A Highland GP on life the universe and anything…

s-GMS : an opportunity

With the increasing divergence of the NHS in England from the model in the other 3 nations there is a reluctant move towards a Scottish General Medical Services(s-GMS) contract for General Practice.

Much debate will rage as to what form this might take but I wanted to get down some thoughts on why it should change and what the needs of stakeholders in the negotiation might be.

Problems with existing

  1.  QoF Performance related pay is flawed,
    1. undermines internal motivators (autonomy, mastery, purpose)
    2. QoF depends on agreed/evidence based measures so fails to recognise complexity
  2. Enhanced Services fails to recognise workload (cf Diabetes LES in NHS Highland)
  3. Scottish Funding Allocation is crude at best
  4. No mechanism for transfer of funding that goes with work transfer to GP (How to achieve 2020 Vision?)
  5. Failure of pay stability in GP and failure to respect DDRB findings
  6. Pay discrimination
    1.  GP vs Hospital consultants
    2.  Remote vs Rural vs Town
    3. Scotland vs England
  7. Raid on pensions
  8. Recognition of additional expertise (leadership, research, educational etc.)

Stake-holders views


  • Pay should be reasonable, predictable and  updated in line with DDRB recommendations
  • Performance related pay (PRP) should not distort the delivery of holistic, patient centred care
  • GP need to have the autonomy to deliver the care needed by patients in their communities
  • Workload needs to be manageable
  • As workload increases there needs to be corresponding increase in resources to deliver that care
  • We need the opportunity to innovate and develop quality initiatives
  • Recognition of the complexity and variety of the work of GP[i]

Health Boards

  • Robust governance arrangements must be in place and respected
  • Recruitment and Retention problems must be acknowledged
  • Minimal paperwork or bureaucracy
  • Strong primary care to continue Barbara Starfield’s vision of effective and efficient health service


  • A caring relationship
  • Getting better and staying well
  • Access to GPs
  • Continuity of care
  • Being heard
  • GPs as advocates for them and their community

Scottish Government



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