Meeting of the Parliament [Draft]

Meeting date: Thursday, March 21, 2024

Official Report 985KB pdf

---

GP Surgery Closures (Highlands and Islands)

I encourage members who are leaving the chamber and visitors who are leaving the public gallery to do so as quickly and quietly as possible. The next item of business is a members’ business debate on motion S6M-12449, in the name of Douglas Ross, which is on save our surgeries—Burghead and Hopeman. The debate will be concluded without any question being put.

Motion debated,

That the Parliament expresses concern about the closure of GP surgeries in the Highlands and Islands region, including Hopeman and Burghead; praises the tireless efforts of local campaigners, including members of the Save Our Surgeries group, in advocating for the reopening of what it considers to be these vital healthcare facilities; recognises the reported disappointment and frustration felt by many regarding the consultation on the future of these facilities; understands the pressures that these closures have placed on residents of the two villages and surrounding areas; notes the calls for both the Scottish Government and NHS Grampian to prioritise the healthcare needs of smaller communities, and further notes the view that the Scottish Government, NHS Grampian and Health and Social Care Moray should fully engage with, and support, the local communities and campaigners.

12:48  

I thank all members who supported my motion and those who will contribute to the debate. I also express my thanks and appreciation to the members of the save our surgeries group, who have been determined to get the very best for their villages and reinstate the general practitioner practices in Hopeman and Burghead.

Today, five members of the save our surgeries group have travelled from the Moray coast to Holyrood. I welcome Dennis Slater, Rhona Grant, Ness Tunggal, Hazel Grant and Liz McKnockiter to the Scottish Parliament to have their voices heard. [Applause.]

We also welcome Abbie Duncan from The Northern Scot newspaper, who is here to report on not just the debate but the meetings that the group has had with Scottish Labour and the Scottish National Party. They will meet members of the Scottish Conservatives after the debate.

The group, along with fellow campaigners and residents, have been strong, passionate and determined voices calling for healthcare facilities to return to their villages. It is important to note that, although the surgeries are based in Hopeman and Burghead, the surgeries also serve the communities of Duffus, Cummingston, Roseisle and the outlying rural areas. The campaigners are representing not just Hopeman, Burghead and those other villages but 1,500 people who signed the petition to reinstate those vital general practices.

Their voice is now being heard in the Scottish Parliament, but it has taken us too long to get to this stage, and it is only because of their determined efforts that the campaign is continuing. I hope that, at the end of the debate, we get more responses from the Scottish Government. I welcome the fact that the Cabinet Secretary for NHS Recovery, Health and Social Care himself will be responding to the debate and has agreed to meet the group afterwards. We also need to get more action from NHS Grampian and Health and Social Care Moray.

I will give a brief overview of how we got to this stage. Back in June 2017, the Hopeman practice closed due to an information technology fault. On 14 March 2020, both practices closed because, we were told, they were incompatible with Covid regulations. However, we were promised that the closures of Burghead and Hopeman would be temporary. Here we are now, in March 2024, and those surgeries have never opened their doors again. Indeed, the Hopeman premises have now been sold and the lease for the surgery at Burghead has been handed back. In Burghead, a local family are so determined to continue the surgery’s presence in the village that they have offered to work with the health board and with Health and Social Care Moray to offer for that property and to put in the improvements that are needed, but their approach has been rejected. That offer still stands today. The family have offered the first year free of rent if the health board goes back to Burghead, but the temporary closure has continued.

Much work has been done by the save our surgeries group and by campaigners throughout the intervening time. Where the frustrations really come alive is with the lack of any tangible, significant or realistic engagement with the health board or Health and Social Care Moray. It is almost shocking to have to remind the Parliament that a consultation was carried out. It was a sham, however. It was a consultation in name only—a tick-box exercise. How else can we describe the outcome when 85 per cent of residents who responded to the consultation were against the closures but the surgeries were still shut? At the public engagement events, 100 per cent of the people said that they wanted the facilities in Hopeman and Burghead to remain open, but they were closed. It was nothing more than a tick-box exercise, and at a cost of more than £11,000. It is so frustrating that the voices so articulately making the case for the surgeries to be retained have been ignored in that way.

Although the campaigners have made it very clear that this is a local issue in Moray, and although my motion refers to the Highlands and Islands, members across the country will be feeling the same impact in relation to local services in their own areas. The issue deserves to be addressed in Parliament because the closures of local GP surgeries have an impact on national policies that are set by the Scottish Government.

