After more than 30 years as a GP in Blairgowrie, Dr Andrew Buist knows how difficult it is to be a community doctor better than anyone.
But I was still surprised to hear Scotland’s leading GP admit the profession is “flatlining” in Scotland after years of underfunding.
Dr Buist, 60, spoke candidly during our interview at Ardblair Medical Practice, where he has been based for the past 26 years.
He invited me along to have a chat about his career ahead of his retiral as a Blairgowrie GP at the end of last week.
As well as hanging up his stethoscope at the Ann Street surgery, the grandad-of-one is also stepping down from his role as chairman of the BMA Scotland GP committee next month.
I spoke to him about the current crisis general practice in Scotland is facing.
And when I point out that many people at local surgeries are still struggling to get appointments with their GP, he admits “that’s not good and not what we wanted”.
Scottish Government funding ‘vital’
He believes a cash injection from the Scottish Government is desperately needed.
“We don’t have enough general practitioners,” he tells me.
“In 2017 The Scottish Government said there would be 800 more GPs in Scotland by 2027, which is only three years away.
“Yet we still don’t have 800 more GPs. We are flatlining.
“There is a demand from a huge workload.
“Yet there isn’t enough funding being put into general practice to employ enough GPs to meet that demand.
“We spend a lot of money in healthcare. But it tends to be in hospitals rather than in the community.
“But if you put more resources into the community – with more district nurses, more practice nurses, more GPs and mental health counsellors – you don’t then need to refer people to other services.
“It would mean patients could be less likely to go into hospital.
“And people would be able to get a doctor’s appointment when they need one.
“We have got the balance of how we spend resources in our NHS wrong.”
In response to Dr Buist’s points, Scottish health secretary Neil Gray said: “We are fully committed to increasing the number of our GPs.
“Scotland has a higher number of GPs per head than the rest of the UK and a record 1,200 plus trainee GPs coming through the training system.
“Since 2017, the overall GP headcount has risen by 271.
He adds that to support GPs the primary care multi-disciplinary team workforce has been ‘significantly expanded’.
And that funding to general medical services has also been increased by almost six per cent over the last year to over £1.2 billion.
The early days of working as a GP
Originally from Edinburgh, Dr Buist’s family moved to Broughty Ferry when he was a young boy and he went to Grove Academy in Dundee.
He attended Edinburgh University Medical School and graduated in 1987.
After graduating he completed further training before going into general practice.
“The GP practice in Reform Street, Blairgowrie was the third job I applied for and luckily I was chosen.
“So in 1993 I moved to Blairgowrie and started working as a GP here.”
He later became one of two doctors who worked with the architects to design and build the new Ardblair Medical Practice.
What’s great about being a GP?
Chatting to him, I can see why Dr Buist is probably very popular with local people and why his departure will be a loss keenly felt at Ardblair Medical Practice.
Not only does he come across very professional and knowledgeable – as you would expect a doctor to be – but he genuinely cares about his patients.
“One of the things that really gives me professional satisfaction is being able to help someone who is going through a difficult time in their life, ” he says.
“You are in a privileged position.
“Patients trust you and it is a trust you have built up over a number of years.
“Sometimes they will end up telling you things they might not have even told their spouse.
“It’s these small things which happen infrequently in the job that make up for the difficult times.”
What does the chairman of the BMA Scottish GP committee do?
Dr Buist has been the chairman of the BMA Scottish GP committee for the past six years.
He describes the role as being the “pinnacle of his career”.
“It involves me being the lead person dealing with the GP contract in Scotland and ultimately working with the health minister,” he says.
The GP contract is the agreement between the Scottish Government and GP members of the British Medical Association that manages the services they provide to the NHS.
“In my time I have worked with Jeane Freeman, Humza Yousaf, Michael Matheson and now Neil Gray.”
“I am really proud of the way we worked collaboratively with the Scottish Government during the pandemic.”
He says: “I got on very well with Jeane Freeman. I found her a very practical health secretary to work with and we kept the system going.
“We also managed to put additional supports in place to help GP practices and keep the service running through that very difficult period.”
Changes in GP practice over the years
Dr Andrew Buist has seen a lot of changes over the past 30 years.
This includes the introduction of telephone consultations.
But one of the biggest changes was the introduction of a contract in 2004 that allowed GP practices to opt out of providing out-of-hours services.
“Typically I was working five days a week, but every fourth night I also did the 15 hours on call overnight. I was also on call every fourth weekend.
“After one of those weekends when you had been on call for over 40 hours, you would be absolutely knackered.
“This wasn’t good for patient care and it wasn’t good for the doctor either.”
Dr Buist knows how ‘burn out’ can affect GPs.
“GPs are leaving their jobs prematurely in their 40s and 50s because they are burnt out.
“We need to do something about GP retention.
“We can do this by helping to reduce their workload, offering more support for training, as well as enhancing the multi-disciplinary teams at GP practices to help ease the pressures.”
Becoming team doctor for two football clubs
As well as being a local GP at a busy practice, I was surprised to discover that Dr Buist is also a huge football fan.
And during his career, he was given a unique chance to combine both of his passions.
“In 2009 I had the opportunity to become the team doctor at St Johnstone Football Club.
“I stayed in that role until the pandemic.
“The role would involve me running onto the pitch with the physiotherapist if any of the players were injured during matches.
“I was the team doctor on the day when the team won the Scottish Cup in 2014.
“The following day I was on the bus going around Perth with the cup – it was a great experience.”
After finishing with St Johnstone, he thought his stint as a team doctor was over. Until he took a call in 2020 which would prove to be a career highlight.
“I had a call from Ann Budge, chairman of Hearts Football Club.
“I would have loved to have played for Hearts but the next best thing was being the team doctor!”
What’s next for Dr Andrew Buist?
While Dr Buist is retiring as a local GP, he confesses he isn’t quite ready to hang up his stethoscope permanently just yet.
“I am going to become a locum GP.
“My plan is to do locums in rural places I have never been to in Scotland like Shetland, Orkney and Tiree.”
Dr Buist also plans to spend more time with family which includes wife Morag, their son Marcus, 29 and grandson Murray, 4.
He adds: “I still feel I have something to offer in terms of clinical care.
“I enjoy that side of it.
“But my wife, who was also a GP, retired at Christmas.
“Now we are both just wanting to slow down a bit.”
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