Reform Scotland

Vaccinations & the real risk of not prioritising quality Clinical Care – Dr Alastair Noble

Vaccinations work. The last outbreak of Polio in Nairn was in 1959.

As a GP I still had to help those damaged by the disease cope with the long-term disabilities they suffered from. 

Why then are we looking at the recurrence of completely avoidable infectious diseases in infants?

How can we have allowed contractual discussions and agreements between the Scottish Government and the Scottish BMA to put our infant population at risk?

The combination of effective vaccines and herd immunity has meant when I was examining an infant with an infectious disease, I could reasonably assume that they were vaccinated or at least had the benefit of herd immunity and could discount some really serious infective diseases.

But not now. For me it would be like being back in Nepal in 1973, I would have to consider in my differential diagnosis some extremely dangerous and potentially fatal diseases. I vividly remember a father carrying his oldest son to our hospital, where we  did an emergency tracheostomy and saved his life. His 4 younger brothers had all died from the same condition-Diphtheria. A simple course of vaccinations would have saved them all.

So why are we seeing immunisation rates in the low 80% when we know we need the high 90% for herd immunity?

We simply failed to understand and prioritise that the main role of a health service is to keep our population as healthy as possible. Vaccination, especially of all our infants, is a proven, tried and trusted way of making sure we offer the best possible start to our infants on their journey to be healthy, wealthy and wise.

Certainly, in Nairn there was a real determination to ensure that all our infants were fully immunised. That team effort involved everybody from Health Visitors, practice staff, GPs and especially the parents. We all worked together to give our infants the best possible start.

The GPs in Nairn have not routinely been giving the injections themselves for many years. Occasionally our receptionist team would flag up that Jimmy or Jeannie had not had their injections and could vaccinate them when they they  were in with a parent.

This was not a workload issue for us. We know that continuity of care works. We know that Nairn Healthcare was recognised UK wide as one of the Practices who coped best with Covid-for example vaccinating over 800 patients in  a single day for example.

Who decided that Nairn Healthcare should not be allowed to continue giving this essential and vital service? Why have we had to fight so long and so hard to continue, or now reintroduce doing what works?

The problems have been repeatedly raised locally and nationally. Dr Jenny Wares, acting in her professional capacity as a public health consultant raised concerns in her paper to the Health Board.

Dr Ross Jaffrey from Beauly, in another excellent paper, showed the effect that this constant undermining of General Practice and Community Care is resulting in poorer health outcomes for individuals and our communities. As a result of his paper our local MSP, Fergus Ewing, issued a press statement which made the front page of the Herald on Saturday January 27,2024.

I cannot improve on his diagnosis of what is wrong or explain more clearly what has gone so disastrously awry.

Fergus Ewing’s press release read as follows:

“These statistics give serious cause for concern. The low uptake of MMR vaccine in particular could lead, as  Nairn GP Adrian Baker has said, to a preventable tragedy

The problem is  because of bureaucracy, pure and simple. The 2018 GP contract  required vaccination and other services to be taken from  GPs and handed to Health boards. Their schemes are rigid, more difficult for people  to access, and more expensive. Fewer folk get their vaccinations for Measles and Flu’  — but  despite the service being worse,  it actually costs far more:   it costs £4M a year more in the Highlands, according to the  NHS Highlands  own internal report.

“The NHS  top Management both in Highland and Edinburgh  know this fine well,  and I have pressed them and the Scottish Government, without success,  for the past two years to permit GP practices in Highland to resume provision of these services.

“This has already been permitted in the Inner Hebrides I believe. But they thus far have blocked this for the rest of the Highlands despite similar problems of distance travel costs lack of public transport and so on which have caused the lower vaccination  uptake.

“Whilst I had an amicable meeting with the First Minister  when he was Health Secretary, it led nowhere, and  my later request to meet  his successor , Michael Matheson was rejected. I am  now to try  once again to get a meeting with him,  and Dr Baker on the basis of these shocking statistics. 

“Perhaps in the light of these statistics being publicised,  at long last the Scottish Government and Health Managers will finally take heed of what Dr Baker, campaigners in Nairn led by retired GP Alastair Noble, and myself have been telling them?

“There is a means to vary the GP contract , and this has been used for the islands in Argyllshire, but my impression is that the Senior Health Officials in Edinburgh have essentially put pressure on the NHS Highland Management  not to rock the boat;  Even though GP practices as in Nairn  and elsewhere in the Highlands would want to resume provision of these services and that they believe very strongly that this is indubitably in the best interests of their patients.

“This is sadly a perfect and shameful example of a giant  and  unaccountable bureaucracy failing to listen to people on the ground and imposing on the Highlands and Rural Scotland a metropolitan designed model of service provision .    These statistics now prove that the system is failing my constituents and demonstrate that there is now, in the view of the GPs I have dealt with a potentially serious risk to public health. I regret that it is necessary for me to speak out in these strong   terms –  but that is my plain duty as constituency MSP, and my job. If my constituents had  wanted a doormat they would have gone to B and Q!”
Fergus Ewing MSP

What then do we all need to do to get this sorted ASAP?

We now have the Scottish BMA supportive and willing to negotiate with the Scottish Government.

The local GPs in Nairn and elsewhere in the Highlands are willing to restart giving these services.

The local population are clearly saying, for example through our discussions at Community Council level and with our Local Councillors ,that we must prioritise local services-fit for purpose and locally accountable and responsible.

We can now see clearly that the original 2018  contract did allow for local solutions to be found-one size does not need to fit all!

Following local pressure with full support from Fergus Ewing and widespread publicity, we now are seeing local negotiations between our Local Medical Committee and Highland Health Board with the support of the Scottish BMA. This was discussed at First Minister’s Questions last week and we now appear to have an understanding that the priority is to make sure all our infants are vaccinated.

Delivering a Vaccination service to our infants and by definition and extension  all who live in their natural locality could just be the tipping point.

We can then prioritise Integrated Health and Social Care Provision in all of Scotland. Allied to Fair Share budgets and the right sizing of essential Specialist Care, we might just deliver the NHS 2048 model of the best Health and Social Care in the world. We have the right skills, workforce and clinical and financial data to deliver this.

Reform Scotland are arguing for a National Conversation to make our NHS and Social Care Services-Integrated ,productive and value for money.

Can we find the political honesty and will to deliver?

Dr Alastair Noble worked as a GP in Nairn and was awarded an MBE for his work in integrating Health and Social Care in Nairnshire