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by Andy Drane
16 September 2014

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Blog: #indyref and Scotland’s NHS

How will general practice be affected if Scotland decides to become independent? Two days before the ground-breaking vote specialist healthcare solicitor Andy Drane outlines possible changes

Only a matter of weeks ago political analysts in Scotland said the Yes campaign [for Scottish independence] needed a game changer. It seems that game changer may have been protecting the NHS from “English” cuts and creeping privatisation. This argument has played out very strongly for the Yes campaign and the referendum outcome is now too close to call. Clearly the NHS is dear to a Scotsman’s heart.

What would the impact of a Yes vote be for GPs in Scotland and the NHS more generally? 

In the short term the impact may be limited. Healthcare is already devolved and the Scottish government have been steadfast in ring-fencing NHS funding albeit at the expense of other areas. It’s hard to see how this would change in the immediate aftermath of a Yes vote. The widespread rollout of new surgeries by the Hub companies will continue.

That doesn’t mean life will be easy for doctors and their businesses. GPs across the UK face challenges in terms of recruitment and retention of doctors. An independent Scotland will not readily fix that. Scottish Health Boards are already seeking to pass additional non-reimbursable costs – particularly related to property risk – on to practices. This will continue. 

The big challenge comes in addressing an independent Scotland’s many health inequalities. Scotland is well-documented as the Western world’s sick man; life expectancy in the most deprived parts of West Central Scotland is depressingly low. Alcohol, tobacco and drug abuse in Scotland is a serious blight. Obesity is the norm for many. There are significant elderly and rural populations. Addressing issues around these will be high on the agenda of an Independent Scottish government.

The Yes campaign say the combination of oil revenues, not paying for Trident, staying out of other people’s wars, flexing economic levers such as lower corporation tax and a more progressive tax regime will more than pay for this and a plethora of other policies. The true answer is no one really knows if this will be the case. It is salutary to note that the Scandinavian economies the Yes campaign seek to emulate have high levels of personal taxation; a progressive tax regime. For high earners – such as GPs – it is inevitable that they will face higher personal taxes. 

Those who own property may also expect to be adversely affected at least when they come to buy, sell or transfer their assets. There’s much speculation as to the impact of a Yes vote on property values. Again the honest position is “who knows”? But for those practices which own their own premises there must be a risk to balance sheets and ability to meet banking covenants.

Lastly, will life be any different in the event of a No vote? Well, of course in some respects it will. However, the uncertainties of independence will be replaced by the uncertainties of devo-max. The NHS at least has the advantage that whatever the outcome it has been administered from Scotland for many years with a distinctively Scottish hue. At least to that extent it has already been independent for some time.