Lothian LMC / analysis & debate
LMC position
Lothian LMC has significant concerns about the expansion of GP walk-in centres. This is not a criticism of the staff who work in them, or of the boards asked to deliver them. It is a concern about a policy that spends scarce money on a model already tried and abandoned elsewhere — while the problems it claims to solve go unaddressed.
The first Scottish walk-in centre opened in Wester Hailes in February 2026, here in Lothian. What began as a plan for fifteen sites became sixteen, then thirty, and this week the First Minister announced a further twenty-four locations — forty in total — with the pilot extended to April 2029. The original commitment was £36 million; the cost of the expansion has not been published.
The stated aims are to end the “8am rush” and relieve pressure on practices and hospitals. Those are the right problems to want to solve. Our concern is that this is not a solution to them.
England built a network of walk-in centres and GP-led health centres in the 2000s under the Equitable Access to Primary Medical Care programme. By 2013 around fifty of the 230 centres had closed in three years, and in 2014 the health service regulator, Monitor, published a full review of what had happened.
Its findings should be familiar reading for anyone designing a walk-in programme today. Provision varied enormously between sites. Commissioners closed centres because they duplicated services already provided in general practice. Some described the arrangement as paying twice for the same patients — once through the registered list, and again for the walk-in attendance. The centres were popular with the public, but popularity was not the same as value, and the model did not durably reduce pressure on either general practice or emergency departments.
Scotland is now rebuilding that model, at pace, without having answered the objections that closed it down south.
Public Health Scotland now publishes monthly activity from the pilot. In the first six months, just over 10,500 cases were seen across all centres. In June, of the six centres open for the full month, attendance ranged from around 28 cases a day to fewer than three.
Cases per day, June 2026
Six centres open for the full month — Lothian’s Wester Hailes highlighted
PHS advises against direct comparison: centres opened on different dates and have different opening hours and eligibility criteria.
One centre, in Hawick, has already had to close temporarily because of staffing pressures — a reminder that these services are not staffed from a separate workforce. They draw on the same finite pool of GPs and nurses as everything else, at a time when fully qualified GP numbers have fallen while list sizes have grown.
A walk-in centre costs much the same to run whether it sees thirty patients a day or three. The premises are open, the rota is filled and the doctor is on duty regardless of who comes through the door. That is the nature of a standing service with unpredictable demand — and it is why attendance figures in the low single digits per day matter so much. They are not a slow start that will average out; they are a fixed cost meeting very little activity.
The wider picture is starker still. The Royal College of General Practitioners in Scotland calculates that the first nine centres delivered around 120 appointments a day in July. General practice across Scotland handles roughly 136,000 patient contacts a day.
The scale of the contribution
Daily activity, July 2026 — drawn to scale
Source: RCGP Scotland analysis of Public Health Scotland data.
We have deliberately not attempted to publish a cost per patient. The Scottish Government has not released the running costs of individual centres, and we would rather make this argument from figures everyone can check than from estimates that could be argued over. But the published facts are enough. A programme originally committed at £36 million, now expanded to forty sites and extended to 2029 at a cost not yet disclosed, is delivering a fraction of one per cent of Scotland’s primary care activity.
Value for money is not the only issue, and it may not be the most important one. Walk-in care is, by design, care without a relationship. The clinician does not know the patient, may not have their full record, and will not see them again.
The evidence on relational continuity is unusually strong for general practice research: continuity of care with a doctor is associated with lower mortality, fewer emergency admissions, fewer A&E attendances and less fragmented care. It is one of the few things general practice does that demonstrably keeps people alive and out of hospital. Every episode diverted into an anonymous same-day encounter is a small erosion of that, and the erosion is invisible on any dashboard. Activity is easy to count. Continuity is not — which is precisely why a policy measured in appointment numbers will always undervalue it.
Walk-in models tend to be used most by those best equipped to navigate them: people who are mobile, who can attend at short notice, who can travel to a centre that may not be in their neighbourhood, and who are confident enough to present without an appointment. The patients who most need general practice — older people, those with multimorbidity, those with poor health literacy, those least likely to engage with services at all — are the least likely to benefit, and the most likely to be harmed if resource is drawn away from the registered practices that hold their care together.
There is a real problem to solve here. Some people genuinely struggle to access their practice, and that is not acceptable. But the answer is to resource practices to reach those patients, not to build a parallel service that self-selects for the people who already find access easiest.
Every new service boundary creates work at its edges. A walk-in encounter generates results that need actioning, prescriptions that need continuing, follow-up that needs arranging and a record that needs reconciling — and in most cases that work lands with the registered practice, unfunded. We have spent years across the Lothian Interface Group trying to reduce exactly this kind of friction between services. Adding a new one, deliberately, at a time when practices are already absorbing unresourced transfers of work, is difficult to justify.
We welcome the £531 million investment in core general practice, and say so plainly. The argument here is not that nothing is being done — it is that this particular thing is the wrong thing, and that the money and ministerial attention it consumes have obvious better uses.
Walk-in centres are not a solution. They are a way of being seen to do something.
They deliver a fraction of one per cent of Scotland’s primary care activity at significant cost; they dilute the continuity that keeps people out of hospital; they draw staff from a workforce that is already short; and they create a new seam in a system that has too many already. The 8am rush is a symptom of a capacity problem. You do not fix a capacity problem by building a second front door and staffing it from the same rota.
We will continue to make this case to NHS Lothian and to the Scottish Government, and we will engage constructively with the evaluation Healthcare Improvement Scotland has been asked to carry out. We would ask only that it is a real evaluation — one capable of concluding that the policy should stop.