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Improve primary care provision in deprived communities across Central Fife

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Across deprived communities of Central Fife, residents are facing exceptional and unjustifiable difficulties in accessing GP services. A league table of 122 GP practices in Fife and Tayside published in the Courier newspaper on June 7 2016 showed certain Central Fife surgeries at or near the bottom for access and patient satisfaction.

Measuring GP practice performance against a number of criteria, the NHS Scotland Health and Care Experience Survey 2015/2016 revealed:

  • The GP practices at Crossgates Medical Practice, Cowdenbeath Medical Practice, Lochgelly Health Centre and Lochgelly Medical Group were rated worst in Fife and Tayside for ease of phone contact, with almost two-thirds of patients finding it difficult to speak to the surgery by phone.
  • Lochore Medical Centre in Benarty and Lochgelly Health Centre were the worst in terms of allowing patients to see or speak to a doctor within two days, with one third of patients who needed to unable to do so.
  • Less than two-fifths of patients at Crossgates Medical Practice and Cowdenbeath Medical Practice, just over two-fifth of patients at Kelty Medical Practice and Lochgelly Medical Group and half of patients at Lochgelly Health Centre who want to see a doctor within three days manage to do so.
  • The overall experience of seeing a doctor at Lochgelly Health Centre was rated the lowest (at 31.3 %) for the whole of Fife and Tayside. Kelty Medical Practice scored 33.9%, Lochgelly Medical Group 36.7%, Wallsgreen Medical Practice in Cardenden 39.2%, Lochore Medical Centre in Benarty and Cowdenbeath Medical Practice 41.7% and Crossgates Medical Practice 45.3%. By way of comparison, 52 out of 122 practices surveyed reported a patient satisfaction rating of over 80%.

A table extracting results for Central Fife can be found at and reports on individual practices are at

Since Julian Tudor Hart framed the inverse care law in 1971 ("The availability of good medical care tends to vary inversely with the need for it in the population served"), it has been recognised that deprived areas in the UK tend to have fewer primary care services than affluent ones. This exacerbates existing social, economic and health inequalities in a downward spiral of deprivation. Research shows that the solution to geographical inequities in GP provision is targeted area level policies.

The immediate solution to lacking primary care provision at Central Fife surgeries is to increase staff resources to meet clinical demand. This is what happens in schools and hospitals which call in supply teachers and agency nurses respectively when there is a shortfall in staff.

Of course longer term actions, such as reorganising the division between social care and heath care, or better physical facilities, will also help, but none of these will deliver fast the simple remedy that people want: to be able to speak to the surgery when they pick up the phone, and to see a doctor when they need to.

Policy-makers have been able to ignore the worsening levels of unmet clinical need for primary care in places like Lochgelly, Benarty, Cowdenbeath and Crossgates because it is largely invisible. Closed hospital wards or school children being sent home signify a much more obvious failure on the part of managers and policy-makers than the so-called 'anecdotal' evidence of individual complainants. So it is unsurprising that resources can be found to provide expensive cover for staff shortfalls in schools and hospitals while they are unavailable to provide more GP access.

The impact of not being able to see a GP when you need to isn't just one of cost elsewhere in the health system - for example, people end up so ill, or desperate, that they have to resort to emergency services. Inadequate GP provision also creates entirely avoidable suffering, stress and worry - with long-term consequences on health and well-being for patients and their families.

Improving primary care provision for deprived communities in Central Fife is also a matter of social justice. People living in Central Fife are entitled to the same level of GP care from the NHS as those who live in North-East Fife. Instead they face a double whammy: struggles to access GP services reinforce existing health inequalities which in turn reinforce long-standing social and economic inequalities.

So this petition calls on NHS Fife, Fife Council and the Scottish Government to form an emergency taskforce to address the lack of GP and associated services in Central Fife's deprived communities by lifting the NHS Scotland Health and Care Experience measures for practices in these areas to the Fife/Tayside average within 6 months. The obvious way to do this is to send in locum GPs and other health personnel, using temporary accommodation if necessary, until permanent and sustainable primary care at an acceptable level has been introduced.

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