Reform Scotland

Examining Access

This report builds on work Reform Scotland set out in Patient Power (2009) and Patients First (2012), focusing on the relationship between the public and their GPs.

This paper is not about the medical care provided by individual doctors or GP practices, but about the practical arrangements as to how patients access their GPs, the “gate-keepers” to our health service, and whether we can’t improve arrangements to encourage a better provision of service.

Surveys such as the Scottish Government’s Health and Care Experience Survey tend to suggest that while the public often praise the care they receive, there can be frustrations with the difficulty in accessing that care to begin with, something which was echoed by the public reaction to our 2012 report on programmes like BBC Radio Scotland’s Call Kaye.

Reform Scotland believes that people should have a wider choice of GP. The purpose of this report is to outline a survey we have done of every GP practice in Scotland highlighting the very real differences that exist with regards to access across Scotland’s GP practices; differences to which the practices’ size or location are irrelevant. Yet, despite these differences, patients have little choice over who and where their GP is. This is despite the fact that the vast majority of GP practices are privately, not publicly, run. There has been much discussion in the referendum campaign about protecting the NHS in Scotland from privatisation, even though most people in Scotland’s contact with the NHS is through a private contractor – their GP. However, whereas in any other situation dealing with a private company you are likely to have a choice to take
your custom elsewhere if the services you need are not provided in a way that suits you, such a choice is extremely difficult to make with regards to your GP. Basically, they are private monopolies within our NHS.

Reform Scotland believes that giving individuals greater choice over their GP practice would mean that people were able to easily walk away from GP practices they felt did not provide services that suited them. We don’t envisage that such a policy would lead to a mass exodus of patients from GP practices, but the potential that they could would give them much greater influence over the way services developed. It is also worth remembering that when the NHS was set up in 1948, information leaflets advised that the first thing people had to do was “choose your own doctor”. So what we are proposing is nothing particularly radical or even that new, but an extension of something which patients were advised they could do when the NHS was set up over sixty years ago.