The final item of business is a members’ business debate on motion S4M-13973, in the name of Jim Hume, on promoting sustainable general practitioner recruitment. The debate will be concluded without any question being put.
Motion debated,
That the Parliament notes with concern the reported challenges facing GPs across Scotland, including a shortage in numbers in South Scotland; understands that the British Medical Association and the Royal College of General Practitioners Scotland have said that the country will need an additional 740 GPs by 2020 and that it is facing a recruitment crisis in general practice; believes that around 90% of patient contact with the NHS is through the primary care provided by GPs and that quality primary care is the bedrock of the NHS and a lifeline to many, particularly in remote and rural communities; further believes that the pressure on GPs is intolerable and that the situation at present is unsustainable, and notes the calls from Scotland’s healthcare professionals for a full and frank debate on the future of primary care.
17:02
I welcome fellow members back for the first members’ business debate after the summer recess. Unfortunately, I must bring to the attention of the chamber the many issues surrounding the state of our general practices. As many members are aware, progress has not been made on the number of general practitioners or their working conditions.
Scottish Liberal Democrats have taken a strong stance on the issue and have raised it many times. Earlier this summer, my colleague Willie Rennie conducted a survey that uncovered some truly disturbing facts about the mood of GPs and the state of affairs in GP practices across South Scotland and the rest of our country.
The issue of GP recruitment and the future of GP surgeries that face a crisis is one that affects the heath of nearly everyone, as general practices deliver 90 per cent of patient care in the national health service, yet they receive less than 8 per cent of NHS funding. Naturally, that has hard-hitting consequences for GPs, who face increasing demands with increasingly shrinking budgets. Their funding has faced near-constant reduction, from 9.2 per cent of NHS funding in 2007 to 7.8 per cent in 2013, and it is further reduced by inflation of 1.2 per cent. Those are preventative funds that the Government is not spending, even though evidence suggests that investing in GP practices could save the NHS in Scotland around £200 million.
In line with its 2020 vision, in November the Government first pledged £40 million for primary care in 2015-16, but it then said that £50 million would be spent through the primary care fund over three years. That is a reduction of £24 million per year from the amount that was originally announced.
One of the elements of the scheme—the pharmacist independent prescribers—promises to recruit 140 new pharmacists, which is 10 pharmacists per health board. I do not deny that that is a welcome start, but it is only the first step in a very long journey, and we need to ensure sustainability. We are already seeing health boards taking over GP practices, so we need to face the real numbers and the real issues. If the Government does not reverse its spending cuts and remove them from where they are most hazardous, we will face a 2020 crisis rather than have a 2020 vision.
The Royal College of General Practitioners has called on the Government to provide urgently a clear strategy for sustainably investing in Scottish general practices, and we back that call. We also back a call from the British Medical Association, which has raised a warning flag over recruitment. One third of GPs are currently considering retirement and more than one in 10 are planning to move to part-time work, which will leave a number of practices unable to operate.
Does the member accept that one of the factors impacting on retirement dates for general practitioners is the change in the lifetime allowance for pensions and that that has been encouraging a lot of senior GPs to consider retirement, making the problems worse? As far as I recall, the Lib Dems were in government when that change was proposed.
I can assure the member that the replies that we have had from GPs focus on issues that are very different from pensions.
We do not need to look into the future, because a real problem already faces us. A total of 463 practices have at least one GP vacancy and some have not been able to secure locum GPs for 15 days or more in a one-month period. Practices are not able to see as many patients as need to be seen, appointments are being slashed, waiting lists for registration are getting longer and people are being sent elsewhere because practices have reached maximum capacity.
I stress the importance of the issue because the Scottish Government risks turning GP services from an accessible, first-point-of-contact service for every Scot into an exclusive service that many will not have access to. I point out how important it is for the Scottish Government to work constructively with GPs and listen to what they are saying, because we are at risk of losing the right to healthcare for all Scots.