Richard Lochhead (Moray) (SNP) rose—

Will Mr Ross give way?

I will give way to a couple of members in a moment. I want to come on to how the closure of the local facilities hampers what the Scottish Government is trying to do with its national policies.

I give way to Richard Lochhead.

I thank Douglas Ross for giving way, and I congratulate him on securing this important debate. I join him in paying tribute to the save our surgeries campaign, whose members are here today to promote the interests of their communities.

I concur with the member’s concerns as he has expressed them in his opening remarks. Does he agree with me that it is really important, given that new general practitioners will be coming into the workforce in the near future, that NHS Education for Scotland works closely with NHS Grampian to ensure that those new GPs are channelled towards the areas that are most in need, such as Burghead, Hopeman and the rest of Moray?

I can give Douglas Ross the time back.

Richard Lochhead and I, as well as other members who are here and those in the public gallery, are very blessed to live in Moray. I know that, if we can attract those new GPs to Moray, they will want to stay there and work in our community. They will want to work with the residents of Hopeman and Burghead. I fully endorse everything that Richard Lochhead has said.

This has been a truly cross-party issue, with no party politics being played. The Scottish Labour leader, the Scottish National Party health secretary, Richard Lochhead and others have all met with the campaigners. They have worked right across the political spectrum because their case is far more important than party politics, which is a credit to the save our surgeries campaigners.

Is Mr Ross aware that, in my region, NHS Borders is facing the prospect of cutting front-line budgets by 10 per cent and NHS Lothian faces a £120 million black hole?

Dr Jo Smail, a GP at the Tranent medical practice, has written to inform me that NHS Lothian is now set to increase facilities management charges on the practice by 600 per cent. Doctors there have said:

“In order to cover this new cost imposed on us, the practice would potentially have to lose about 3,200 GP appointments per year.”

They go on to warn:

“we would no longer be able to provide Primary Care services for our patients and would have no other option but to hand back our contract”.

Does Mr Ross share my concern that the chronic underfunding of GP services, particularly in rural and remote areas, is seriously undermining the delivery of patient care?

I agree. We have seen that throughout the country, and it is a worrying trend that seems to be continuing.

Before the interventions, I spoke about how local closures can lead to problems in implementing national policies. For example, multidisciplinary working cannot happen when local facilities are closed. The Scottish Government is supposed to be against the centralisation of services, yet people in Hopeman and Burghead are now supposed to go to Lossiemouth. I will come to that in a moment. The Scottish Government has also promoted 20-minute neighbourhoods, but those are not possible when surgeries like those at Burghead and Hopeman are being closed.

I will finish by referring to an excellent policy briefing that I received from Age Scotland ahead of the debate and for which I am grateful. I asked for figures specific to Moray and was told that

“44% of over 50’s in Moray had to wait a week or more to access a GP appointment”.

The briefing goes on to say:

“Although Lossiemouth is around a 15-minute drive each way, many older people are unable to drive or do not have access to a car”

from Hopeman or Burghead to Lossiemouth. It also says:

“21% of over 65’s in Moray did not own/have access to a car”.

Age Scotland goes on to say that the journey by bus from Hopeman and Burghead to Lossiemouth is not direct. For some, it could take a four-hour round trip—four hours—for potentially just a 10-minute appointment. That is the impact that the closures are having on local people.

Age Scotland says that 44 per cent of over-50s in Moray having to wait a week or more to access a GP appointment is

“almost double the national average”

of 23 per cent. That is why the closures are having such a big impact.

Finally, Age Scotland says that the whole closure programme goes against

“Moray’s own Health and Social Care Strategic Delivery Plan 2023-2025 which has a key focus to progress the integration agenda by increasing access to community-based health and social care services ... Moray Health and Social Care’s Joint Commissioning Strategy for Older People states that older people will ‘Live more independently as long as possible in their own homes’”.

They cannot do that if we are closing down local GP surgeries.

Presiding Officer, I am grateful for your indulgence in allowing me a few more minutes. I again reiterate my heartfelt thanks to the save our surgeries campaigners, who have tirelessly made the case for the reopening of those facilities or having some kind of healthcare facility in the two villages. They have worked their socks off. We are proud of them throughout Moray for everything that they have done. They are now here, in their Parliament at Holyrood, hoping for reassurance that their message is being heard at the highest possible level, but it cannot just be heard; it must be acted on.

We now move to the open debate.

