Aberdeen patients claim they are “being held hostage” by rules blocking them from changing GP surgeries – introduced over doctors’ fears of an “exodus from failing practices”.
Health chiefs have enforced a blanket ban on swaps for anyone already registered with a Granite City practice, blaming Scottish Covid laws.
But it has left unhappy patients feeling trapped, having been told moving practices was illegal.
And one Aberdeen clinician – speaking to The P&J anonymously as a whistleblower – claims the move comes amid “anxiety” about one practice being run with a “dangerous” reliance on nurses.
In our in-depth look at the issue:
- One patient “locked into” a move to Denburn speaks of his reluctance to be transferred to the “ghetto”
- A woman already at Denburn describes her six-week wait to be diagnosed after a mystery illness left her “unable to complete simple household tasks”
- A city medic says hard-pressed doctors are fighting to keep the ban in place to avoid becoming swamped with unhappy patients leaving their current practice.
What has caused the problem?
Newburn, based at Denburn and Northfield And Mastrick medical centres, took over the running of Old Aberdeen’s last year on an emergency basis.
We can now reveal the group has been given the contract to run the Sunnybank Road practice, with near 11,000 patients on its lists, permanently.
As 2020 ended, the facility was thrown into turmoil as all nine of its GPs walked out as the extent of reorganisation there became clear.
In December, a year on, they offered to come back if the change was undone.
The contract to run Old Aberdeen is expected to be worth around £4.43m over the next four years.
Cash for GPs running practices is awarded per patient on their books and it is one of the city’s largest.
Elsewhere, One Medical Group will take on Whinhill while Torry and Camphill will be run by River Dee Medical Group.
The management changes will come into effect on March 1.
Earlier this month, thousands more were added to their lists after the demise of Carden Medical Centre.
Along with the four above, it was another of the publicly-run surgeries in Aberdeen recently put out to tender with the aim of finding a privately-run firm to takeover.
However, failure to recruit staff to “crucial vacancies” left Carden unsafe to remain open long term – and so its 8,600 patients have been transferred.
It is thought Newburn took around 3,600 onto its collective books – with Denburn signing up the most of any city practice as the lists were divvied up.
ACHSCP declined to confirm or correct those figures.
The Scottish Government has previously declined to pause the tendering of Aberdeen GP practices, with Health Secretary Humza Yousaf not wanting to “intervene in local decision-making”.
Some would prefer not to move to Denburn – but have been told it’s against the law to switch GPs
One anonymous patient, who has been locked into a move to Denburn, said it was “absolutely to the detriment of patients”.
All 8,600 registered at the West End practice were told where they would end up after its closure at the start of this month.
‘John’ told us he had previously pulled his wife out of the Newburn-run facility in Rosemount Viaduct as they refused to prescribe her required medication.
Now they are both being sent back.
“I don’t know where we stand. There was an NHS number to phone about any concerns. I did and, of course, no one has got back to me,” he said.
“Denburn’s reputation proceeds it. It’s like the ghetto down there.
“Having been told by Whinhill we could apply to move once February came, we tried to and were told we couldn’t.
“The sad thing is Carden had great doctors there and you could nearly always see the same person who knew your condition, which is half the battle.”
John said he was told they could jump ship once February came, but they have now been turned down for a move because they live within the catchment area of their new practice at Denburn.
The Newburn partners said: “All complaints are taken seriously and handled through a formalised process.
“We cannot comment on individual cases but the highlighted testimonies are not representative of the practice population as a whole.”
Are Covid rules behind ban on changing GPs in Aberdeen?
It was in setting out the response to Carden’s collapse – prompted by a lack of staff to safely run the facility – that ACHSCP’s ban on patients moving to another surgery came out.
The partnership’s boss Sandra McLeod wrote: “Due to the current Covid guidance in place by Scottish Government, patients should not move practices unless they have recently moved home into the catchment area of another practice.”
However, the government has since confirmed that policy is not mandatory and patients could move – if local authorities allowed it.
“While practices can still accept patients who have not moved home at their discretion, the guidance is intended to protect practices from sudden changes to their patient lists during a pandemic,” a spokesman said.
Aberdeen’s ban on GP switches follows doctors’ pleas, whistleblower reveals
But it is unlikely ACHSCP will do so, The P&J understands, due to pressure from GPs, worried they could be overwhelmed by patients fleeing from other centres.
This is confirmed by a city clinician who has anonymously revealed concerns over the number of patients Newburn is now treating.
“There are fears patients will vote with their feet and register elsewhere. And because they have so many patients, the volume of people going would destabilise other practices,” they said.
“Many have sought assurances – in a nice enough way – that their list sizes would be protected.