The results of the GP survey undertaken by my colleague Willie Rennie speak volumes: almost four in 10 GP practices find their workload unmanageable—I say to Mr Campbell that these are the real problems—and they say that that is their greatest challenge. What is most telling, however, is that 92 per cent of the survey respondents want the Scottish Government’s quality and outcomes framework for primary care to be reduced in scope or abolished. Perhaps one of the most worrisome and discomforting facts is that one third of GPs unfortunately answered “no” to the question whether they would choose to become GPs again.
The survey raises many questions about the future of our GP services. Why is the Scottish Government not ensuring that the right amount of resources is being put where GPs think it is important to put them? Why are we seeing fewer GP trainees and less retention of GPs across Scotland? Why are GPs under so much stress and work pressure that many see their own health deteriorate? When the Scottish Government enables GPs to put professionalism back into the profession, many such questions will surely find an answer. If the Scottish Government wants to listen and to implement substantial solutions, both the Royal College of General Practitioners and the BMA have a number of recommendations.
Investment in the tools that GPs have at their disposal to lead the development of new models of care would empower GPs and enable them to provide better services to their patients. Whether we are considering the recently announced investment of £500,000, which I welcome, for the programme for improving out-patient services through better technology or enabling GPs to work alongside advanced nurse practitioners in their practices, it is important to recognise the leading role that GPs play, and must continue to play, in communities.
I urge the Government to improve support and resources for general practices in order to ease GPs’ workloads and the pressures that they face. That support must include reducing GPs’ administrative burdens. We know not only that GPs currently work more hours than they should during a typical day, but that they are also responsible for administrative work when the practice closes for the day.
Instead of being forced to do tasks that are not related to medical practice, GPs should be enabled to spend more time with their patients, have closer working relationships with other professions and have a good interface with other experts who are involved with their patients’ care. With the advent of social care and health integration, we can and should prioritise that.
I close by expressing once more my concern for the future of our general practices in South Scotland and in the rest of the country, and also my respect and gratitude to all our hardworking NHS staff. I hope that, by listening to the facts today, the Scottish Government will decide to act to prevent that cornerstone of our healthcare system from reaching a crisis.
17:10
I thank Jim Hume for bringing this important debate to the chamber. I begin by thanking the national health service for the services that it currently provides, in case I forget to do so at the end of my speech.
General practitioners are a linchpin of the national health service, so I am surprised that the Government did not respond earlier to the British Medical Association’s statement back in March that the shortfall in general practitioners would impinge on patient care. It is important to try to encapsulate the difficulties faced not only by GPs but by the public.
My colleagues have highlighted a number of issues facing our doctors, including the fact that vacancies are not being filled. I know of a practice in Glasgow that has been looking for somebody to fill a vacancy but has failed to find anyone. It is quite shocking that morale is low among our doctors, because we depend on them to boost our morale. We depend on our doctors to be there for us to ensure that we are not suffering from all sorts of ailments, but if they themselves feel under pressure or feel that they have inadequate resources at their disposal to treat their patients, that sends a poor signal to our citizens.
The inequalities in Glasgow are probably the greatest. We talk about services for communities that are sparsely populated and where patients or doctors must travel long distances only to find that they do not get the services that they want at the end of their journey. I would have thought that that is pretty detrimental for any community. However, I see more and more people in densely populated areas such as Glasgow now complaining about not being able to get appointments or, when they get appointments, being rushed in and out of the surgery because of pressures on doctors’ time.
It is really important not only that doctors feel valued and that they have the resources at their fingertips but that patients who go to see their doctor feel that they are listened to and get a proper hearing. No patient feels comfortable going in to see a doctor who says, “Right, what’s wrong with you?”, starts scribbling and then says, “Here’s your medication—now, out the door.” A lot of people do not think that that is what they go to see the doctor for. Sometimes, people do not need medication—just good advice can be valuable, but that can depend on the resources that doctors have at their disposal.
