Improving together: a new quality framework for GP clusters in Scotland

Smith et al’s editorial is welcome in that it describes a way forward to promote quality in general practice in Scotland, but many GPs will be disappointed with it because of what it conspicuously fails to address.¹

The authors ask GPs, among others, for ‘patience’, ‘mutual trust, empathy, and lenience in judgement’ in the final paragraph. This is an extraordinarily audacious request on their part, given how long GPs have struggled to cope with the many negative consequences of the GP contract agreed by the BMA in 2004, and the sustained disinvestment imposed by the Scottish government since 2006. The combined impact of their policies contributed to the ‘production’ of the ‘clinical environment’, a euphemism for the inadequate and falling capacity, via the haemorrhaging of GPs and failure to attract new recruits.

GPs should be asking the BMA and the Scottish government to use this opportunity of a new contract for a complete overhaul of the way they are funded. A new system is required which ensures that the additional funding apportioned to deal with higher workload and unit costs is not at risk of being diverted away from patient services to personal incomes. They should also be asking the BMA to ensure the financial accountability of GPs, as opposed to the protectionist role that enables the variation in personal income, unrelated to performance.

For their union leaders to represent them legitimately in the future, GPs should demand transparency and access to the relevant documentation rather than the unacceptable secrecy and restricted access that characterises general practice funding to date. The latter may have been deemed essential by the BMA, but it self-evidently has not been in the interests of the majority of GPs, and, by virtue of their essential role, the interest of the NHS more widely.

• © British Journal of General Practice 2017