The 2018 General Medical Service (GMS) contract aimed to address the financial pressures and growing workloads facing GPs and to improve patients' access to care.

However, Audit Scotland reveals that seven years on, the estimated number of whole-time equivalent GPs has fallen, pressure on general practice has increased, proposals to support GP teams with more nurses, physiotherapists and other specialists have moved more slowly than planned and people report finding it more difficult to access care.

Audit Scotland says the Scottish Government has not set out how it intends to invest in general practice over the medium-term and it is unlikely to hit its target of 800 more GPs by 2027. Spending on general practice as a proportion of overall NHS spending has fallen slightly in recent years and between 2021/22 and 2023/24 spending decreased by 6% in real terms, putting more pressure on GP practices.

Stephen Boyle, auditor general for Scotland, said: ‘The pandemic pushed back plans for general practice. But the new delivery deadlines that were put in place were missed, and there's not been enough transparency about progress since then.

‘The Scottish Government needs to clarify its plan for general practice and set out the actions, timescales and costs to deliver it.'

In response, Dr Iain Morrison, chairman of the BMA's Scottish General Practitioners Committee, said: ‘The failure to invest in general practice and plan effectively to recruit GPs is taking its inevitable toll.

‘After seven years, the 2018 GP contract has failed to create anywhere near the services and capacity promised to the profession by the Scottish Government.

‘Given the rising demand from a growing and ageing population, with more complex health conditions, it means GPs are simply unable to provide the best possible service to their patients and the community.'