A lot of doctors now say that they would rather not be in the job and that they would not choose that career if they had another opportunity. I remember that people used to want to give their right arm to become a doctor. It was a profession that people tried very hard to get into because they wanted to serve their community and to make a difference where they lived. If that is not happening, it is a bad day.
A proper policy needs to be developed to look at all the issues and the pressure that is being put on doctors. The Scottish Government really needs to take up the gauntlet, address the challenge and work more closely with doctors than it has done so far. Talking to doctors is not a bad idea. Let us do that, please, and let us hope that we can improve on the service and reduce the pressure on people.
17:14
I thank Jim Hume for bringing the debate to the chamber.
General practice is central to the future of the national health service in Scotland. It is the front line for many people. The recent BMA conference for Scottish local medical committees discussed the struggle that many general practices are facing to recruit doctors and get locum cover.
General practice can be a cost-effective part of the Scottish healthcare system. Recent calculations by the Royal College of General Practitioners show that investing another £72 million in GP consultations in the United Kingdom would lead to a saving of £375 million, rising to £708 million by the end of 2019. That translates into a possible saving of £70 million in Scotland. That could be done by looking at creative ways of freeing up time for general practitioners.
The Scottish Government recognised that when, in June this year, it announced increased funding for primary care of £50 million over three years. That will provide an initial impetus to encourage GPs to try new ways of working over the three years and it will help to address the problems with recruitment and retention that are so common in primary care services.
Alan McDevitt, the chair of the BMA’s Scottish GP committee, also raised another important opportunity to increase primary care funding: the evolving health and social care integration plan. Mr McDevitt states that
“investment in leadership training will provide GPs with additional skills to influence the design and delivery of community services for their patients.”
He went on to state:
“The recruitment of additional pharmacists working directly with GPs will provide much needed support and I would hope that in the long term this investment could be extended so that every practice in Scotland would be able to have a practice based pharmacist.”
Practice-based and community pharmacists are uniquely placed to work with GPs to improve patient care and safety and can play an important role in the long-term management of patients who have chronic diseases. I wrote to the Cabinet Secretary for Health, Wellbeing and Sport to suggest that we should have triage nurses in pharmacies in this instant society, so that lesser illnesses can be treated in pharmacies, which would free up time for GPs.
In March this year, the RCGP and the Royal Pharmaceutical Society issued a joint statement on general practices in which they highlighted the important role that practice-based pharmacists can play in creating efficient general practice services. There should be investment in the recruitment and training of pharmacists who are based in general practice and who could be of considerable value in reviewing patients’ medication, managing polypharmacy and medication for the housebound within the newly integrated healthcare system, linking effectively with community pharmacists and undertaking medicines reconciliation across the interface. That would all have a significant benefit for patient health and safety, and it could improve care and save the NHS a significant amount of money while alleviating the pressure on GPs, thereby creating a free-time investment opportunity.
The RCGP and the RPS also worked on how community pharmacists and GPs can work together to improve patient care. They set out recommendations on the benefits to patients of improving liaison between community pharmacists and GPs.
A number of initiatives across Scotland already promote collaborative working with community pharmacists, of which the Highland community pharmacy project is one example. There is also the Healthcare Improvement Scotland national patient safety programme.
Much is being done to improve the recruitment and retention of GPs, and I commend that work. However, let us look at much wider vehicles for the provision of a more extensive landscape for recruiting and retaining GPs.
17:19
As the motion states, 90 per cent of patient interactions with the NHS come through the primary care services. Since the whole direction of health policy for more than a decade has been towards more services being delivered in community settings, that percentage can only be set to increase. That is the background to the serious concerns that I am sure everybody has about the current situation.
I have found that to be the case in my own constituency recently. The starkest example has been the Leith Links medical practice: three GPs left and it could not replace any one of them. The results were that 2,000 patients were told that they had to leave the practice and were sent somewhere else, and the health board took over the running of the practice. Of course, that health board intervention is not unique in Edinburgh.