12:59  

I thank all of Scotland’s GPs for the invaluable work that they do to support the health and wellbeing needs of people across the country. I worked as a nurse for more than 30 years and know how valuable, essential and important our GPs and the multidisciplinary teams in GP practices are.

I am really sorry that I will not be able to stay for the whole debate, and I thank the Presiding Officer for agreeing to let me leave for a meeting that I had already arranged.

I pay tribute to Douglas Ross and also, as he did, to the save our surgeries group. I welcome some of its members, who are in the public gallery. It is clear that the group—like many community action groups, such as the Galloway community hospital action group in my South Scotland region—is crucial in advocating service improvements and enhancements and advances in healthcare delivery, which should be delivered at a local level.

Will the member take an intervention?

I will not, because I have only four minutes. I am sorry, but I also have to shoot out of here to meet the George Washington University students.

The statistics that Douglas Ross mentioned really highlight the challenges that older people in rural areas face with travel to different areas. He mentioned a four-hour bus journey to get to Lossiemouth, which would be quite a challenge for older people.

Turning to Douglas Ross’s motion, having looked into the case, I agree that the closure of the Hopeman and Burghead surgeries has had an impact on the local communities. The surgeries were a feature of Hopeman and Burghead for many years. That was recognised by the local integration joint board, which carried out a consultation in 2022 to ensure that the voices of the community were heard. However, from my casework, I am all too aware of how disappointing some approaches to IJB consultations can be, so I can understand the residents’ concerns that are noted in the motion. I urge the IJB and NHS Grampian to ensure that the healthcare needs and, indeed, the voices of the people in smaller rural communities are met appropriately. That can be achieved only through engagement with local campaigners, residents and members of the communities, and I would expect all partners to work to that end.

Unfortunately, challenges with the delivery of GP and associated services are not confined to the Highlands. I note that Mr Carson is in the chamber, and the issue is also important for us in Dumfries and Galloway. It is a very large rural region, and we hear daily from the NHS board that it continues to struggle to recruit GPs to staff the region’s rural surgeries. According to the Information Services Division, the available data shows that 100 per cent of GP practices in Dumfries and Galloway are reliant on locum GPs due to recruitment challenges.

However, some welcome improvements have been made recently. The Scottish graduate entry medicine programme offers people who are graduates in subjects such as pharmacy, nursing and science the opportunity to obtain a medical degree in a four-year graduate programme, and it has a particular focus on preparing doctors to work in rural areas of Scotland. The course launched in 2018 and, after the students’ initial year of university, NHS Dumfries and Galloway welcomed its first intake in 2019. The ScotGEM programme is working well. So far, the region has supported 54 graduates, which is pretty good news. However, we want to see the continuation of ScotGEM. I ask the cabinet secretary, in responding to the debate, to tell us a little about the success of ScotGEM and the commitment to continue with it so that recruitment can be made for our rural areas.

I will stop there. I acknowledge the progress that has been made and I apologise again that I am unable to stay for the whole debate.

13:03  

I, too, thank Douglas Ross for bringing this debate to the chamber, and I join him and the other speakers in commending the work of the save our surgeries group’s campaign. Its fight to save the GP services in its community has been fantastic and it refuses to take no for an answer. I also thank Age Scotland for its briefing on the debate.

As Douglas Ross said, the surgeries that were closed have never reopened and they will now remain closed permanently. They not only covered Burghead and Hopeman but encompassed a population of around 7,000 people. Despite the fact that there has been no response from the joint board, the practice or indeed NHS Grampian, the campaign group remains pragmatic, because it believes that there is a better local solution to be found. It has suggested nurse-led services, with nurses being available locally in the community to do things such as taking bloods, physical checks and enabling older people who are not good with new technology to have video consultations with the practice at Lossiemouth.

However, that has fallen on deaf ears, and people are forced to travel from Burghead and Hopeman to Lossiemouth. Those are short journeys in miles, but there is no direct bus service, so patients need to travel by bus via Elgin. As we have heard, that can take four hours. Not only that—the fare is £9. If people cannot get a bus, they can take a taxi, which costs £60. If people have to pay such huge amounts of money simply to see their doctor, that is no way to be an NHS that is free at the point of need.

There is a dial-a-bus service as well, which was suggested as an alternative, but that requires to be booked the day before. If someone needs an emergency appointment, it is absolutely unsuitable, and it does not cover the whole of the surgery opening times, so it might be that people can get a dial-a-bus service to the surgery but cannot get home again.