“This rule is because GPs are scared of a mass exodus from Newburn and other failing practices and being forced to take patients they can’t deal with.”
Previously, The P&J has reported on the concerns of the GPs who walked out of Old Aberdeen – but this senior physician is not related to that controversy at all.
They added concerns about the number of patients at Newburn now per GP, though the partners said a “more meaningful and modern metric” would take account of the multidisciplinary teams working there too.
“In this regard, Newburn is well staffed to meet the care needs of the population,” they added, pointing to a direction of travel across Scotland towards freeing up GPs from “more routine tasks”.
As well as GPs, they list paramedic practitioners, advanced nurse practitioners, prescribing pharmacists, link workers, a first contact physiotherapist and counsellors at their practices, working to treat patients “within their areas of clinical competence”.
The anonymous clinician said while GPs were encouraged to work this way, Newburn was taking this to an “unheard of and unprecedented” extreme.
“If you speak informally to most GPs, there is a real anxiety that the quality of care is so poor. People can’t even get through the phone because they have created so many barriers,” the whistleblower added.
The Newburn partners said an independently commissioned patient survey was “at odds” with claims access to care there is restricted.
Recent results of the annual health and care experience survey by Public Health Scotland scored Newburn in line with, or better than, the Scottish average on access.
They added: “We are generally able to provide clinical contact the same day, or at least within 48 hours.”
Patients ‘held hostage’ as Newburn takes on even more from other Aberdeen practices
Critics of the Newburn model point to the use of advanced nurse practitioners (APNs) to triage patients traditionally seen by GPs.
This, along with a heavy reliance on the use of video and phone consultations, is argued to risk patient care.
The use of technology is also feared to be side-lining some of the most vulnerable in society.
But online e-consultations are a way of working backed by the NHS and adopted by a number of other Aberdeen GP practices too – though some have reverted back to more traditional methods given patient resistance.
The Newburn partners said it was a “simple concept”, adding: “As every practice has limited incoming phone lines, if 30 people phone the practice at the same time, lines will be jammed and there will be a significant delay for patients.
“If 20 of the phone calls are young patients with minor skin rashes, fungal nails infections, UTIs etc and instead send in an e-consult- this liberates significant capacity for the 82-year-old patient with weight loss who is amongst the incoming calls and who may not have got through if this alternative route of access was not available.”
E-consult feels like Aberdeen GPs are ‘hiding’
But one of their patients, who remains unable to work more than a month after first taking ill with a mystery ailment, said she felt “held hostage” at Denburn.
‘Jane’ told us she felt like “doctors are hiding” given the use of APNs and e-consult, diverting her away from her GP.
It took six weeks of campaigning to speak to a doctor – on the phone – after being subjected to an array of blood tests and x-rays while stumped staff tried to work out what was the cause of the recent illness.
“Their stinking attitude is beyond a joke,” Jane, registered at Denburn, told us.
“On the morning of my first set of tests, they called me up and asked if I knew I was due at Newburn. I thought ‘where on earth is Newburn?'”
Unfit for the bus, she shelled out a last-minute £25 on taxis to make it to Newburn – the Northfield And Mastrick centre – in time.
After six weeks of being wiped out by the simplest of household tasks, Jane reached breaking point: “I can’t go on like this.”
At another appointment being treated by another nurse, she demanded to see her GP.
“I asked what the point in more tests without seeing a doctor was, and the nurse turned to me and said: ‘I can do what a doctor can’.
“But she can’t, she’s not a doctor.”
Use of nursing staff in place of GPs at Aberdeen practice ‘dangerous’
That is a concern shared by the clinician whistleblower, who believes the extensive use of nurses at Newburn practices is “dangerous”.
“I feel nurses are being asked to work outside of their competence as their training is fundamentally different to doctors, in that it is specialised in adult nursing or mental health or paediatrics,” they warned.
“A doctor spends years building up experience in general practice and to bring nurses into that, and expect them to do all the jobs of a GP after very specialised training, it’s dangerous.
“This is desecrating primary care in the city.”
But the Newburn partners scoffed at that suggestion, branding it “elitist and outmoded” and not in line the nationally approved contract agreed by Scottish GPs in 2018.
It notes that a “refocusing” of what GPs do requires multidisciplinary teams to carry out work previously expected of doctors where “safe, appropriate and an improvement of patient care”.
“APNs are a cadre of allied health professional who have undergone specialised and advanced training in several areas of practice relevant to primary care,” the Newburn partners hit back.
“Nurses have always formed the backbone and foundation of the NHS and such comments denigrate their role and progression in delivering high quality patient care.
“Newburn’s care model is in line with the strategic aims set out in the new GP contract and supported nationally.”