Crisis – it’s a word that has almost become a cliche in the debate over the future of Scotland’s health service.
But the inescapable reality is that the NHS is under increasing strain to cope with the demands of an older population, while also struggling to recruit new doctors and nurses.
Primary care is among the areas suffering most acutely from this perfect storm, with GP surgeries across the length and breadth of the country battling to keep their doors open.
Last year, a survey by the Royal College of General Practitioners Scotland (RCGP Scotland) revealed that almost nine in 10 doctors worried that patient care was being put at risk by a lack of resources.
The organisation warned that the GP service would be “unrecogniseable” in five years if nothing was done.
Now, a new strategy has been launched by health bosses in the hope it could ease the strain on the country’s GPs.
The scheme aims to encourage patients to use community pharmacies as a “first port of call” for minor ailments and for treatment for long-term conditions.
As part of this process, more pharmacists would undertake independent prescribing and “advanced clinical skills” training.
The plan would also strengthen the role of pharmacies in hospitals through “safe, effective and productive working” across seven days.
Health Secretary Shona Robison said: “This strategy is a vital part of our efforts to transform primary care, enabling more people to be treated at home or in the community and easing pressure on other services.
“It sets out our priorities for improvements over the next five years – helping to deliver our commitment that every GP practice will have access to a pharmacist with advanced clinical skills by 2021.”
RCGP Scotland’s survey revealed that nearly 90% of Scottish doctors believed there was a link between staffing pressures and their own anxiety over patient safety. And 77% of medics admitted they worried about missing something serious because of their workload. A further 58% said they planned to reduce their hours or quit in the next five years.
Grampian and Highlands have been among the worst hit by the recruitment crisis, with rural areas in particular finding it difficult to attract new personnel.
In 2015, 8,000 patients in Bucksburn and Dyce were told they would lose their doctor when the Brimmond Medical Group closed its doors. And Gardenstown residents now make a 20-mile round trip to see a doctor in Macduff after their surgery shut because of lack of staff.
In January, Northfield and Mastrick Medical Practice changed hands after a number of resignations combined with a lack of new staff left it in an untenable position.
Further north, management at Cromarty Medical Practice handed the surgery back to NHS Highlands, citing a “chronic recruitment crisis” in the region. And in June, the health board admitted it was considering pooling staff at three surgeries – Lybster Medical Centre, Riverview Practice in Wick and Riverbank Surgery in Thurso due to plummeting staffing levels.
Changes decided last year mean there will no longer be locally-based out-of-hours GP cover in Lochaline in Morvern, Glenelg and Arnisdale in Lochalsh, Applecross in Wester Ross, and Lochinver, Armadale and Tongue in Sutherland.
Retired GP Ken Lawton, who worked in Grampian for more than 35 years, said he welcomed any measures which could help the GP service.
Mr Lawton, who was a senior partner at Great Western Medical Practice in Aberdeen, said: “Anything that can be done to use the valuable resources in the community can only be for the best, but it would have to be in partnership with patients’ GPs.
“We need to have a good system of exchanging patients’ records. Communication will be key and certainly the current systems we have in the NHS do not have that capability.
“My worry would be that a patient could visit one pharmacy in the morning and if they don’t get satisfaction they may go to another one or to their GP who may not know they have already been given medication.
“The key to patients’ safety is an efficient means of communication, whether that be electronic or a paper record.”
The strategy, Achieving Excellence in Pharmaceutical Care, has been launched by the government’s chief pharmaceutical officer, Dr Rose Marie Parr.
She said the plan was the next step in a shift in medical care which was already ongoing in the community.
She added: “In the community, we are making good progress in promoting local pharmacies as the first port of call for our most common healthcare needs and I want to encourage more people to see them as their initial point of care.
“Coupled with the commitment to transforming hospital pharmacy services, I believe this strategy will support our ambition to deliver world-class pharmaceutical care.”
Charles Michie Pharmacists have been in the north-east for close to 90 years.
The family-run business insisted it shares the belief that pharmacists can play a bigger role in health care locally.
Charles Michie, superintendent pharmacist, said: “We look forward to seeing the full report, but strongly agree with Dr Parr of the importance of pharmacies within communities and on the local High Street.
“Michies is delighted, along with other community pharmacies, to be playing their part as the first port of call for many common healthcare needs and, in many instances, their initial point of care.”
Opposition parties have backed the plan, but argued the measures were overdue.
Miles Briggs, the Scottish Conservative’s shadow health secretary, said: “This is a very welcome move, and one which the Scottish Conservatives have been calling on for some time. In fact, we set out very similar plan to this last year.
“If community pharmacies can play a greater role in preventing issues and dealing with minor cases, it will have a positive impact on both GPs and accident and emergency units.
“We know many people who show up at their GP or casualty probably don’t need to be there.
“This approach can help ensure they can access the care most beneficial to them, and take the pressure off other parts of the health service in the process.
“The SNP government must now implement these changes and make sure they happen.”
Meanwhile, Scottish Labour claimed the measures did not go far enough.
Anas Sarwar MSP, the party’s health spokesman, said: “We welcome any plans to improve both services for the public and conditions for our healthcare staff, but there must also be a recognition of the strain which services have been put under after a decade of mismanagement under the SNP – including in the north-east and Highlands.
“Scottish Labour believe this strategy could be bolder – we introduced the minor ailments service when in government and indeed our 2015 manifesto committed to extending the service to everyone and widening the conditions it covers.
“The SNP’s failure to match our position is a missed opportunity and will leave people missing out.”
It sounds like something from a dystopian nightmare: thedents and businesses we represent.”