Nationally, we know of some alarming figures. Part of the background is the percentage of the budget that is spent on GPs. It was 9.8 per cent 10 years ago, while the 2012-13 figure was 7.8 per cent. That in itself is grounds for serious concern.
The overall number of full-time equivalent GPs is flattening and the applications for GP training posts last year fell by 10 per cent. Clearly, something must be done, and I am sure that the Government accepts that, too. We probably need a whole range of measures—including, perhaps, incentives for graduates to enter GP training—but the big issue that has to be addressed is workload. Jim Hume referred to the survey that overwhelmingly put workload as the number 1 issue. Of course, that is partly related to the overall number of GPs—that is fairly obvious—but it is also related to what GPs do and who they work with.
Some people may be surprised that workload is such an issue because after the new contract was introduced, which I was involved with as health minister at the time, some people were saying, “They’ve got it easy now—they’re not having to do all that out-of-hours work.” That was the mood music among a lot of members of the public. However, we have to understand that, as the years have passed, several things have happened. That includes demographic change—there are more people in the population, simply—and the fact that there are more older people with complex medical conditions who have to be looked after by GPs and primary care more generally. There has also been a shift towards primary care, which has not happened as much as we wanted but has still been happening.
To some extent and in general terms, the Government has addressed that issue in the programme for government. It talked about developing clusters so that the skills and expertise of GPs are shared across practices, which is a good thing. However, we also need to embed general practice in the wider primary healthcare team and expand the wider primary care workforce, including practice-based pharmacists. On the clusters, I should also have made the point—which, in a way, is fairly obvious—that they need to be aligned with the locality integration arrangements; there is a good opportunity to do that.
The quality and outcomes framework is much talked about as well. Some GPs want to abolish it; others want to disassociate it from practice income. When the GP contract came in—and I was getting a bit of stick for the new consultant and GP contracts in those days—I was quite pleased that some of the extra money for GPs was related to doing specific things via the QOF. I notice that even GPs who are critical of the QOF have said that it transformed the management of care—certainly for some practices that were perhaps lagging behind the best practices. No doubt the best practices, such as Dr Simpson’s practice, were doing many of those things anyway. My own view is that we need to keep the good bits of the QOF and still relate it to practice income, but clearly not all GPs agree with that.
My last point is that infrastructure is clearly important. One particular concern in my constituency is the development of the north-west Edinburgh partnership centre just on the edge of my constituency, which will have a new GP practice as well as many other services. That, of course, has been delayed because of the changes to the funding arrangements for the hub programme. I know that that is not totally within the control of the Scottish Government, but if the minister cannot say something about it, I would expect the cabinet secretary to make a statement about it to Parliament in the very near future.
17:24
I, like others, congratulate Jim Hume on securing the debate. It is a motion that should—and obviously does—concern each and every one of us, and I would like to think that it is an issue that can be addressed by a genuinely cross-party approach, as my party has been advocating over the past few years.
The statistics that surround the subject really do speak for themselves. If Scotland’s predicted growth up to 2020 reaches its maximum, we will require 915 more GPs. If it reaches its minimum, we will still require a further 560-plus GPs. Let us take the average and assume—as the motion itself does—that we will require somewhere around 740 or 750 more GPs by 2020.
That is quite a challenge, especially when we take into consideration the fact that fewer medical students are opting to go into general practice every year, two thirds of all GPs could retire in the next five years and 20 per cent of GP training positions were not even taken up this year. If this is not yet the crisis that the BMA claims, it is certainly a major problem that demands urgent attention.
Much more needs to be done to improve the recruitment and retention of GPs. Too many currently go abroad, because of improved salaries and conditions, and they do not return. Too many GPs—92 per cent in the survey that members have spoken about—believe that consultation times are inadequate. Sixty-nine per cent said that their workload has a negative impact on the care that their patients receive. Surely we need to review urgently aspects such as the box-ticking activities that GPs have to undertake, which could just as easily be undertaken by nurse practitioners and others, especially as patients who need more specialist care are increasingly transferred from hospitals to their local communities. It seems to me that the primary care structure is not geared up to deal with the current policy of having more and more people spend their later years in their homes rather than in a hospital.
