Michael Matheson today – and delivering that warning in person, I hope that will mean the Scottish Government finally addresses the full-blown crisis it has on its hands and acts.”

Notes to editors

The sustainability dashboard details the background to the current sustainability crisis in GP practice in Scotland as a result of an inability to implement the commitments of the 2018 GMS contract.

Some practice closures have resulted in mergers with other practices – explaining some of the huge leaps in practice list sizes.