To add to that, Age Scotland tells us that 82 per cent of older people prefer face-to-face appointments with their GP. The changes are therefore more likely to impact on the very vulnerable. Age Scotland also tells us that 26 per cent of people with a disability and 47 per cent of people with long-standing health conditions in Moray do not have access to a car, so they are absolutely dependent on public transport.

As we have also heard, those villages are expanding and are therefore in more need of GP services. Anywhere else, that situation would be seen as a success story, because we are always talking about depopulation in rural areas. Where we have growing populations, we need to preserve the services to allow people to continue living there.

This debate speaks more widely to closures and changes to services in rural areas, through centralisation, which means that people do not receive the same levels of services if they live in rural areas.

There are wider issues, as others alluded to. The 2018 GP contract was supposed to make GP services sustainable, but it has had the opposite impact on rural GPs. The Scottish Government can see that—it is demonstrated in front of it—yet has not acted to look at a rural GP contract. Those problems do not appear to be at play on this issue, but we need to find a solution for the people of Moray. Will the cabinet secretary therefore make sure that the IJB meets the campaigners, as they want it to do, and will he intervene to make sure that those people have access to local GP services in one form or another?

13:07  

I, too, thank Douglas Ross for bringing the debate to the chamber, and I thank Rhoda Grant for her contribution. I will not say that she has stolen a lot of my thunder, but she is very well researched on the problems of the closure of Hopeman and Burghead surgeries. I welcome the campaigners who have come to the Parliament—their Parliament—to make their voices heard.

I will be entirely clear: every GP closure is a disaster, every adopted GP surgery is a failure, and every GP surgery that has no succession plan is doomed. We cannot afford to have that.

We must be clear about some of the figures in the public domain. Over the past 10 years, 89 GP surgeries have closed. One in 10 GP surgeries is now run by a health board. There has been a huge increase in the use of locums. In Moray, the Aberlour health centre, which is my health centre, had to be taken over by NHS Grampian because there were not sufficient doctors and all the patients were leaving. That has still not been resolved and is a huge concern to communities.

I wonder, why does that happen? Why do we get ourselves into such a situation? A lot of it can be put down to the point that Rhoda Grant made about GP contracts. The 2018 GP contract that was negotiated seems to work fairly well in the central belt—in Glasgow or Edinburgh—but it does not work for rural GPs or practices. If it did, there would be more GPs in those rural practices.

It has not delivered the extra staff that were promised as part of it. We have seen NHS boards removing vaccinations from local GP surgeries, which GPs across the Highlands were against. We have also seen them removing secondary care from GPs and thus undermining GP practices, which, frankly, we cannot do.

I am delighted to say that I am working with Mr Ewing and Rhoda Grant on the issues faced by Grantown medical practice, which has had funding removed from the building project that it had been promised, and which was almost complete. That is a disaster for the local community. The petition has been open for five days, and I have never seen such a flurry of people trying to sign a petition. They cannot all sign it online, and so there are also paper applications to join it, but well over 500 people signed up in the first five days. That is how important GP surgeries are. I trust that we will get a chance to discuss that in time.

We also need a review of the mechanism of how we run our GP surgeries, and of the GP contract. The problem is that, when the Government negotiated the GP contract, there was no review process in it. It therefore looks as though we are going to lurch on and on with declining GP numbers and contracts that do not work across rural Scotland. That is a huge mistake.

I am delighted to be part of today’s debate. My plea is that we review the GP contract on a wider scale across Scotland, get a new workforce plan out, deliver to GPs the extra workforce that we promised, and stop removing the very sensible additional services that they provide. Then we will not be faced with the disasters that the closure of GP practices such as those at Hopeman and Burghead cause.

13:11  

I congratulate Mr Ross on bringing the debate to the chamber and on the consensual spirit in which everybody has participated.

I used to live in Lossiemouth with my late wife Margaret, just along the road from Burghead and Hopeman. I nearly visited the Burghead surgery many years ago when I was dive-bombed by a seagull, which managed to make contact with my ear, at the breeding ground just beyond Burghead, which I am sure that our visitors will be aware of.

If Margaret had been here, she would have been campaigning alongside people in all other parties, as she did with the Keep MUM campaign and others over her 19 years as the parliamentary representative.

As does the motion, Mr Ross referred beyond Burghead and Hopeman to the wider Highlands. The motion also refers to serving local communities. I therefore hope that it is in order for me to refer to the campaign that is currently being mounted on a cross-party basis by myself, Ed Mountain and Rhoda Grant—all of whom are here—to persuade the cabinet secretary for health to overturn the decision to halt the refurbishment of the Grantown health centre.

