A healthcare crisis is developing, according to Dr Graeme Eunson, a consultant pediatrician based at Borders General Hospital and the outgoing chairman of the BMA’s Scottish consultants’ committee.
He claims a two-tier system is emerging, with double the number of medical professionals retiring in 2021 compared to 2020.
One major problem he has identified is the tax issue, whereby senior clinicians can end up paying tens of thousands in annual tax if they do not either retire early or reduce their working hours. He also claims that waiting times for elective operations will lengthen, possibly to up to 4 years, meaning lengthy delays unless you can afford to go private. He also says that social care packages will probably be reduced, as people all across Scotland are discovering to their cost is already happening.
NHS advice on Lyme Disease
Harvard Medical School has found that environmental changes are leading to ticks thriving in a wider geographic area and staying around longer. The NHS advice, to seek medical help only if you are bitten, appears to have become outdated. The optimal time for treatment is the first four weeks, and if it is not found early, the infection can migrate from the blood stream to tissues, joints, organs and nervous system, leading to neurological problems, heart arrhythmia, and joint inflammation.
In March this year, more than 1700 hospital beds were unavailable to new patients due to the lack of social care packages or care home places for those ready for discharge. Part of the problem is that there is Covid in care homes or those ready to be discharged, but another problem is that many care at home packages are suspended when someone goes into hospital, and it can take many months to reinstate them when the person is ready to come out of hospital.
Private Consultants for National Care Service
The Scottish government has paid nearly £1 million to private consultants in a year for advice on the design and delivery of the new National Care Service (NCS), with a further £500,000+ for health and social care projects not directly connected with the new NCS. Accountancy and consultancy firm KPMG is getting over £90,000 a month to prepare ministers for the new care service, and Price Waterhouse Cooper (PwC) got nearly £70,000 for the NCS consultation report to go out for comment by interested parties, having previously got £107,000 for an initial deal.
The Scottish government appears to have failed to use its own tendering system. Under the Procurement (Scotland) Regulations 2016, all Scottish public sector bodies should go through Public Contracts Scotland to advertise goods and services sought which are over the value of £50,000, but it was advertised and awarded through the UK Crown Commercial Services framework agreement instead.
They are also advertising a 12-month contract for an external VAT adviser to the National Care Service at a salary of £75,000. KPMG has received well over £3.5 million since the start of the pandemic, some for the National Care Service and some to support Scotland’s vaccination programme and other health and social care services.
Orkney and Multiple Sclerosis
The Orkney islands have the highest rates of multiple sclerosis (MS) in the world, affecting around 80 people, ten times the world average. MS is manageable, but as yet there is no cure. It is a degenerative disease, causing brain and spinal cord problems, movement difficulties, and sensation, vision and balance issues. In those developing it as teenagers or older, it may even lead to chronic fatigue (ME), and in extreme cases even lead to some cancers, lupus, hepatitis or blood abnormalities.
Research has identified some genetic factors in the islanders’ DNA but it also appears that a common virus, the Epstein-Barr virus (EBV), makes those who have been infected with it 32 times more likely to develop MS.
EBV causes glandular fever, and the virus remains in the body for life once infected, showing up in brain lesions of MS patients. The previously identified culprit, Vitamin D deficiency, does not appear to be a factor in the Orkney cases, as they appear not to have abnormally low Vitamin D.
MS hotspots in Orkney include South Ronaldsay, Westray and Rousay, but there are also ‘coldspots’ like Deerness on the east coast. Vaccine research is being carried out in the United States to attempt to break the link between EBV and the development of glandular fever.
GPs becoming harder to reach
The Health and Care Experience Survey of 2021-22 sought the views of 130,000 patients, the vast majority of whom said they had no choice about whether to see the GP in person. Overall satisfaction with GP practices has dropped from 85% to 67% since 2014. To blame is a chronic shortage of GPs particularly in rural areas. Back in 2009, 90% were satisfied with GP services. Problems even surround getting phone appointments on the same day in case of emergency, and getting appointments more than three days ahead.
As far back as 2017, 87 practices were closed to new patients, or limited. Nine of Shetland’s 10 practices were run by the health board at that time. Royal College of GPs Scottish GP chair Dr Miles Mack claimed that investment in GP services fell from 9.8% of NHS Scotland spending in 2005/06 to 7.2% in 2015/16.
But the 2018 reforms do not appear to have improved GP services. GPs were intended to be Expert Medical Generalists, assisted by expanded multidisciplinary teams. The £360 million pot was to enhance and improve multi-disciplinary GP and community services throughout Scotland, to allow these services to be established in every GP practice in Scotland, plus improve accessibility to physiotherapy and pharmacy services.
General practice was to remain at the heart of the healthcare system, with funding meant to reflect practice workload, with a practice income guarantee to ensure income stability. Improved access for patients and better healthcare outcomes were supposed to result. The final tranche of £77.5 million funding was released in February, plus an extra £3.1 million from last year’s budget.
Health Secretary Humza Yousaf recognises that
“The contribution general practice makes to the health and wellbeing of communities is invaluable”.
But in the decade to 2018, over a tenth of GP surgeries have closed in the north east of Scotland, 13% of them in NHS Grampian alone, which now has 73 practices. The closure figure Scotland-wide was 8% according to Public Health Scotland, with the total of GP surgeries 944 in 2018 compared to 1025 a decade earlier.
By 2020, that figure was down to 928 practices in Scotland, that is one in 10 GP practices have closed since the SNP gained power. This despite the fact that in 2019, Scotland had the highest number of GPs per head of population in the UK at 76 per 100,000, compared to the UK average of 60. The number of registered patients has also increased over that decade by 5% to 5.7 million. The average practice in Aberdeen has 9,074 patients, compared to 8,065 in Edinburgh, 7,360 in Dundee and 5,158 in Glasgow.
The Scottish government is pledging to recruit 800 more GPs over the next decade, but that is not stopping practices closing now, with a knock-on effect to other practices’ workload with no increase in staffing.