Fears over patient services as 3 Edinburgh GP practices set to be put out to tender
Three Edinburgh GP practices currently managed directly by the NHS are set to be put out to tender, sparking fears about the future level of service for patients.
Braefoot Medical Practice near Cameron Toll and Links Medical Centre and Mill Lane Surgery, both in Leith, are among eight practices in the Capital directly run by the NHS's Edinburgh Health and Social Care Partnership (EHSCP) rather than by GP partners.
The formal process to put the contracts for the three practices out to tender has not yet started, but it is understood it is intended to begin within the next few weeks.
There is concern that the most likely outcome is the practices will be taken over by consortia, which typically operate multiple medical practices across the country.
Critics say consortia then often seek to cut costs by reducing the number of appointments, replacing doctors with advanced nurse practitioners and using paramedics for house calls.
One Edinburgh doctor said: "General practice is already in crisis, but if people think GP services are bad at the moment, they're going to be a lot worse when they're taken over by people who want to run it as a business.
"The reason NHS Lothian are getting rid of practices is that they're costing a lot of money, so no-one is going to take them over without making cuts because otherwise how are they going to make them pay?"
The doctor said in theory practices could be taken over by independent GPs in the area rather than consortia from outside. "If that happened, that would be fantastic, but it hasn't happened so far. It would be lovely if it was a group of local GPs who knew the patients, but it is highly unlikely in the current climate anyone is going to throw their hat in the ring to do that.
"It's really difficult to make money in general practice now unless you are extremely business-minded.
"To make money you need as few GPs as possible because they're expensive, so there's an incentive to switch to advanced nurse practitioners and to paramedics doing house calls. There would likely be a reduced number of appointments and reduced continuity of care."
And the doctor said particular groups could be worst hit, especially in more deprived areas.
"Housebound patients are the most frail, most complex, they are the people who need an expert generalist which is what GPs are, to look after them and keep them out of hospital and there is a lot of evidence that, particularly for elderly people, continuity of care is really important. And some of the consortia won't deal with people who are drug addicts, won't give methadone - that's their policy.
"NHS Lothian does need to save money but there are many other ways they could do that - the whole procurement process, the maintenance operation for buildings is extremely inefficient and there is lots of waste there - so there are plenty ways they could save money without cutting frontline services."
Earlier this month, NHS Lothian announced that another of the directly-run practices, Polwarth Medical Practice in Tollcross, would close at the end of November, with its 5,000 patients reallocated to other nearby practices.
NHS Lothian said at the time its policy was to offer new contracts for the directly-run practices via a tendering process or to develop the practices as a "good practice model".
The British Medical Association acknowledged concerns about consortia and the impact on patient services and underlined the benefits of the independent GP contractor model.
Dr Al Miles, deputy chair of BMA Scotland’s GP committee said: "The emergence of mega-practices run by consortia in Scotland is an issue that we have been aware of for some time, which is often a response to smaller, independent GP practices being forced to hand back their contracts due to funding challenges.
“While this can allow local GP services to be maintained, in some cases there are concerns how the centralised approach, required under this model, influences the services available to patients, and questions over whether it offers the best solution for meeting the needs of communities, which we have seen reflected in patient feedback.
“Concerns have been raised that mega-practices may be more likely to rely on nursing staff and other allied health professionals to deliver services, instead of offering GP appointments. There is also concern about how some of the models used jeopardise continuity of care.
“The independent GP contractor model has served us well for more than 70 years: it is incredibly efficient and gives practices the autonomy and flexibility to meet the needs of their patient population.”
NHS Lothian said there was no tendering process currently live for any of its directly-run practices, known as "Section 2c" GP practices.
Tracey McKigen, director of primary care at NHS Lothian, said: “NHS Lothian, alongside EHSCP, remains committed to reviewing section 2c GP practice arrangements, with the aim of returning them to independent contracts through a tendering process.
"This aligns with Scottish Government’s drive for an independent contractor model of GP care across Scotland. Where practices are being tendered, this is subject to a robust tendering process to ensure continuity of care using a multi-disciplinary approach. For clarity, there are no tenders currently live for 2c practices in Edinburgh.”