Centre stage for NHS

As chair of the BMA’s Scottish council, and a GP partner with many years’ experience, Iain Kennedy (pictured above) is only too familiar with the challenges facing the health service.

But when he became a patient last November, it all got that little bit more personal.

‘I developed gallstones and was on an elective waiting list for surgery. But, like many other people in the NHS at the moment, nothing much was happening, and I was getting recurrent episodes of quite severe biliary colic – about 15 in the end.

‘So I did what many people have to do and arranged for a private consultation to try to get the operation done. I was waiting for the consultation and it [the gallbladder] perforated. So I never had the private consultation and I had urgent surgery, and actually experienced how fantastic the NHS is – I got absolutely fantastic care – but it’s a bit sad that you have to become an emergency before you get the treatment you need.’

Ahead of the Scottish Parliament election on 7 May, The Doctor caught up with Dr Kennedy in his surgery at Riverside Medical Practice in Inverness. As the name suggests, this relatively modern building is situated near the River Ness, just along from the cathedral and Eden Court Theatre. It was a cold and blustery day, with sleet blowing through, but nevertheless Inverness had the feel of a city on the up. A guide shepherding a group of tourists was pointing out Inverness Castle – previously a courthouse and prison, but now a visitor attraction – and a few hardy people were even sampling ice cream from a kiosk next to the river.

Local health services, however, are less rosy. The health board, NHS Highland, is facing the same issues as the rest of Scotland, with lengthy waits for treatment, particularly in specialties like orthopaedics and gynaecology, high consultant vacancies, and financial pressures. High levels of rurality also bring challenges.

So what are Dr Kennedy’s key messages for the politicians who will take power after next month’s election? He is in no doubt about where their priorities should lie.

‘Workforce planning for Scottish health services is abysmal,’ he says simply. ‘We have a 16.8 per cent consultant vacancy rate in Scotland – that’s more than 1,600 consultants – and the Scottish Government needs to start being honest about that.

‘We have GP practices across the country that are falling over. We have 18 practices in Highland that are run by the health board, because general practice has become so difficult, because of poor resourcing, so we can’t recruit GP partners to run these practices. We need a proper workforce plan that gives us enough consultants and enough GPs.’

Sorting out the pipeline of doctors should also be a priority, says Dr Kennedy. ‘We need a workforce plan that provides adequate training posts for resident doctors – we have all these resident doctors coming through without jobs to go to when patients across Scotland aren’t getting the care they need; it’s an absolute scandal that we don’t have the training jobs for resident doctors to move into.’

BMA Scotland has published its manifesto ahead of the election, with detailed asks under the broad headings of health service delivery, valuing doctors, doctor wellbeing and culture, and public health.

Dr Kennedy is clear that radical change is needed, no matter which political party (or parties) take power. ‘There’s no doubt that things have got worse in health in the last two decades,’ he says. ‘There’s been a lot of rhetoric about, for example, shifting the balance of care from hospitals to the community, but the exact opposite has happened. Around 15 years ago, the percentage spend in the community was about 11 per cent, and we now spend around 6.7 per cent, so it’s no wonder that the NHS isn’t coping because we’ve got the resources in the wrong place. We do need to protect and invest in our hospitals, but we have to invest hugely more into the community, into general practice, and in social care, or we’re never going to get out of this situation.

‘We need a whole reform of the NHS and to stop pretending to the public that things are improving when they are so obviously getting worse, and patients are being let down across the country.’

Dr Kennedy’s term as chair of Scottish council ends this year. When standing for election, he did so on the basis that he wanted a Scottish BMA that was strongly focused on its role as a trade union. ‘I spoke to members across the branches of practice and they made it very clear where they saw the problematic areas for the profession, and they were around doctor pay, which had dwindled over many years, about pensions, about workload, which was becoming intolerable, about the medical workforce, and about doctor wellbeing, where we were not in a good position at all.

‘Over the past three and a half years, we have observed all the branches of practice in Scotland rise up and challenge the current situation of being in NHS Scotland as doctors and medical students. I also think BMA Scotland has become bolder about publicly challenging the current [Scottish] government, and that has enabled other sectors to start challenging it too.’

Certainly BMA Scotland has seen major successes over the course of his tenure. Resident doctors and consultants have achieved improvements in pay and conditions, for example, while SAS doctors are beginning to benefit from the introduction of a new specialist doctor grade. General practice has also received an injection of funding.

But he will leave office knowing that there will still be much to be done. ‘Our resident doctors are experiencing bottlenecks in training, and our medical students are now challenging the [Scottish] government because there isn’t enough capacity or resource to give them the education they deserve. Our consultants are saying loud and clear that they’re finding their workload intolerable and that their own health is suffering as a result, and our GPs have had enough – you may have noticed when you walked through the corridors that we can’t even afford a lick of paint for the walls.

‘We have a profession that feels disempowered, is suffering moral distress and injury from not being able to give patients the care they need, and a profession, including medical students, that are feeling very stressed. The health of doctors and medical students in Scotland is not as good as it should be, and it fundamentally comes down to poor workforce planning, a lack of resourcing in the right place, a focus on the wrong targets, and a lack of attention to preventative care.’

He sounds partly energised and party discouraged by his own recent brush with health services as a patient. On the one hand, he is sickened by the state of waiting lists for elective care which is contributing to a growing private healthcare sector in Scotland. But on the other, the care he received when he needed urgent treatment was outstanding. ‘Everyone was fantastic. In fact, I wrote down the names of everyone I interacted with when I was admitted, and in total there were 60 people. The acute service is fantastic, once you access it. But it’s the getting there that’s letting people down.

‘What we fundamentally need is reform of the NHS. We need to stop our politicians’ obsession with hospitals – while maintaining secondary care services. But the focus needs to shift to the community then to social care, and it needs to happen as a matter of urgency.’

He hopes the new government will bring about the reforms that BMA Scotland has been recommending – speaking as a doctor and a patient. ‘I’ll have at least three more years to go as a GP in Scotland,’ he says. ‘I’m looking forward to that, and I hope we will have a better health service for all of us.’

Find out more about the Scottish BMA manifesto