Thank you for the invitation to be here today.
I thank the petitioners for bringing this important issue to Parliament. The services that they and we are talking about are critical to the communities served.
The focus of the petition is on two main issues. The first is the new GP contract and its impact on rural general practice, and the second is Sir Lewis Ritchie’s short-life working group. I will make brief remarks on those issues.
The new GP contract, which was negotiated with the British Medical Association, is Scotland’s first stand-alone contract, and it has been in place for one year. In that time, some fundamental questions have been raised about whether the new contract values rural general practice and whether it ultimately threatens rural general practice.
It is important that I state very clearly, at the outset, that we value rural general practice, and that I do not believe that it is threatened by the new contract. Of course, rural general practice faces challenges, some of which, such as recruitment and retention, are shared with practices in more urban areas, and some of which are unique, not least the remote geography and what that implies for general practice. However, the new contract does not cause those challenges; it is expressly designed to address them.
The new contract does two things. First, it seeks to develop a new role for the GP as the clinical leader in the community that they serve, leading enhanced, more integrated teams to ensure that we continue to deliver the right care for patients at the right time. Secondly, it responds to the serious challenges that have been identified by the GP profession of increasing workload and risk, particularly the risk of owning property and employing staff. On those points, all GPs, whether urban or rural, can see real benefits to the new contract. The role of clinical leader in the community—the expert medical generalist—is a role that is already fulfilled by many rural GPs. In that sense, the contract is intended to enhance and not diminish rural general practice and to recognise the work that they do.
The issue is whether the measures that we are taking to reduce workload and financial risk, which includes a new workload formula and bigger teams employed by the health board, diminish that role. I am clear that the GP contract and the associated primary care improvement plans must allow flexibility to suit local circumstances, particularly in rural communities. I stress that no changes have been made to the GP contract in relation to services such as vaccinations.
If a rural GP practice wishes to continue to deliver vaccinations or other services that are set out in primary care improvement plans, it can do so. GP practices continue to be paid to deliver vaccinations, but we are also offering GPs the opportunity to benefit from support from health boards if that improves outcomes for patients. Although flexibility is important, I believe that it is wrong to suggest that a team-based approach does not suit rural communities. For example, in the Western Isles, an integrated approach to vaccinations means that the uptake of flu vaccine among primary school pupils has increased from 67 to 74 per cent since its delivery was transferred from GPs to school nursing teams.
We have heard a number of concerns about the Scottish workload formula, which is a substantial component in determining the level of funding that a GP practice receives. First, it continues to be said that rural practices have lost funding as a result of the new contract. That is categorically not the case. We have invested £23 million to ensure that no practice loses funding. In addition, we have increased the overall value of the GP contract by £23.7 million, or 3.46 per cent, which rural practices also benefit from.
Secondly, it is said that, because we are having to protect the funding of rural general practice, we do not value it. However, my point would be that you protect what you value. I know that there is concern that protection might be removed at any point and that rural general practice has been more fragile because of that, but funding protection has been a feature of the GP contract since 2004. It was not an issue with the previous contract, and I do not believe that it should be an issue now. I cannot envisage a situation in which a Government of any political persuasion would remove that protection and thereby threaten rural general practice. The national health service depends on quality general practice.
Finally, it is claimed that, although the new formula better captures the variation in GP workload, it does not include the effect of geography on costs, and so does not reflect the reality of rural general practice. However, the funding steps that I have outlined mean that the change to the formula does not impact on the funding that practices receive. Transparency is the key to understanding the effect of geography on the cost of providing primary care services and the cost of running a GP practice, whether in an urban or a rural setting. Therefore, as part of the contract, we have agreed with the BMA that all practices will provide income and expenses data. That will significantly improve our understanding of the cost of delivering services across Scotland, including in our rural communities. Parliament has explicitly welcomed that development. Once we have that information, we will be in a better position to refine the formula as necessary. We will take that course of action into phase 2 of the GP contract.
We recognise that GPs in remote and rural communities work hard in exceptional circumstances, and I would like to assure the committee that the fundamental aim of the working group that Sir Lewis Ritchie chairs is to ensure that the voices of rural GPs are heard and to bring about agreed actions to strengthen the implementation of the contract in remote and rural areas. As the contract also impacts on patients and the wider primary care team, there is patient and multidisciplinary professional representation on the working group. It is fair to say that, since the inception of the group, Sir Lewis has worked tirelessly to build collaborative and trusting relationships, and I know that he will be happy to answer any questions that the committee might have. With his team, he has travelled extensively across Scotland, engaging with GPs, health board colleagues and rural communities and hearing their views. I am very grateful to him for joining us this morning to deal directly with any issues that members might want to raise.
Concern has been expressed that, because the representative of the Rural GP Association of Scotland has resigned, rural GPs are not represented on the group. We sincerely hope that RGPAS sends another representative, but I assure the committee that there are a number of rural GPs on the group and that the voice of rural GPs is being heard, while discussions continue in an effort to resolve the issue with RGPAS. I hope that it will return to the group.
We are taking a truly transformational approach with the new GP contract. Our aim is not only to preserve general practice as the cornerstone of our health service in Scotland but to ensure that it flourishes and strengthens. I believe that achieving that is possible by taking professionals and patients with us, building relationships and directly recognising that one size does not fit all. However, as with everything that is worth doing, there is always room for improvement, and we remain open to looking at how, in the short term and then in phase 2 of the GP contract and in the negotiations on that, some of the issues that people remain concerned about can be considered fully and steps can be taken to resolve them.
I am grateful to the petitioners for taking the time to ask questions, to challenge constructively and to allow me to explain the intentions behind the contract.