From our conference call with NHS Highland this morning, we understand that the project had been substantially completed: two million pounds of the work had been done, but it was cancelled because of £400,000. We have been besieged by letters locally, and they all make the same point. People can understand the cancellation of projects that have not started, emotive although that is. There have been many excellent such campaigns—for example, that in relation to the Belford project. However, it makes no sense for a project that is nearly completed, because it will end up costing an awful lot more.

My specific plea, without labouring all this, is that the meeting that I requested last Friday take place very soon—if possible, next week or soon thereafter. I know that the recess is coming up soon. The reason for that plea is that Morrison—the contractors—are still on site and are champing at the bit to complete the contract. However, if we do not sort this out quickly, they will have to remove their two portakabins from the site and will incur further abortive costs. Those abortive costs, which we will intimate to the cabinet secretary, will mount and exceed the notional capital savings of £400,000. I know that ways can always be found in Government, so I make the plea that we sort this out.

I will make a brief point to back up what Edward Mountain said about the GP contract. It was not popular in the Highlands; it was a metropolitan concoction. In particular, Dr Adrian Baker from the Nairn GP practice has been arguing recently—in fact, for the past three years—with successive health secretaries, I may say, about restoring the right for GPs who wish to do so to provide various services that the GP contract is taking away from them, including vaccination. In the case of vaccination, my understanding is that NHS Highland’s own internal report found that moving the service back to GPs would secure a greater number of people having vaccinations and protection, in particular against measles, whereas centralising provision is resulting in a dangerously low level of cover.

Moving the service back to GPs would not only be better for the patient; it would save several million pounds. I will do a deal with the cabinet secretary. If he grants GPs the right to restore their vaccination services and, by taking up my advice, he saves several million pounds, I will be happy with that, as long as he makes a modest contribution of £400,000 towards the refurbishment of Grantown health centre.

13:16  

I thank Douglas Ross and congratulate him on bringing the debate to the chamber. Like him and every other member who has spoken, I welcome the save our surgeries campaigners to our national Parliament. I look forward to meeting them after the debate. As Douglas Ross and other members have done, I recognise their doughty campaigning efforts. The fact that they are here today, in spite of the situation that the branch surgeries are in, is testament to those efforts. Mr Ross rightly outlined that one facility has now closed and that the other’s lease has expired. I will return to the helpful suggestions made by Douglas Ross and Rhoda Grant, who spoke of pragmatism, but at this point I say that they are very welcome.

I will respond to Mr Ross’s fair point about the wider area that is served by the Burghead and Hopeman surgeries, and the situation that residents will face not only in those villages but in the wider area. I recognise the offer that has been made, through Douglas Ross, that a property could be made available free of rent for a period.

On Mr Ross’s point about consultation, he will be aware that my predecessor, Michael Matheson, instructed a review by Evan Beswick of the Argyll and Bute health and social care partnership. Publication of that report is imminent. I understand that the campaigners have seen an early draft of it, which they feel is fair. I expect NHS Grampian and the health and social care partnership to take due cognisance of the content of that report and to respond accordingly.

Richard Lochhead made a helpful suggestion about new GPs. During the debate, there has been commentary on where we are with GP numbers. We currently have 1,200 new GPs in training, which is positive. We have seen an increase in GP numbers since we announced our wish to see 800 coming through per year from 2017. We are not exactly where we want to be, but we are making progress. In relation to Mr Lochhead’s suggestion, together with the evangelical advocacy that I would expect to hear from him and Mr Ross on the beauty of Moray being a reason for people wishing to locate there, let us see what is possible with regard to GPs coming through.

I, too, am grateful for the members’ briefing from Age Scotland, which colleagues across the chamber have referenced.

As someone who grew up in a rural island community, I more than recognise the challenges in accessing public services, particularly healthcare services.

Will the cabinet secretary take an intervention?

I will do in a second.

There is an expectation among residents there that they will have to travel some distance to access such services, because, by their nature, they cannot all be delivered safely in those areas. However, I concur absolutely with the point that has been made about the need to ensure that services are provided as effectively and as locally as possible.

Will the cabinet secretary give way?

I will give way to Finlay Carson and then come back to Richard Lochhead.

