Last month, I wrote to NHS Lothian’s David White, the Primary Care Specialist Lead for the Edinburgh Health and Social Care Partnership, about the appalling state of GP services in South East Edinburgh.

The Scottish Government overrode concerns raised by the council in 2012 that an increase in housebuilding was not being accompanied by an improvement in public services. We are now seeing the effects of that decision, with 20,000 residents in South East Edinburgh soon to be left without access to a GP service.

I created my Build Better Places petition, which calls for increased investment in GP services, schools and public transport in South East Edinburgh, which you can sign here.

You can read my original letter to David White here.

Thursday 25th May 2023

Dear Ian

Thank you for your letter of 17^th May, requesting clarity on the provision of primary healthcare for the current and future residents of south east Edinburgh. My apologies in advance for what is a somewhat long winded reply, but I know you are already well-informed about the lack of local premises capacity. I therefore thought it might be useful to describe some of the work which may not be obvious, but stop short of giving reassurances which may not reflect the true seriousness of the current situation.

You have previously been very supportive in acknowledging the longstanding efforts of local GP practices to increase their list sizes and offer registration to as many local residents as possible. This has not been comfortable for some practices, who struggle to attract all the staff they require in the context of UK wide shortages and highly constrained premises.

As we have previously explained, the current situation has been predicted since 2014. What might not be so well understood, is the efforts which were made to try to identify a suitable additional GP practice site for the area. Whilst this may seem a straightforward exercise amongst all the local house-building, existing local practices may not wish to either move or increase their lists. Furthermore, additional primary care premises funding has no direct or proportionate link to new house-building and population expansion, however extensive this is. After the exploration of numerous options over several years, Edinburgh Council offered the very welcome opportunity of inclusion as part of the ‘Liberton High School Campus.’ We were proceeding with this option for a new practice building, with the expectation of building starting early this year, until the sudden decision of Scottish Government to pause any new NHS capital funding commitments in March. This meant that the additional capacity we anticipated being available from early 2025 is now without a timescale and by implication, ultimately uncertain. As you know, the Liberton Campus development was only half the answer for the area and we were keen to subsequently progress the other locally relevant opportunity at the ‘Gilmerton Gateway’.

The alternative option of inclusion in any prospective plans for the Liberton Hospital site would be welcome, except the timescale is much too late. Certainly, if the High School Campus option is somehow lost, we will need another relevant site.

There are always concerns about new GP practices being built and then not able to be adequately staffed. We are very conscious of this and careful to consult with local GP practices,  before committing to any development. In simple terms, the situation in Edinburgh remains challenging, but hopeful in this regard. We continue to be able to attract a growing clinical workforce and doctors in particular, to reflect our increasing population. We struggle however, to reduce the substantial capacity gap created by increased workload and limited funding over many years, which occurred prior to the New GP Contract introduced from 2018.

The number of doctors, receptionists and practice nurses which a GP practice can afford to employ, is directly linked with the number of patients registered. In contrast, the premises and ‘New Contract Multi-disciplinary team staff’, are funded separately using less sensitive population size estimates. Consequently, as an individual practice or group of practices grows, only part of the required funding to support expansion is available.

We believe the current funding arrangements are not sustainable, given the continuing national commitment to give each citizen reasonable access to primary care (ie GMS – General Medical Services). The dilemma of having a growing population unable to be registered, is with us now. In anticipation of this being resolved, we are actively planning to develop a model of General Practice delivery which builds an enhanced multi-disciplinary workforce onto a solid medical team foundation. We have a local south east practice which is keen to develop these arrangements, although we have not yet finalised exactly when this will begin.

Our confidence in the potential efficacy of these arrangements, grows with our collective experience from 2018 onwards, when a range of new clinicians were introduced to augment (not replace) medical capacity. Using our own experience and looking further afield, we will explore whether an increased concentration of these professionals can support an established medical team to grow their list size, without further increasing medical capacity. Patient satisfaction with these new primary care clinicians is very high – and at a much earlier stage than could have been anticipated.

In short, we will continue to build the medical workforce as population grows. Alongside this expanding medical workforce, we hope to create a new clinical (multi-disciplinary) workforce able to expand to absorb our growing population, without over-reliance on medical capacity. If the funding is available, we believe we are on the way to re-establishing a stable workforce, offering improved access and flexibility to the public.

If all the relevant funding does not grow in tandem with population increase, then we will risk losing the momentum we have begun to build in the last couple of years and restrictions in access to GMS will become more widespread, just as has happened in other parts of the UK. Restrictions in access build resentment amongst patients and tie up valuable capacity in unproductive interactions. Primary Care clinicians repeatedly emphasise their huge satisfaction and professional pride in delivering a good level of service to their patients. When this becomes impossible and patients lose faith in our responsiveness, once stable teams can quickly become destabilised. 

I hope this is helpful and please don’t hesitate to get in touch if further information or  a local meeting would be helpful.

Kind regards,

David