General Practitioners, or GPs, are often a patient’s first and only contact with the NHS in Scotland. However, unlike hospitals which are owned and operated by the public sector, the vast majority of GP surgeries are private sector contractors to the NHS. This is similar to the situation of most opticians and pharmacists in Scotland, where the services are paid for by the taxpayer and are free at the point of use, but are privately-owned.
Health Boards can either establish General Medical Services (GMS) contracts with individuals, partnerships or companies of medical practitioners (who may in turn employ other medical practitioners); or establish a local contract, again with individuals, partnerships or companies of medical practitioners. As a result, there are three categories of practice:
- 2C practice: A practice run by an NHS Board
- 17C practice: A locally negotiated agreement, enabling, for example, flexible provision of services in accordance with specific local circumstances.
- 17J practice: A practice with a standard, nationally-negotiated contract.
The Tobacco and Primary Medical Services Act 2009 amended the eligibility criteria for persons contracting or entering into arrangements with Health Boards to provide primary medical services including a requirement that all the contracting parties must regularly perform, or be engaged in, the day-to-day provision of primary medical services. This prevented commercial companies from entering into contracts with health boards and employing GPs as had been allowed, even though it had never actually happened.
The GMS contract states that GP practices must provide certain ‘essential services’ to patients, which are:
- Management of patients who are ill or believe themselves to be ill with conditions from which recovery is generally expected
- Management of patients who are terminally ill
- Management of chronic disease
- Provide ongoing care to registered and temporary patients
- Provide primary care medical services in core hours to treat accidents or emergencies.
In addition to essential services, practices can also provide what are termed additional services, although each practice can choose to opt out of providing any additional service if they so wish. Practices that opt out of providing one or more additional services have a portion of their potential income deducted. Additional services are defined as:
- Cervical Screening
- Contraceptive Services
- Vaccinations and Immunisations
- Childhood Vaccinations and Immunisations
- Child Health Surveillance
- Maternity Medical Services
- Minor Surgery
- Out of Hours Services
Almost all funding in the current contract is practice-based. Expenses such as rent, wages and utility bills are taken out of this funding pot and the amount remaining, after the cost of providing clinical services has been taken out, makes up the pay available to the GP partners. The funding is distributed to practices according to the weighted needs of their population – for example a practice with a large elderly population, and therefore a greater workload, will get more funding than a practice with a relatively young, healthy population.
It is worth noting that in contrast to limited companies or limited liability partnerships, sole practitioners and partnerships, such as those running GP practices, do not need to publish their accounts. According to a Freedom of Information response Reform Scotland received from the Scottish Government, private sector GP practices, which provide the majority of GP services in Scotland, are under no obligation in law to provide a Health Board, or any other organisation, with details of how they spend the public money they receive.
Research carried out by Reform Scotland in 2014 looked at the variation in access arrangements at GP surgeries. It found:
- Only 67 per cent of GP practices had a website, only 51 per cent of practices allow patients to order repeat prescriptions online or by email and only 10 per cent allow appointments to be booked online. This is despite a report developed by the Royal College of General Practitioners and the Scottish Government in 2010 suggesting that improvements in access could be made by adopting such practices.
- There are huge variations in the way appointment systems operate between practices, with some only allowing appointments to be booked for that day, while others allow appointments to be booked up to 6 weeks in advance.
- As at 1 July 2015, there were 987 GP practices in Scotland
- Of these 815, or 83%, were contractors to NHS Boards, while the remaining 17% were run by NHS Boards.
- 24 practices had a patient list size smaller than 500, while 13 had a patient list in excess of 15,000.
- There were 4,918 GPs in post in 2014.
Reform Scotland reports:
- Examining Access: Survey of GP Practices in Scotland, August 2014
- Patients First: Improving Access to GP practices, September 2012
- Patient Power, April 2009
- ISD Scotland General Practice pages – http://www.isdscotland.org/Health-Topics/General-Practice/
- Scottish Government Health & Social Care pages – http://www.gov.scot/Topics/Health
- Royal College of General Practitioners Scotland – http://www.rcgp.org.uk/rcgp-near-you/rcgp-scotland.aspx
 Scottish Government, ‘Health and Care Experience Survey 2013/14”, May 2014
 BMA, “General Practitioners – briefing paper”, 20 October 2010