That issue particularly impacts on a rural constituency such as my own of Galloway and West Dumfries. Across the local Dumfries and Galloway health board region there are currently around 12 GP vacancies out of a required establishment of 130 GPs, which is near enough 10 per cent. Some of those vacancies are proving extraordinarily difficult to fill. The further west we go—or, if I could put it another way, the more remote we become—the harder it becomes to fill those vacancies. Recruitment becomes harder; retention becomes even harder; and the issue itself therefore becomes harder to solve. On top of that, the risks to both in-hours and out-of-hours services also increase and become very substantial under such circumstances.
To the board’s credit, advanced nurse practitioners are being appointed to try to plug some of the gaps, but the board accepts that, if it is to manage age-related and chronic conditions outside acute hospital settings, comprehensive primary care GP coverage is absolutely essential. If that coverage continues to decline at the current rate, the default position will simply be higher hospital admissions, with a real possibility that there simply will not be enough hospital beds. Simultaneously, the planned integration of healthcare with social care services will not be able to achieve its full potential without the required GP workforce.
That does not paint a very pretty picture, so we must have a clear strategic direction to reverse the decline in recruitment and retention. On that note, I was interested in the First Minister’s announcement this afternoon that 10 pilot schemes of new models of primary care are to be introduced across Scotland. I would strongly recommend that one of them be located in the west of my constituency, where, if nothing else, it would be extremely well tested. I hope that that initiative works because, if it does not, the crisis that the BMA is talking about will become a very serious reality.
17:28
I congratulate Jim Hume and I thank him for bringing the issue to the chamber, because, as Alex Fergusson has said, a lack of GPs is a significant issue in Dumfries and Galloway, albeit that it is more significant in his constituency than in mine. It is significantly problematic to the extent that the BMA specifically referred to Dumfries and Galloway in its briefing.
The chief executive of NHS Dumfries and Galloway has told us that one of the reasons for the problem is that graduates are more interested in specialisms. Specialist medicine is more attractive than general practice for a host of reasons, and it is difficult to get people to go into general practice. However, shortage of professionals is not confined to general practice in Dumfries and Galloway. There is a shortage when it comes to recruiting teachers and social workers. Some of those shortages are around opportunities for the partners of professionals—there is certainly a shortage of professional jobs.
Other professions have had initiatives to grow more professionals. For example, Dumfries and Galloway Council paid for the training of social workers at the University of Glasgow, and in Dumfries and Galloway an initiative has recently been launched called grow your own teacher, in which people are being encouraged to come out of other education professions and train as teachers.
That is not as easy to do with GPs. We cannot really grow our own GPs, particularly in an area where there is no teaching hospital and no medical courses are on offer at the universities, so we attempt to recruit from other countries, for instance. However, that always makes me slightly anxious because we recruit from countries that need their own GPs and often we take them from countries that are worse off medically than we are.
I, too, am concerned about recently trained GPs going off abroad, perhaps into private practice. I wonder whether there are ways in which we can dissuade people who have been trained by the taxpayer in Scotland or the United Kingdom from taking the skills that they have recently acquired into private practice abroad.
This it is not Labour Party policy, so I hope that nobody will take it as that—the idea comes from me—but I wonder whether there is a possibility of training other suitably qualified professionals to bring them into medicine. My daughter has degrees in psychology and is training as a mental health nurse. I know a number of young people with degrees in history or even chemistry who trained to become lawyers after they graduated. I wonder whether there is a possibility of well-qualified scientists, for example, managing to be retrained into medicine, perhaps with an indication that they go into general practice. I am not suggesting that lots of scientists should leave science, because we know that there is also a shortage of scientists, but people with that sort of training might be able to be retrained. There is a loss of people from science, particularly women; perhaps there is a possibility there.
