ONE in six GP surgeries in the Lothians have been forced to turn away new patients in the last year as family doctors struggle to cope with the growing demand for their services.
The Scottish Government was today accused of “burying its head in the sand” over the problems caused by the region’s ageing and fast growing population.
An investigation by the Evening News has discovered at least 12 GP practices which are currently unable to take new patients – including some whose lists have been effectively closed for several months. At least one has been unable to accept new patients for more than a year.
Many GPs complain they are struggling to cope with growing patient lists and rising numbers of older patients who often require more attention and home visits.
NHS Lothian said “demand is outstripping services” and that a major review of its primary care services is under way to identify the best ways of addressing the mounting pressures.
A shortage of prospective GPs graduating from medical schools is being blamed for a large part of the problem.
Despite patients being turned away from many practices, none are officially classified as having closed lists, but are instead described as being “open but full”.
Concerns were raised today that a failure to properly acknowledge closed lists has been masking the extent of the problem facing GP practices.
Lothians MSP Sarah Boyack described the official classification as “Orwellian”, adding lists should be “either open or closed”. Patients who are refused a place at their local GP are directed to other practices, so no-one should be left without a family doctor, but some may be left to travel several miles to their family doctor and there are concerns that some people won’t persist if they find it difficult to register.
The News revealed earlier this week that the pressures on GP services – with many now working at full capacity – has left some patients waiting as long as four weeks for a pre-booked appointment.
Dr Dean Marshall, a partner at the Dalkeith Medical Practice, where patients struggle to book routine appointments, said the practice is so busy that it is considering “closing the list”. The surgery – which has seen patient numbers rocket by 800 in the past two years and now has more than 10,000 on its books – is struggling to meet demand.
Dr Marshall, a former chairman of the British Medical Association’s Scottish GPs committee, said: “We are the only practice in the area and have now got nearly 11,000 patients. We’ve been talking about having to close our list and not take any more on because there’s more houses being built in our area.
“We have 800 new patients, less money to provide care and we’re trying to employ more doctors but no-one wants to work. We can’t get any locum doctors to help us out because of lack of morale, we’re seen as a practice that’s far too busy, people can’t cope with working here. That’s the reality of the problem.
“The government is piling on more work for less money, because our costs and expenditure are up so we’re taking pay cuts, getting more work and more patients which is why doctors don’t want to work.”
The British Medical Association warned today that the kind of problems experienced in Dalkeith were widespread and the results of the News investigations found many neighbouring practices taking it in turns to close their lists to new patients for a limited time in an effort to control the pressure on them.
Dr Andrew Buist, deputy chairman of the BMA’s Scottish GP Committee, said turning away patients was a “last resort” for GPs which was only ever taken when the number of patients at a particular practice was growing beyond the doctors’ capacity to cope.
He said: “Across the country, general practice is under increasing pressure and doctors are dealing with a rising workload and growing population. Improving access for a growing number of patients will require a significant investment.”
Lothian MSPs have demanded answers from Health Secretary Alex Neil. Labour health spokesman and Lothian MSP Neil Findlay said: “The government cannot put its head in the sand and hope the problem goes away.”
Fellow Labour MSP Ms Boyack said: “If the GPs are telling us the system is at breaking point then we need urgent action. These are clearly not isolated incidents and this problem is not going to go away on its own.”
This view was echoed by Green MSP Alison Johnstone, who said: “Added to the problem of lengthy waits for appointments it’s becoming clear NHS Lothian has a serious problem on its hands.”
Margaret Watt, Scottish Patients Association, branded the ‘open but full’ status employed by NHS Lothian as “a con” and “totally unacceptable.”
“For all intents and purposes these surgeries are closed if they can’t take more patients on – end of story,” she said.
“Who are they kidding? If they aren’t taking on patients they aren’t open. They are closed. It sounds like a con and I don’t think that’s appropriate language to be using.”
Edinburgh and the Lothians has one of the UK’s fastest growing populations – with Edinburgh’s expected to rocket to 600,000 by 2033.
A Scottish Government spokesperson said there are a small number of practices are operating “open but full” patient lists.
She added: “On these occasions, health boards are expected to work with the practice, finding ways to either support the practice to once again take on patients or to agree a formal, usually time-limited, closure, informing other local practices in the area.”