A theme is emerging. Emma Harper talked about action groups trying to enhance services, but that is not what it is really about. It is about saving services, whether they be GP services, maternity services or cottage hospitals. There is a complete crisis in rural Scotland and a lack of services that are delivered as close to home as possible, as we would wish to see. Is it not time to review the NHS Scotland resource allocation committee formula? It certainly does not seem to be working. I know that you have given us assurance that a review will take place, but can you accelerate that process to make sure that rural health boards get the funding that they need?

Comments should be made through the chair.

Finlay Carson makes a fair point about ensuring that services continue to be provided as locally as possible. I pay tribute to general practice managers, GPs and staff in the multidisciplinary teams who serve our constituents incredibly well, whether they are in rural and island communities or in urban Scotland.

I point Finlay Carson to the remote and rural GP working group, chaired by Professor Sir Lewis Ritchie, which was created in response to concerns about rural GPs under the 2018 contract. One of the working group’s recommendations was about establishing a centre of excellence for remote and rural healthcare. Following the business case development, the national centre for remote and rural healthcare was launched in October and is being delivered by NES. The Scottish Government is providing £3 million of funding in 2026. However, I take Finlay Carson’s point. I will consider it and come back to him.

I thank the cabinet secretary for his constructive response to the debate so far. He might be aware that, in my Moray constituency, Glasgow School of Art has a campus, which hosts the rural centre of excellence for digital health and care innovation.

At my instigation, the centre has been discussing with the Moray health and social care partnership the possibility of a project on innovation in the delivery of rural health services, using Moray for a pilot, prompted by what is happening in Burghead and Hopeman. I understand that the centre and the HSCP are looking for about £30,000 to take forward that project and that there are some question marks about how it will be funded. Will the cabinet secretary look into how it could be funded? The whole of rural Scotland would benefit from the outcome of that research project.

I thank Richard Lochhead for pointing out the situation. I am conscious that Jenni Minto has met him to discuss the issue. In concert with her, I am happy to take away Richard Lochhead’s asks and see whether anything can be done to enable the project to continue. It is an opportunity for us to learn more and to see what can be done in rural communities.

I go back to the briefing from Age Scotland, because I recognise the points made about access to public transport, access to a vehicle, the statistics that Douglas Ross pointed to on car use in the part of Moray that we are discussing and how such challenges increase when facilities such as those in Hopeman and Burghead close. The public transport links provide a particular challenge in that part of Moray. Although Rhoda Grant pointed to the dial-a-bus option, that is not suitable for same-day appointments. That is why Evan Beswick’s work will be important, and it is why I encourage the health and social care partnership and NHS Grampian to engage with the campaigners on practical suggestions for how that challenge can be overcome.

Campaigners and people in the area will take great comfort from the approach that the cabinet secretary has taken to the issue. There would be even greater encouragement if he would use his influence as Cabinet Secretary for NHS Recovery, Health and Social Care. I accept that the decisions will be taken locally by NHS Grampian and the Moray health and social care partnership, but the cabinet secretary stressing the importance of facilities in Burghead and Hopeman will have a big impact on what campaigners are seeking. They are not looking for all-singing, all-dancing general practices to be reopened. Great though that would be—I absolutely support that—there are opportunities to have some healthcare facilities in either village or both villages. They do not need to be full replacement services, but any such services could have a big impact on local people in the villages.

That is a helpful suggestion. It is characteristic of the fair and pragmatic way in which Douglas Ross opened the debate, and I am happy to take it away for consideration.

However, we will have to work with NHS Grampian and the health and social care partnership, because this is a local decision, and certain practical issues would need to be overcome before such facilities could be put in place. For example, who would run them, and how would they be staffed? Therefore, I cannot make any promises to Douglas Ross or, indeed, the campaigners—and I would not wish to do so—but any suggestions for practical changes that could be made to benefit the local communities, recognising the demographic and geographical challenges, should at least be considered in consort with those communities.

In closing, I thank everyone who has participated in the debate, and I again thank Douglas Ross for securing it. I particularly thank the local campaigners who have ensured that Scotland’s national Parliament considers an issue being faced by colleagues across Scotland to differing extremes—indeed, I have faced the issue of branch surgery closures in my constituency. As a result of their doughty campaigning, we are considering the matter today, and they will have a further conversation shortly. Although I make no promises about what the future holds, I hope that, at least, they will feel that their voice is being heard both today and as we go forward.

That concludes the debate. I suspend the meeting until 2.15 pm.

13:26 Meeting suspended.  

14:15 On resuming—