I ran the possibility of retraining other people past the chief executive of NHS Dumfries and Galloway, who was a bit concerned about it. He felt that people who were not adequately trained in medicine could be risk averse, just refer everybody on to consultants and create workload problems elsewhere. However, people who are trained to a high level in science have expertise in assessing the evidence and making evidence-based decisions, so I lay the idea on the table.
I will probably completely horrify the entire medical establishment in Scotland by making the suggestion, but I wonder whether we could examine whether other professionals might be able to be trained. It would be shorter, quicker and less expensive than training people from scratch. It might be one of a number of possible solutions.
17:32
Having spoken a little bit about primary care in my speech during the programme for government debate and during a health debate that we held prior to the summer recess, I thank Jim Hume for bringing the issue back to the chamber.
I was interested by the comments on workload. I have spoken in the past about how we can better align primary care services in order to reduce GP workload by triaging people to other services if they can more appropriately deal with their conditions—Malcolm Chisholm alluded to that. Some GP practices in my constituency do that; they speak to people when they request an appointment and redirect them to, for example, the pharmacy, if that is the more appropriate place for them to be seen. Some GP services do not do that yet, which might be a contributing factor to some of the workload issues. A percentage of the workload might be able to be redirected and dealt with in a different environment.
How we use other primary care professionals needs to be examined. I am confident that that will happen through the work that the Scottish Government is undertaking to redesign how primary care is delivered. Good-practice examples exist: for example, the minister will be familiar with the Middlefield healthy hoose in Aberdeen, which is an example of good practice and good use of nurse-practitioner services based on which other areas could remodel their services, depending on their circumstances.
The point on pensions that my colleague Rod Campbell raised in his intervention is relevant. The conversations that I have had with GPs—in particular, GPs who are in their mid to late 50s—suggest that, as a result of the changes that the UK Government introduced, they now face making the decision whether to continue to work in general practice and to take the pension hit that will follow as a result, or to retire early in order to benefit from their pensions. One does not want those GPs to have to make that decision, but there is a financial element to the decisions on retirement that they now face.
We also have to consider the fact that the make-up of the GP workforce has changed over time. It used to be a predominantly male full-time workforce, but it is now a predominantly female part-time workforce. There are a number of reasons for that, which I probably do not have time to go into in detail. I acknowledge that you are shaking your head, Presiding Officer. Do not worry; I was not going to go into the issue in detail.
We need to consider how GP services are structured in relation to that change in the workforce and we also need to think about how we attract graduates into the profession. That point has been made by members in various parts of the chamber. In discussions that I have had with medical students and their representatives, I have learned that the issue of partnership has been a decisive factor for many. I agree with the point that Dr Murray made about the issue also being about the fact that specialisms might be more attractive, but it might also be to do with the view that there might be a requirement to take on the role of partner, which is something that graduates might not want to do. That is why it is worth considering a confederated model, in which a smaller cohort of partners could operate a number of premises and employ GPs in them. I know that that is being considered by NHS Grampian.
There are a number of things that can be done; the programme for government contains some encouraging signs with regard to the reforms that are taking place. I am sure that they will help us to address some of the issues that we face in our general practices at the moment.
17:36
I am glad that we are debating general practice. I welcome Jim Hume’s motion and the survey that he did. As he knows, I did a survey this summer, as did the BBC. A lot of work has been done on trying to collect data, so the first question that I would like to ask is this: why on earth were the data not clearly available before?
This crisis—that is what it is; a growing crisis—has not just emerged out of nowhere. In 2010, I warned that we should be considering having a separate GP contract because the NHS in Scotland is now radically different from that in England, but we still have a UK contract. I am glad that we are now going to have a separate contract.
Let us look at the factors. I am not going to talk about the solutions. I will publish tomorrow a document that has a list—it is not a comprehensive list, because it is a consultation document—of all the suggestions that I received over the summer. I received 400 replies from doctors representing 330 practices. After the survey closed, another 49 practices responded.
