Medical practice - contract and context principles of the Scottish Approach: update

5. Reducing Risk

Income Stability

5.1 To support the vision of the GP as expert clinical generalist in a new GMS contract we have agreed a full review of all aspects of GP pay and expenses will take place in 2017, and inform options from 2018.

5.2 We agree, in principle, that we need better information and evidence to inform both accurate recompense of expenses and options for the long term trajectory on GP pay in Scotland. To this end, we have agreed to jointly commission a review of general practice funding, pay and expenses to provide a proper, robust evidence base for improved decision making. This will take place in 2017, and inform options from 2018.

5.3 To allow this work to take place we are therefore extending the current pay stability agreement to April 2018.

Clear Career Path

5.4 The new GMS contract will enable a new role for GPs in Scotland - a new role designed to better attract more medical students to choose the GP profession; to encourage those have left to return; and to retain those who are thinking of leaving.

5.5 Last year we increased the number of general practice training places in Scotland by a third. And, for the first time, we made a recruitment bonus of £20,000 available to attract trainees in traditionally harder to fill posts.

5.6 This year we increased to 76 the number of training programmes advertised with bursaries. We are starting to see the impact of these efforts. The 2016 GP Year one training recruitment fill rate was up 19% compared to 2015.

5.7 These measures are only the start of our efforts to increase GP numbers. We know we also need to fundamentally influence the balance of medical training, so that Scotland produces more GPs each year.

5.8 That is why, in June last year, the Cabinet Secretary confirmed a new Graduate Entry Medical School will be established - delivered by partnership of Dundee University Medical School, St Andrew's University Medical School, and the University of the Highlands and Islands.

5.9 This new school will provide high quality community experience as central feature of the curriculum. We know exposure to community settings during training increases the likelihood of graduates choosing careers in primary care. We are encouraged by the progress the partnership are making in establishing the school which, subject to GMC approval, will be open in 2018.

Premises

5.10 We recognise that premises matter when planning for the future, and can cause recruitment challenges.

5.11 That is why last year the Scottish Government and SGPC jointly agreed to establish a Short Life Working Group on premises which reported to the Cabinet Secretary in December. The group recommended that the Scottish Government recognise and support a long term shift that gradually moves with general practice towards a model which does not presume GPs own their practice premises.

5.12 This model would lower the risk to general practice and allow for better financial planning and risk management by NHS Boards. Change will involve a range of approaches, depending on the circumstances of a GP practice, the needs of GP partners and local needs.

5.13 The Scottish Government and the BMA are working to produce a national Code of Practice for NHS Boards for use when a contractor wishes the Board to acquire property or take on the contractor's responsibilities under an existing lease.

5.14 This will ensure a more consistent approach across Scotland, protect general practice from the "last person standing" scenario, and allow NHS Boards to more quickly respond to these situations.

Practice Sustainability

5.15 At the conference the Cabinet Secretary provided an update on the work of the Improving Practice Sustainability working group. The group has concluded the first stage of its work and presented recommendations for action at a number of levels.

5.16 We recognise that improved support for GPs at the interface between primary and secondary care will reduce risks to patients as they navigate through the healthcare system. Through our shared work in the Improving General Practice Sustainability Advisory Group, the Scottish Government and BMA are considering options to address issues of un-resourced transfer of work and a poorly functioning interface between Secondary and Primary Care.

5.17 The Sustainability report contains practical recommendations for reducing workload by improving interface working. These include following up test results. There is an important principle here. Whomever orders the test should follow up the result.

5.18 The Scottish Government shared the clear view of the BMA that this is a patient safety issue. The clinician who requests the investigation is responsible for acting on the results. The Practice Sustainability Group, that first met on 17 January 2017, is now focusing attention to provide oversight and advice on the progression of the recommendations.

Sharing Data

5.19 We recognise that GPs bear considerable professional and personal risks in the course of managing the safe and secure use of patient data. The Scottish Government and the British Medical Association have jointly agreed to establish a Short Life Working Group to take forward a proposal to draft a new Code of Practice for the sharing of patient data between health services in Primary Care.

5.20 The group will create an agreed code of practice with regard to information sharing for the next GP contract in Scotland. This code of practice will support the safe and appropriate sharing of information across boundaries of care and help to clarify roles and responsibilities in a complex information governance system which has both employed and contracted elements. We are developing the code in accordance with the Data Protection Act 1998 and with the support of the Information Commissioner's Office ( ICO) in Scotland.

5.21 The Code of Practice will make clear the roles and responsibilities of GMS contractors and Health boards for systems and processes; clarify who has meaningful control of information held within GP-held health records, in different circumstances and provide guidance on internal data governance for GP practices.

5.22 When the code is agreed, GMS Contractors and Health Boards will be required by the GMS contract to show due regard to and comply with this Code.