It’s not every GP who has experienced the giddy joy of parading on the top deck of a bus while being cheered on by crowds of excited citizens.
But that was what happened to Andrew Buist when he was team doctor for his local football club, St Johnstone, when they won the Scottish Cup in 2014.
‘It was good fun,’ says Dr Buist, a GP partner in Blairgowrie. ‘I was the team doctor for around nine years, which meant sitting in the dug-out with the management team, looking after the players and running out on to the pitch when they needed medical attention. Winning the cup – and travelling with the team on the open-top bus – was just one highlight.
Much as he enjoyed the part-time post, Dr Buist has now hung up his team doctor tracksuit to focus on a new role. At the end of August he became chair of the BMA Scottish GPs committee. Having served as deputy chair since 2006, playing a crucial role in negotiating the new Scotland-only GP contract, he is aware of just how challenging the top job is.
It’s fair to say, however, that he is very much looking forward to it.
‘It is a privilege to be chairing SGPC at such an exciting time for Scottish general practice,’ he said as his role was confirmed.
‘Having been involved in the negotiation of the 2018 GP contract in Scotland, I am keen to build on this and ensure that we maximise its potential to reduce the workload pressures and GP recruitment difficulties that many practices have been facing.’
We are speaking the day after Dr Buist took the helm at his first meeting of SGPC as chair. The agenda for that meeting reflects many and complex issues that face the profession – and, indeed, the committee – in the months and years ahead. Most of these are common to the UK, including topics such as GP education and training, IT, and meeting the needs of sessional GPs. But there was also an update on the new Scottish GP contract, which came into force in April after receiving overwhelming backing from the profession in Scotland.
‘This is a contract that is being implemented over a three-year period,’ he stresses. ‘It was never the intention that there would be a big change from this April. But we are very hopeful that it will help to release GPs to do what we came into the job to do, that is, to be the expert medical generalist who can spend our time seeing the patients who need us, that is, dealing with people with undifferentiated conditions, and those who need complex care.’
He is keen to ensure that GPs across Scotland benefit under the new contract, which includes measures to stabilise GP income and reduce risk to GPs, for example, by revolutionising the way that GP premises are paid for.
‘It’s no longer appropriate that GPs provide the “estate” for the purpose-built, multi-disciplinary premises that we practise from today,’ he says. ‘It’s nonsensical that GPs use their personal borrowing capacity to pay for this. It’s off-putting for people who might otherwise want to become a GP partner, but who don’t want to take on £200,000 of debt at what is already likely to be an expensive time of life when they are getting married, starting a family, and buying their own house – especially if they are also saddled with substantial student debt.’
SGPC is currently working with the Scottish Government to develop a new system that will effectively see health boards take on the financial responsibility for most GP premises over the next 25 years, reducing the risk to individual GPs and making the profession more attractive. More details are expected to be announced later this year, but Dr Buist is optimistic that this – and other measures in the contract – will help with what he sees as his key priority in his years as SGPC chair.
‘We need to increase the GP workforce,’ he says simply. ‘That’s objective number one, if you like, and it’s what my “report card” needs to be based on. We want to persuade people thinking of retiring at 57 or 58 that they want to stay on until they are 60 or older. We need to attract the next generation of doctors into general practice – and we need to do that by making the job more attractive.’
The current workload and pressure on general practice is having a detrimental effect, he says, with many GPs choosing to work part time. This can be a positive choice – for example Dr Buist himself actively wants to have a portfolio career, combining clinical work with medical politics. But it can also be for negative reasons. ‘A lot of GPs are working less than full time because they find it the best way to cope with long days – the GP day has become too intensive.’
He hopes the new contract will help address some of this overwork by, for example, relieving practices of responsibility for some services, such as immunisations, and by appropriate delegation of work to other members of the multidisciplinary team. He cites pharmacotherapy, pointing out that 10 per cent of his time is occupied dealing with things like repeat prescriptions and medicines queries which could more effectively be done by practice-based pharmacists.
As a GP in a semi-rural practice in the Perthshire town of Blairgowrie, Dr Buist is well aware that recruitment and retention issues are even more acute in rural areas than in their urban equivalents. He also has a strong interest in remote and island general practice, so much so that he took a sabbatical eight years ago to spend a month working as a GP locum on the small island of Colonsay (population 130). ‘You’re a one-person health service,’ he smiles. ‘You do everything – and you never know what is going to come through the door.’
He enjoyed this experience so much that when he addressed a Scottish rural general practice conference last November he offered up his time as a locum this May, ending up working in Benbecula in the Western Isles. ‘There are a lot of similarities wherever you are working as a GP, but GPs in remote areas do a much broader range of healthcare – as an island GP, often you are the healthcare; you are it.’
This ‘refresher’ reminded him of some of the challenges – such as a three-hour round trip to do a home visit out-of-hours – and the joys, such as being part of the local community and having a high level of autonomy, and variety.
Dr Buist clearly loves general practice and talks with enthusiasm about the job, although he obviously just as clearly finds it frustrating to be working in a system with all the current pressures such as rising demand and limited resources.
Even here, he looks at it with a glass half-full type of attitude. ‘We can do so much more for patients today than even when I graduated [in 1987],’ he says. ‘It’s not unusual today to see a patient who has had two knees replaced, a hip replaced, cataracts done, and who is leading a happy and healthy life at an advanced age. That’s good news – I want to be that person myself. But we have to accept that with the ageing population comes even more demand, however reasonable that demand is. That’s why we need a strong and healthy general practice for Scotland, and that’s what we’re trying to achieve at SGPC.’