General practice is buckling under current demand, with no improvement in capacity over the past 12 months and further gaps in staffing, BMA Scotland said today as it published the results of a survey of practices, demonstrating the huge challenges being faced.

The survey revealed that despite practices delivering approximately half a million appointments each week across Scotland, demand is still significantly outstripping capacity, with more than a third of practices that responded to the survey reporting having at least one GP vacancy – up from just over a quarter this time last year.

BMA Scotland said there must also be an end to the unacceptable abuse of GPs and their teams, which data showed is continuing, despite support from politicians across all parties that this cannot and should not be tolerated. There must be renewed messaging around what is possible for GPs at the moment in order to manage public expectations as the country enters what many believe will be the hardest winter Scotland’s NHS has faced.

Funding cuts, that directly support General Practice, which are expected to be greater than £70 million this year and were due to support the sustainability of practices and the crucial multi-disciplinary staff members who work with GPs must also be urgently reconsidered and the cash re-instated, the BMA said.

The survey found:

• 81% of practices said that demand was exceeding capacity – with 42% saying demand substantially exceeded capacity.
• Only 4% of those who responded said capacity was exceeding demand.
• 65% of practices said abuse of staff had worsened since the BMA last asked this question in October 2021, with only 2% saying they felt things had improved.
• More than a third – 34% - of practices which responded reported having at least one GP vacancy. This is an increase of 6% from last year. Using this data, and applying it to the position across the country, BMA Scotland estimates there may be as many as 312 WTE (whole time equivalent) vacancies across GP practices in Scotland.

Dr Andrew Buist, chair of the BMA’s Scottish GP Committee, said:

“The majority of GP surgeries are saying there is simply not enough capacity to meet demand for care – however I am deeply disappointed that there has been no improvement at all in 12 months despite pledges from the Scottish government to support general practice and recruit more doctors. Indeed, Covid was a much more prominent factor impacting capacity when this survey was last conducted – now that is simply not a viable explanation for the huge imbalance we face.

In fact, the situation appears to be continuing to deteriorate, with the percentage of practices reporting having at least one GP vacancy increasing from 28% last year to 34% this year – if that position is replicated across the country, we are looking at a shortage of approximately 312 WTE GPs just to carry out basic care. As each GP can usually provide care for around 1300-1500 patients, that means there could be effectively half a million patients in Scotland squeezed onto the lists of already very busy GPs. Doctors are leaving the profession because they are exhausted, burnt out and cannot see the light at the end of the tunnel.

“On top of this, GPs continue to be under increasing pressure from their patients, with 65% of practices reporting levels of abuse towards staff have got even worse than this time last year. I cannot make it clearer that this is simply not acceptable, and I implore everyone please do not blame general practice for this situation – the doctors, nurses and non-clinical staff are doing everything they can, they do not want to see their patients unhappy or struggling. Things are not going to get better until there are more GPs in practices and the government must get on with its pledge to deliver that.

“With that in mind, we need more openness from government about what GPs can deliver right now. While our current struggles are in part due to increased demand, it is also clearly because we don’t have enough GPs. We have been saying this for some time, we believe it is widely accepted and acknowledged and is why we have always welcomed the Scottish government’s commitments to recruit the additional GP workforce. However, we need up to 1000 more WTE GPs right now and I am concerned the government may not be on course to meet its target on delivering 800 additional GPs by 2027. This would be disastrous for Scotland and our patients. We are now looking at serious issues of patient safety and staff safety – a burnt-out and exhausted GP simply cannot provide the level of care our patients need and deserve.

“Recruitment is essential – but we also need a renewed focus and commitment on the retention of GPs so we can boost overall numbers. We cannot allow things to get any worse – it will be catastrophic for the system if they do.

“And while I appreciate difficulty getting an appointment can cause understandable frustration at times, it will never be acceptable when this spills over into abuse. No-one – least of all those people in caring services – should face abuse for doing the best they can in the extremely trying circumstances set out above.

“Finally, the signal that recent funding cuts to General Practice sends is hugely disappointing. We hear lots of warm words about the importance of GPs and multi-disciplinary teams that support them – but having this vital money cut off suggests they are not being backed up at all by actions. Indeed, it threatens to undermine practices, at the exact moment when we should be doing the opposite and shoring them up against what threatens to be a winter worse than any we have experienced. The funding should be restored urgently.”

Notes to editors

We received 420 responses to this survey – which accounts for 46% of GP practices in Scotland, with a patient roll of 2,877,057 which makes up 49% of the total number of patients registered with GP practices in Scotland.

In the week from 3-7 October 2022, 296 practices which answered this question, reported a total of 166,374 patient consultations– if the same rate of consultations to number of patients was applied to the total population of Scotland, approximately 470,907 appointments would have been held in a single week in general practice.