The 2018 GP contract had a disastrous effect on recruitment and retention of GPs to rural areas. This contract awarded substantial funding increases to practices in the central belt of Scotland and nothing to rural practices. The map illustrates this point - practices shown in red gained no extra funding while those in green gained substantial amounts. Furthermore, the multi-disciplinary teams promoted in the 2018 contract are relatively easy to establish in urban areas but near-impossible in remote and small island settings. Consequently, delivery of physiotherapy, treatment room, pharmacy services etc is much worse in rural areas. There needs to be a radical rethink of the 2018 contract for rural practices, with a new and fair funding formula reflecting the fact that rural practices have to deliver a much larger range of services (eg emergency trauma care) than their urban counterparts.
The underlying issue for any rural public service is that we lack economies of scale and any service is more expensive to deliver, as well as likely dealing with historic neglect - this is the basis of the Barnett formula for Scotland's funding from Westminster after all. Every part of health care in Scotland therefore has a rural weighting to account for these increased costs - every part except general practice as the 2018 contract scrapped the rural weighting completely. Imagine if primary schools in urban and suburban areas were all given a funding uplift in a national contract and rural ones got nothing - that is what effectively happened in the 2018 contract
The provision of multi-disciplinary services requires proper funding in remote rural areas, likely to cost more per person; that does not mean it shouldn't be provided - it should and people in remote rural areas should have the same services provided locally, free at the point of delivery, just the same as in urban areas, regardless of the additional cost needed to achieve this.
This content is created by the open source Your Priorities citizen engagement platform designed by the non profit Citizens Foundation