SPEAKING up for the rights of GPs has been a major part of Dr Dean Marshall’s career. He qualified in 1994 and was elected chair of the British Medical Association’s Scottish General Practitioners Committee (SGPC) in 2006. He is now a member of the UK negotiating team of the General Practitioners Committee which is responsible for negotiating the UK GMS contract. Based in Dalkeith, Midlothian, Dr Marshall leads on revalidation and clinical and prescribing issues for the GPC team. He is a member of BMA Council and a Director of the BMA.
Debate over health reform in England has dominated political discourse in the UK over the last year or so. What do you see as the major implication of the divergent approach to healthcare delivery in Scotland and England?
The diverging health system in England is likely to cause significant pressure on the UK GMS contract as it is likely that contractual means will be used to try and force GPs into engagement with the changes. This is despite clear messages from GPs that they do not support the direction of travel of the health service in England.
Do you think the demise of a UK-wide GP contract is now inevitable?
My view has always been that at some point the Scottish Government would decide they did not wish to continue with a UK GP contract. It now seems more likely that England will be the prime mover and will decide in time that they do not wish to negotiate on a UK level. This will result in us having to quickly negotiate a new contract for GPs in Scotland instead of taking time to plan and make sure that any new contract improves on what we currently have in place.
Are you supportive of the Scottish Government’s decision to say ‘no’ to private providers in primary care?
GPs in Scotland are very supportive of the Scottish Government’s policy of excluding private providers from primary care. We have seen the problems with private providers in England and the lack of evidence of any benefit to patient care. We believe GP practices should be run by those working in them and have a connection with their patients rather than being employed by private providers with a responsibility to their shareholders to increase profits.
How do you think the squeeze in government funding will most affect the NHS in Scotland?
The Scottish Government have argued that the current financial situation will result in improved efficiency and therefore improved quality. Those of us who actually work in the NHS are well aware that there comes a point where we have reached maximum efficiency and if demand continues to rise, in a climate of stagnant or reduced resources, then quality of care begins to suffer. I believe we are at that point now.
Are GPs in Scotland being given adequate resources to support the shifting balance of care from secondary to primary?
We have had no real investment in general practice in Scotland for five years and there is no evidence of any funding being transferred from secondary to primary care despite clear evidence of a significant transfer of work. GP practices are struggling to cope with this unfunded workload and there is no sign the situation will improve.
Given Scotland’s reputation as the “sick man of Europe” – what more can general practice do to reduce the nation’s health inequalities?
Politicians regularly complain that the GMS contract has failed to address health inequalities, which is unfair as that was not its purpose. The Quality and Outcomes Framework, however, has led to a significant improvement in the health of the UK population. In my view, general practice can do little to address the majority of health inequalities as these are largely linked to social issues.
Are extended opening hours the answer to improving patient access to GP surgeries?
GPs were not supportive of the introduction of extended hours as we saw no evidence that they would improve access to those at most need and we made it clear to government that there were better ways to spend scarce NHS resources. Our experience of extended hours has confirmed those views. While there may be some areas of the country with a high number of commuters who would like to see their GP in extended hours, the majority of the country does not have this type of population and there is no sense in GPs in remote and rural areas sitting in empty surgeries in the extended hours period.
Do you think the GMC is getting closer to a workable system of revalidation for GPs?
I am very concerned about the situation we find ourselves in with less than a year to go before the introduction of revalidation. While I support the concept of revalidation, I remain to be convinced that the proposed process is deliverable and will be of benefit to doctors or patients. We still have major problems to resolve such as difficulties experienced by locums in collecting the required data and the issue of who will pay for the remediation of doctors who fail to be revalidated.
The Scottish Government is opposed to NHS pension cuts but claims it is being held to ransom by Westminster. What is your view?
The proposed changes to doctors’ pensions by the UK government will result in us paying significantly more for our pensions than civil servants on a similar income. The Scottish Government says it is opposed to these changes and has started discussions with the health unions but so far has failed to offer any alternative. I am unconvinced by their defence that they are powerless to act and believe they are hiding behind the UK proposals.
Do you think there is public sympathy for doctors striking over pension cuts?
I hope the public understands that we have taken this step very reluctantly and only because the government will not engage with us to even try and find a fairer way forward. NHS staff agreed to major changes to their pensions in 2008. As a result the scheme is delivering £2billiion to the Treasury each year and staff have taken on sole responsibility for covering increases in costs due to improvements in longevity in the future. Now the government wants to tear up a deal reached through genuine negotiation and impose these further, unnecessary changes.
How do you balance the demands of being a practising GP with your busy role at the BMA?
During my time as SGPC Chair I have continued to work in practice two days a week as required by the role. I believe it is vital that those responsible for representing GPs are still in active practice. This is particularly important in establishing credibility with colleagues, politicians and the public. I have only been able to do my BMA role because of the incredible support of my partners who have put up with me being away from the practice for considerable periods of time. In my view without such support it would not be possible to maintain both roles.
Interview by Jim Killgore, editor of MDDUS Summons