THE number of patients registered with GP practices run directly by health boards has nearly doubled in a decade amid a surge family doctors quitting their contracts.
More than 160,000 patients were registered with so-called '2c' practices in 2016, up from around 83,000 in 2007.
The arrangement was originally designed to ensure that primary care could be provided in remote and rural areas or to provide a specialist service, for example to homeless people.
However, as the Herald revealed in May, a record 52 GP practices - including 11 in Lothian, two in Dundee and two in Greater Glasgow and Clyde - have now handed back their General Medical Services (GMS) contracts to health boards amid a crisis in the recruitment and retention of family doctors.
The latest figures from the Royal College of GPs Scotland show that 160,322 patients - 2.8 per cent of all those in Scotland are registered with practices where the GPs are no longer in charge. That compared to 1.5 per cent of patients, or 83,290, in 2007.
It raises the prospect that more patients are being offered a pared down GP service, meaning that it meets the minimum criteria set out in the GMS contract without any "added extras" which the GP partners might previously have offered. For example, some GP surgeries have hired their own in-house physiotherapists for patients.
There is also evidence that it costs the NHS more to run GP practices directly, for example if the existing GPs leave and are replaced by locums.
Dr Miles Mack, chair of RCGP Scotland, said: “Right across Scotland, GP practices are being forced to close their doors or hand their contracts back to health boards. RCGP is particularly concerned over the impact that changing to 2c has on patient care and on lost value for money in healthcare services. In particular, it means that GPs are no longer in a leadership role and there is less continuity of care for patients."
RCGP Scotland projects that Scotland is on course for a shortfall of 856 GPs by 2021 unless action is taken. In particular, they want the Scottish Government to commit 11 per cent of the NHS budget to specifically to general practice, up from 7.2 per cent in 2015/16. Primary care as a whole currently receives 23 per cent of health spending.
Most GP surgeries are owned and operated as partnerships, with GPs as independent contractors paid to provide a range of mandatory and optional patient services stipulated by Government through the GMS contract. GP partners in turn are liable for all practice overheads, such as staffing and the building's upkeep.
However, retirements coupled with fewer junior medics specialising in general practice has seen an increasing number of surgeries struggling to fill vacancies, increasing the workload and financial burden for remaining partners.
Dr Alan McDevitt, chair of BMA Scotland’s GP Committee, said: “While there can be a variety of reasons for practices to be directly run by a health board, there is little doubt that the severe problems in recruiting and retaining GPs lies behind the increase in practices handing back their contract in recent years.
“If we are to avoid a situation where more practices feel they have no choice but to hand back their contract, it is essential that the spiralling workload demands on GPs are addressed and becoming a GP once again becomes an attractive career option for young doctors."
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