If it feels harder to see your GP than it used to, you’re not imagining it. We want to explain why — not to make excuses, but because we think patients deserve to understand what is really going on.
We are caring for more people, with more illness, more of the time
People are living longer — which is wonderful — but living longer often means living with several long-term conditions at once. At the same time, medicine can now do far more than it could twenty years ago: more tests, more treatments, more medicines that need monitoring. Every one of those advances adds work to general practice.
How often the average patient contacts their practice
Each circle is one contact in a year
The extra contacts (green) reflect an older population, more long-term illness, more treatment options — and more people waiting longer for hospital care.
Work is moving from hospitals into GP practices
When hospital waiting lists grow, the waiting doesn’t happen in the hospital — it happens with us. While you wait for a clinic appointment or an operation, it is your GP practice that manages your pain, adjusts your medicines, deals with complications and keeps you going.
On top of that, tasks that hospitals used to do themselves — blood tests, monitoring, prescribing specialist medicines, chasing results — are increasingly passed to GP practices, usually without any funding or staff to do them. Each task might look small. Tens of thousands of them, across Lothian, are not.
What your practice is actually paid
Most people are surprised to learn how general practice is funded. Your practice is not paid for each appointment. It receives a fixed sum for each registered patient — the same whether you visit once a year or fifty times — and out of that it must pay for everything: the doctors, nurses, receptionists, the building’s running costs, equipment and insurance.
What the NHS pays your practice to look after you
Lothian average, everything included, 2024/25
- About £178 for a whole year of care
- Less per month than a streaming subscription
- The lowest funding per patient of any Scottish health board
And what does that 49p a day buy? Across Lothian, the average patient generates around 16 practice contacts a year, adding up to roughly three and a half hours of practice staff time — appointments, prescriptions, results, referrals, letters and all the unseen work in between. When we price that time at the rates the BMA — the doctors’ professional body — suggests as fair for this kind of work, the work costs more than practices are paid to do it. The difference is made up by teams working beyond what is funded.
A promise that wasn’t kept
In 2018, the Scottish Government agreed a new contract with GPs. It promised extra staff to support practices and 800 more GPs. It recognised, in the Government’s own words, the “fundamental challenges” facing general practice.
Much of that contract has never been delivered. The number of fully qualified GPs in Scotland has fallen, while the average practice list has grown by nearly a fifth. Year after year, the money practices receive has risen by less than inflation — a quiet, compounding cut.
New investment is welcome — and mostly catching up
The Scottish Government has recently announced new investment in general practice. We genuinely welcome it. But it is important to be honest about what it can achieve: after many years of below-inflation funding, much of the new money is simply restoring ground that was lost. Catching up is not the same as moving forward — and rebuilding a workforce takes years, not months.
Private healthcare and your GP practice
More people than ever are paying for private treatment — usually not out of preference, but because NHS waits have become so long. We completely understand that choice, and we don’t judge anyone for making it.
But there’s a knock-on effect most people never see. Private clinics often ask NHS GP practices to do parts of their work — blood tests, monitoring, ongoing prescriptions — and the NHS provides practices with no funding or staff for any of it. Every unfunded private task is done in time that could otherwise go to NHS patients.
Why we sometimes have to say no to “shared care”
Sometimes a specialist — NHS or private — asks a GP to take over prescribing a specialist medicine under a “shared care” arrangement. When a GP signs a prescription, they become personally and legally responsible for that medicine: for its safety, its monitoring, and everything that follows.
That is only safe when strict conditions are met — the GP must know the medicine well, the specialist must stay involved, and the practice must have the staff and time to do the monitoring properly. These arrangements are voluntary and come with no extra funding, and the number of requests has grown enormously. When a practice says no, it isn’t being difficult: it is declining to take a risk with your safety that it isn’t resourced to manage. The specialist service remains responsible for your medicine, and your treatment should continue with them.
The impossible arithmetic: opportunity cost
Here is the heart of it. A GP practice has a fixed amount of money, a fixed team and a fixed number of hours — and already more work than fits in them. So every time a new, unfunded task arrives, there are only two options:
When new work arrives with no new resource…
Economists call this “opportunity cost”. In a GP practice, the cost of unfunded work is always paid by other patients.
Neither option is acceptable, and neither is sustainable. That is why practices have started to draw boundaries around unfunded work: not to do less for patients, but to protect what matters most from being quietly eroded.
Despite everything described here, your practice remains absolutely committed to giving you the best care it can.
The people who answer your calls, fit you in at the end of a full day and chase your results are not the cause of the problem. They are the ones holding it together.
What you can do
If you are unhappy with how hard it has become to access care, please look beyond the practice and hold those with the power to change it to account. General practice is the foundation of the NHS, and it needs to be funded like it.
Figures: NHS payments and activity data published by Public Health Scotland (2024/25 payments; activity year to January 2026, Lothian averages); contact-rate and workforce trends from the Lothian LMC statement of May 2024. “49p a day” is the average payment per registered Lothian patient across all NHS practice funding, divided across the year.