The factors are clear. First, there has been an increase in the population of roughly 170,000 since the SNP came to power. If we want one GP for every 1,500 people, that means that we would have needed about another 120 GPs just to stand still in relation to the population. However, the situation is worsened because the demography of the population has changed: there has been a 17 per cent increase in the number of over-75s and it is they who have more complex conditions. GPs have to spend more time with them. Why? It is because hospital services operate on a silo basis: they treat single-disease entities, not humans in a holistic way, which is what GPs are excellent at. They are good at diagnosis and at managing complex morbidity, but they do not have the time to do that. That is because, although the QOF was useful initially and was a good part of the new contract—it was the first time general practice had been paid for quality—but it became an increasingly bureaucratic exercise. Two years ago, the document on QOF ran to 226 pages. Even this year, with cuts, it was 186 pages.
The other thing that has happened—apart from the increase in morbidity, the increase in population and the increase in the number of over-75s—has been a shift in the balance of care, which is something that we have all wanted. However, that has been almost totally unresourced.
Those are the factors in the background. What is the result? The result is that, as we stand here today, trainee vacancies are at 20 per cent, predominantly in the west of Scotland.
Emigration is up. My local practice in Bridge of Allan and the practice in neighbouring Dunblane—two of the nicest spots in which a GP could want to practise—have lost one doctor each to Australia in the past 18 months. Those are doctors in their 30s. When I contacted them to ask them about it they said that there was no way that they would come back. One of them said that he would try it, but then phoned and said, “No. I’m definitely not coming back.”
That has been going on for some time. Malcolm Chisholm mentioned the reduction from 9.8 per cent to 7.8 per cent in the percentage of the budget that is spent on GPs. With a decrease in the share of funding to general practice and an increase in the resources that GPs need, it is no coincidence that there is a crisis.
In 2011, this party said that we should have a national conversation. We called it a Beveridge commission for the 21st century. This Government ignored that request and so did the Conservatives. However, the Welsh Government established the Bevan commission and, in 2013, it introduced clusters. Only now in its statement today has the Government announced that it will introduce clusters. The introduction of clusters and a raft of other measures, which I have discussed with people in Wales, has resulted in a rise in the per capita number of GPs in Wales in the past 18 months, whereas the number has continued to sink in Scotland.
In my indirect debate with Maureen Watt on the BBC earlier this summer, we were told, “There are more GPs in Scotland than ever.” That has been the mantra for eight years, and yet the number of full-time equivalents has actually gone up by only 35 since 2008. I am glad that the crisis has been acknowledged and that some funding is being applied. In my view, however, that funding is wholly inadequate. We will need to do very much more. My proposals will be published tomorrow and we will discuss them with general practitioners.
17:42
We have heard much this evening about the difficulties in which parts of general practice find themselves. I will address those issues shortly. First, I want to make it clear that this Government attaches the highest value to Scotland’s GPs and to the work that they do. As we have heard, Scotland’s population is increasing and we are living longer, with multiple and often complex conditions. That will increasingly become the norm over the coming years.
I have every confidence that Scotland’s general practice can deliver what is needed to meet the challenge of demographic change. However, at the same time I acknowledge that significant changes need to be made in order to relieve work pressures and to help with recruitment and retention. We are working with GPs and have started to make such changes.
Earlier today, the First Minister set out the programme for government, in which she highlighted the early success of the integration of health and social care, which will ensure that as much care as possible is provided in community settings. She also outlined the importance of testing new models of care, building on the innovation that is being developed and integrating different types of care. We want to ensure that community-based services are delivered by the appropriate range of health and social care professionals working together more effectively.
That comes with a commitment to invest. In Scotland, we spend a record £12 billion each year on our health service, of which some £770 million is invested in general practice. We will be investing our recently announced £60 million primary care fund to transform primary care and to build on great examples from across the country of care being provided for patients at or near their home, rather than in hospital. That funding will help to address immediate workload and recruitment issues through long-term sustainable change. Specifically, the fund will increase the number of medical students who choose to train as GPs, and it will encourage those who want to work in rural or deprived areas. We will continue the enhanced returners programme to support GPs who wish to return to the profession, and we will develop a programme for local GP leadership and networking.
