Our next petition is PE1698, on medical care in rural areas, which was lodged by Karen Murphy, Jane Rentoul, David Wilkie, Louisa Rogers and Jennifer Jane Lee.
At our meeting on 9 May, the committee heard evidence from the Cabinet Secretary for Health and Sport; Sir Lewis Ritchie, chair of the remote and rural working group; and Richard Foggo, director of population health, Scottish Government.
In its submission of 7 June, the Government provided further information on the development of the Scottish workload formula, associated additional funding and the role of the technical advisory group on resource allocation. It also provided a further explanation about the costs of providing rural general practice and immunisation rate figures; that explanation was given to Rhoda Grant and copied to the Public Petitions Committee.
Rhoda Grant had hoped to attend the committee for our consideration of the petition, but she is unable to be here. She has passed on the following comments:
“Richard Foggo forwarded me the Cabinet Secretary’s response to the Committee. I did not find it enlightening. I also shared with my constituents who still have concerns.
They believe the Deloitte analysis of workload is based on incorrect assumptions and meaningless data and therefore is not an improvement on SAF:
• You cannot equate numbers of appointments available or given with need. Practices under pressure will inevitably have fewer appointments to offer per patient than practices that are coping well. Need is not in any way proportional to provision. This is the whole problem highlighted by the “inverse care law”—those who most need health care are least likely to get it. SWAF simply reinforces existing inequalities.
• The dataset on which the analyses was based was out-of-date.
• The definition of rurality was binary, so real remoteness was not taken into consideration.
The end result was a net £10k annual gain per average urban GP in a Central Belt practice, with no gain for rural practices and little for those in the most deprived areas. Even if rural GPs’ incomes are protected at current levels, their position is going to be worse because they will find it even more difficult to recruit from a limited pool of GPs.
The statements about practice SIMD appear wrong when you look at the winner/loser map—Gorbals and Possil get no extra funds while Milngavie gains.
The statements about the exclusion of TAGRA are disingenuous—to say that they cannot play a part in discussions about GP/practice remuneration does not make sense. Sums paid to practices are used to pay GPs, their practice staff and also to provide components of care for patients, including equipment and consumables.
GPs themselves make decisions about how much is spent on service provision, how much on staffing and how much on their own incomes. Awards of funding to practices are not conceptually different to the considerations needed in awarding funding to individual health boards (in which TAGRA is very much involved).
The letter about immunisation does not add anything. The vaccine transformation process has not really started in any rural area and practices are still being paid for offering the immunisation programme. It would not be expected to see any damage until the contract is more fully implemented.
Based on this information I would hope that the Petition would be kept live until at least the Working Group report.
It may also be the case that the Health and Sport Committee could look at this as part of their wider enquiry but it would need to be given a degree of prominence in order to get to grips with these complex issues.”
10:45
In considering that suggestion, members will note that our papers confirm that the issues that are raised in the petition will be addressed as part of that inquiry, which has the dedicated remit of looking at the future of primary care in Scotland.
Do members have any comments or suggestions for action? My main comment is that, as Rhoda Grant said, we have not had an answer to the question about why we have created a new funding formula that takes money out of rural areas and poorer urban areas and puts it into better-off urban areas. That remains an issue. We need to think about who is best placed to take forward the concerns.