Demand for GP services in Falkirk on the rise as doctors continue to leave general practice

Falkirk Integration Joint Board (IJB) heard that demand for GP care is outstripping the capacity to deliver it, both locally and nationally, despite efforts to support GPs with other health professionals such as pharmacists and physiotherapists.

Falkirk IJB took on responsibility for the coordination of Forth Valley-wide primary care services in January, although GPs remain independent contractors and are not directly employed by the NHS.

A report to members said that “increasing demand and available capacity is the underlying issue, constrained by lack of workforce”. It added: “There are concerns in Forth Valley about the number of GPs available to serve the local population.”

The problem is a national one, however, and a hard-hitting report from the British Medical Association this year highlighted the fact that across Scotland patient numbers are rising as the number of GP practices is falling.

BMA Scotland called on Scottish Government to “invest in general practice before it is damaged irreparably”.

The BMA figures showed a rise from 1522 patients per GP in 2013 to 1773 patients per GP in 2022, with the rise in numbers compounded by an ageing population with more complex needs. In 2022, there were 184 whole-time equivalent GPs in Forth Valley serving 320,000 registered patients, according to figures from Public Health Scotland.

The report to the IJB noted that Forth Valley’s position for GP vacancies is better than many other board area, pointing out that Forth Valley NHS has not had to take over any practices over the last five years, while this is happening more and more across Scotland.

Locally, GPs are being supported through the Primary Care Improvement Plan, which has introduced other healthcare professionals into doctors’ surgeries. Head of Integration, Gail Woodcock, said this had been “a significant piece of work” that is now beginning to deliver results. There are now 198 new members of staff in post out of a total of 205, providing around 6000 appointments every week. The roles include primary care mental health nurses, advanced nurse practitioners, advanced physiotherapy practitioners and pharmacists, whose expertise should allow GPs to concentrate on more complex conditions.

But Dr David Herron, who is the GP clinical lead on the IJB, warned the board that many of the answers to the crisis will not be in their power to fix. He said: “The report says it’s constrained by a lack of workforce, which I would probably challenge. We are training more doctors than we’ve ever trained and we’ve got good numbers of people training to be GPs. But what we find is that the highest number of people leaving general practice as a profession are those under the age of 30.”

He said that while “the flow of GPs is good, they are choosing other, more attractive options”.

Dr Herron said that locally they have developed a number of proposals looking at how to make GPs more sustainable and welcomed the board’s commitment to looking at the issue in more depth.

IJB member Gordon Johnston backed Dr Herron’s comments and added that persuading people to see other specialities, in place of their GP, was still “a work in progress”. Mr Johnston said: “I think there is still a communications message that needs to get through in terms of selling that because I still hear people talking about ‘only seeing a nurse’ and not being allowed to see a doctor, when in fact seeing a nurse is actually far more appropriate.”

Councillor Fiona Collie, chair of the IJB, said she welcomed the report on an issue that is so important to many people, saying it was “the start of a journey”.