Getting the green light – an interview with Dr Miles Mack, RCGP Scotland chair

Health news has provided pretty grim reading in recent weeks, with the winter pressures on Scotland’s NHS leading to every health board missing the Scottish Government’s treatment time guarantee.

Catching up with the chairman of the Royal College of General Practitioners, Dr Miles Mack, Holyrood was therefore surprised to find him in optimistic spirits.

Access to urgent health services out-of-hours is the focus of the new review into primary care led by Sir Lewis Ritchie, and Holyrood catches up with Mack shortly after he attends the first meeting. His first impression is positive. “I’m very much welcoming this review, because this is one part of general practice which has not necessarily had a lot of attention. General practice has not had a lot of attention anyway, but the out-of-hours service has tended to struggle a bit with funding and recognition,” he says.

Out-of-hours has seen a 3.3 per cent drop in funding in real terms since 2004 through efficiency savings by health boards. “General practice doesn’t have any targets, and we’re very glad of that, but the trouble is it then means the funding then gets diverted to those areas which do, in particular high profile targets such as A&E waiting times,” says Mack.

Out-of-hours work by GPs needs to be made easier, he says, and should be a “green light” service. “This idea GPs drive round with flashing green lights is something positive and should be a way of giving an identity to what they do.”

"I think out of hours is on a knife-edge"

RCGP Scotland is looking for four things from the review, says Mack. Firstly the scope of out-of-hours needs to be clarified, he says, whether it encompasses only the work of GPs or is also about “district nurse services, palliative care services and other help such as community hospitals. Because actually we’re beginning to see GP out-of-hours being used to cover all sorts of other gaps in the service”.

Also investment must be adequate enough to provide a whole primary care emergency team, services must be able to share patient data, and also the welfare of staff must be protected, argues Mack.

The new GP contract is due in April 2017, but Mack says the situation cannot wait till then, because it is increasingly difficult to recruit and retain GPs. “I think out of hours is on a knife-edge. I don’t think it’s unfair to say that. And to a certain extent out-of-hours has been a harbinger for the rest of the NHS. It’s been the first place we started to see problems with recruitment, and we’re now seeing that across the NHS.”

Mack, who practices in Dingwall in the Highlands, was appointed chairman of the college in November. He says he was attracted to general practice by the chance to do all the bits of medicine which interested him. “I absolutely love the range and variety of my work.  A job where part of it is looking after a small casualty unit and a few medical beds, another part is mental health work, and another part of it is doing minor surgery. I might be doing all of those in the same day. It certainly appeals to me.”

Current pressures have made the job less attractive he warns. “People are retiring early, and what’s very worrying is the large number of female GPs who are leaving the profession in their 30s and 40s. It’s going to have a significant impact in the long-term.”

The college has to balance the risk of turning people off the profession when talking about the problems in general practice with the responsibility to do so, says Mack, but he has optimism for the future in the form of the new GP contract, which he says is moving forward.

 "It could transform the way general practice is done"

“We’re looking toward a system of peer-led values, driven governance by small locality clusters of practices, which is going to be very different to what we’re doing. Actually I think it could transform the way general practice is done, that we move away from looking at single diseases and actually have the opportunity to look at people in the full complexity of their lives, to provide the sort of professional input we want.” This will involve more collaborative working with the whole primary care team, he says.

There is willingness from Scottish Government to listen to the new model, he says, but “it all predicates on having the right resources to do this, unfortunately”.

”The thing which will encourage people most to join the profession and equally not to leave it is to see a profession where they’re able to practice as doctors in a way which is congruent to their professional values. I think we’re moving towards that.”