I welcome the minister’s comments. She touched on students who want to go on to become general practitioners. Would it be possible to work with the education institutions on increasing places for such students in order to try to relieve the shortage pressures that we will face in the near future?
Hanzala Malik makes an important point. For every one student place that we have, there are 11 young people who want it. We have people who want to go into the medical field, but we need to be sure that we are getting the right people in as students—the ones who want to live and work as GPs in their own communities. We are working with the BMA and others on that. We are consulting others to increase the output from medical schools, and we are encouraging and improving training in general practice. By the end of 2015-16 we will have invested an additional £10 million in enhancing primary care. That will be further supported by a total investment of £50 million over the following two years.
However, there are challenges. The Government knows that GP workload is increasing, as is the complexity of healthcare. Where more healthcare is being delivered outside hospital settings, resources have not always followed.
We understand that GP services in some places are stretched and that, at the same time, communities rightly expect more of their health services. Our plan is to transform our approach to primary care to ensure that in the future people see the right professionals more quickly. That is why we will continue to work with Scotland’s GPs to design that new future, that is why a review of primary care out-of-hours services was commissioned, and that is why we need to redesign primary care in a collaborative and inclusive way, thereby transforming and invigorating the workforce, creating new roles and supporting communities to innovate so that services are available where people need them.
Scotland’s GPs have a vision for the future of general practice, and it is a compelling vision that this Government shares. It is a future in which care is provided by multidisciplinary professional teams, and in which it is planned and delivered within the localities that need such teams. It is a future in which GPs are the expert medical generalists—the doctors who make the critical clinical decisions about their patients—but are not necessarily the first point of contact.
We have been working with the Scottish general practitioners committee to redesign the contract and we will have the first version in place by April 2017—a timescale that GP union leaders tell us is realistic. Negotiations on the detail will take place in 2016. As others have mentioned, we have a separate agreement in Scotland, of which English GPs are very envious.
By 2017 we will have made significant progress to change how general practitioners work. We will remove the annual churn of contractual change and introduce the next version of the GP contract three years later in 2020, when the transformation in how GPs work will be nearly complete.
Our approach will build on innovations that are already under way and which reflect local priorities—for example, in reducing health inequalities in Craigmillar and Govan, in improving mental health in Fife, and in helping people to age well in Tayside. Equipped with that flexibility, care will develop in ways that match the needs of individuals and communities in cities, towns, villages and rural areas.
The integration of different types of care is already the practice at Clackmannanshire community healthcare centre, which provides primary care through three GP practices while also providing wider services including outpatient services, two inpatient wards, a day therapy unit and a local mental health resource centre. The centre is also a base for district nurses, health visitors, community rehabilitation teams, health improvement and a wide range of support services and classes.
We know that one size does not fit all, which is why we wish to test and seek views on new models of care, including those that might be delivered by multidisciplinary teams in a community hub type of arrangement, whether physical hubs or virtual hubs, where professionals collaborate across the boundaries of primary and secondary care.
All that is, of course, focused on high-quality care and improved health outcomes that will provide more connected and streamlined working within healthcare and across health and social care and voluntary support services; on professionals being able to support patients who face wider social issues that impact on their health and wellbeing; and on clearer signposting, information and support so that people know where to go for the most appropriate treatment or follow-on service.
The time has come to start talking up Scotland’s general practice, to encourage more doctors to stay within the profession and to ensure that medical students choose a career in general practice because it is one that deserves to be admired and respected. It is time to create some excitement for the future of general practice in Scotland. I know from social media that that is already the case with some of our young students.
For now, this Government will continue to work with Scotland’s general practitioners to deliver a model of sustainable general practice that is right for the profession and—more important—for the health of the people of Scotland.
Meeting closed at 17:50.Previous
Point of Order