This article appears as part of the Inside the NHS newsletter.

Private GPs are on the rise in Scotland – so what does it mean for patients, and the wider NHS?

Missing data

General practice is traditionally described as the "bedrock" of the NHS, but it is becoming increasingly shaky as GP partners quit, practices fold, and Scotland's GP workforce continues to shrink at a time when patient demand is soaring.

The situation is fuelling an appetite for private general practice: patients able to pay can be seen quickly, while doctors feel able to provide a level of care and attention lacking in overwhelmed NHS practices.

As reported by The Herald on Sunday, the number of private GP clinics registered in Scotland has gone from three in 2019 to 11 now. This only hints at the increase in demand for private general practice, however. The actual number of GPs working full or part-time in the independent sector is difficult to ascertain.

The figures – obtained under freedom of information from Healthcare Improvement Scotland – relate only to those clinics that are 100% GP services. HIS, which is responsible for inspecting private facilities, was unable to provide data on "mixed" clinics – where GPs are one of a number of healthcare professionals – as this was too costly to extract under FOI.

The GMC registers all GPs licensed to practice in the UK, but it does not hold any details on how many are working in the NHS, private sector, or both.

The Private Healthcare Information Network (PHIN) currently collects data on the number of consultants active in private hospitals, but has not been tasked – as yet – with gathering equivalent figures for GPs.

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'Heavy heart'

Dr Andrew Buist, chair of the BMA's Scottish GP Committee, says the vast majority of GPs quitting the NHS for private practice "will do so with a heavy heart" – but he understands the appeal.

"They will be able to spend more time with each patient... without that horrible feeling that you've got five other people outside your door who are similarly needing seen and you are running behind time."

Besides "two-tier" healthcare, one of the criticisms often levelled against private practice is that it can lead to over-investigation and end up creating extra work for the NHS.

When patients are paying for tests and scans, there is less incentive to consider whether it is clinically indicated. But if a blood test happens to pick up something potentially abnormal, patients can find themselves back at their GP seeking a referral into the NHS system.

Dr Buist added: "It further increases health inequalities, because you needed the £200 in the first place to get the private blood test but the NHS ends up spending much more than that proving that some minor blood abnormality wasn't anything serious."

The Herald:

Proactive

Dr Naushad Ali, a former NHS GP partner who now runs the Glasgow Private Clinic in Newton Mearns, stresses that such cases are "very provider specific".

"We're careful not to over-investigate," he said. "We will always see patients, we will listen to their symptoms and history, and we will make suggestions as to what is clinically appropriate."

He argues that his objective is to detect problems early enough to prevent them turning into something serious.

He notes a growing demand for PSA – a blood test for prostate cancer biomarkers. Although it is considered too unreliable for routine screening, increased levels can be an early warning sign in some men.

"These are patients who are slightly older, but they might struggle to get that through an NHS GP if they don't have symptoms. To me, that's being proactive in healthcare rather than over-investigative."

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In a sign of the burgeoning demand, Glasgow Private Clinic has gone from offering one four-hour GP session once a fortnight pre-pandemic to a five-day service where nearly all the appointments (which cost £110 for 20 minutes) are taken.

"It's very rare that we've got empty slots," said Dr Ali.

He added: "We see it from both sides. We can understand patients' frustration, but we also see it from clinicians' point of view with waiting lists being so long. They still want to be able to provide good care without the challenges that present themselves in the NHS."