General Practitioners (Rural and Island Areas)
Our members' business debate today is on motion S1M-1897, in the name of Tavish Scott, on rural and islands general practitioners.
Motion debated,
That the Parliament notes the particular pressures relating to the delivery of primary health care in rural, remote and island areas of Scotland; supports the work of the Remote and Rural Resource Centre based at Raigmore Hospital in Inverness, encourages consideration of the particular challenges of recruitment and retention of GPs in areas such as Shetland given the high on-call commitment made by GPs in small rural practices, recognises the importance of equity in the remuneration of GPs and encourages the further development of proposals to assist in their recruitment and retention in rural, remote and island areas.
I begin by expressing my concern over yesterday's court ruling regarding minimum prices for common remedies, which will have an effect on rural pharmacists. I am sure that the minister is aware of that judgment and will reflect on the advice that has been given in respect of it. I hope that he might also reflect on the importance of the Scottish Executive's essential small pharmacies scheme. At times, I wonder whether the 21st century is to be dominated by the Asdas and Tescos of this world. Their role in our lives appears to have grown much out of proportion. I ask for some consideration to be given to that important issue and to the effect that the court ruling will have on rural pharmacies.
I have held a series of useful meetings with general practitioners around Shetland, and with Shetland Health Board, which concluded last Friday with a helpful briefing on this subject. This afternoon, I shall reflect on some of the concerns that have been raised with me. I recognise the fact that my constituency is not unique in experiencing difficulties, and some of the points that I shall raise will be equally applicable to many parts of Scotland. I am sure that other members will acknowledge that.
There is a need for a package of measures to tackle the undoubted problem of the recruitment and retention of good local GPs in rural health board areas such as Shetland. As was explained to me last week, that difficulty reflects the nature of a GP's lifestyle in such remote areas. Shetland has six single-doctor practices, three two-doctor practices and one seven-doctor practice, which is in Lerwick. There are currently two GP vacancies in the Lerwick practice and of serious concern is the fact that nine GPs have left that practice since 1995—the majority for reasons other than ill health or retirement. That turnover is significant, if considered proportionally, and the situation must be addressed.
The main concern is the out-of-hours work that is undertaken on a rota basis in such practices. Lerwick recently lost a GP to Elgin, where a co-operative system is in place that means that less time is spent on call. Such arrangements are a great incentive to people with young families and other interests in life. For those reasons, I suspect that Shetland's problems are reflected in other parts of Scotland. Larger practices, which often operate on a co-operative basis, can offer economies of scale, in a sense. As was explained to me last week, that is the difference between the situation in Elgin and the situation in Lerwick. However, if a co-operative could have worked in Shetland, it would have been tried. That point was made to me by the chief executive of Shetland Health Board last Friday. The sheer inaccessibility that is a feature of the geographical circumstances, the need for ferries and the miles of single-track roads make the idea of running an out-of-hours rota system for Shetland a non-starter. In addition, cross-area systems do not work in areas such as the north isles for the simple reason that the ferries between Fetlar, Unst and Yell, the most northerly islands, stop at 10 o'clock at night. Practices have to be located on each island, which exacerbates the problems.
Just as public demand for our health service is ever increasing, so our medical students demand ever more in relation to their conditions of employment. Recruitment issues are changing and the contrast, in terms of out-of-hours rotas, between a practice that offers a co-operative approach and a single-GP practice in Shetland is considerable. In addition, the balance in graduating medical students has tipped towards women, who may choose part-time work patterns. Furthermore, many graduates choose a work pattern that includes work abroad. As a result, if we are to attract graduates and experienced people into areas such as Shetland, the package that they are offered needs to be more attractive.
The overall package must include relocation expenses. Shetland Heath Board advises me that it can offer relocation expenses to consultants, nurses and associate GPs, but not to primary care GPs. In many areas, however—including the public sector—relocation packages are offered. GP practices are penalised for their independent contractor status. A change of policy for the islands and other remote areas would help with the recruitment and retention of GPs. Housing, particularly the availability of short-term housing, must also be considered in partnership with the appropriate agencies.
Salaried contracts for GPs were introduced recently. Last Friday, Shetland Health Board was given an assurance that, from that day onwards, island health boards could employ salaried GPs under the primary medical services arrangements. I understand, however, that the indicative budget for Shetland is £50,000 in the first financial year. When that money is shared out among the 10 GP practices and 20 GPs in Shetland, it will not make the difference that is necessary. In addition, given that there is to be a move towards a salaried GP scheme, the amounts of money that have been announced are inadequate, as self-employed GPs do not pay themselves by the hour, particularly when they are on call to a considerable extent.
Formulae for primary medical services do not work when they are applied rigidly and, as I argued when the Arbuthnott mechanism was introduced, often they do not reflect island circumstances.
There is a need for a package of measures to tackle recruitment and retention in Scotland's island, rural and remote areas. The primary medical services investment must be considered in detail in co-operation with GPs and health boards. Thought must also be given to the importance of retaining GPs, a remoteness element to the funding package for GPs in remote areas and a package to help with relocation, including short-term housing. Added together, those measures could provide a stable package for building a strong and successful primary care sector in the area in which it matters: the treatment of patients.
I start by congratulating Tavish Scott on raising this important issue. When we debate health issues, there often seems to be a concentration on the problems of conurbations. I do not think that saying that in any way denigrates the problems of conurbations—we need to consider the various needs of the various parts of Scotland. All our health policies and debates should be based on needs, and Tavish Scott made important points about that in his speech.
I represent a rural area—Moray constituency. The area has several large towns such as Elgin, but there are also remote areas. There is a huge difference between Elgin and the Braes of Glenlivet, and between Buckie and Tomintoul. In some of those more remote areas, if somebody's mobile phone actually works, they think that that is a miracle, and will jump out of their car and cheer.
When we consider the provision of health services in rural areas, we are talking about basic health services, and about the distances that GPs and pharmacists have to travel, often over insufficient or poor roads. They face higher fuel costs, which is a continuing problem in rural areas.
I also echo what was said about the likelihood that many rural pharmacies will disappear following yesterday's ruling. Small local pharmacists are the first point for many people who need assistance. The pharmacists know the people and they know the GPs and they are able easily to make a reference to a GP if they feel that help is required beyond that which they can provide. I am worried, because I do not see Tesco, Asda and others moving to Yell or, indeed, to Tomintoul.
We must consider the burden of paperwork that is placed on GPs, as well as the time that is demanded of them. It is sometimes the case that practices are one-man or one-woman practices and it is very difficult for doctors to do all the work that they are expected to do, including the bureaucratic case work. Staying in a rural context, our GPs are very important for those places where we have managed to retain small local hospitals where minor surgery can be undertaken, and where respite care is available to local families.
When I was looking at the Scottish Parliament information centre document that was provided for us as a background to this subject—"Medical Practices (Formulae)"—notional figures and their use in the formulae that are used in calculations for the recruitment and retention of doctors are explained. I do not like the idea of a notional figure, because patients' need for help is not a notional idea, but a reality. Every patient should be treated not in a notional way, but in a real way. While reading that SPICe research note, I felt almost that I was sitting a standard grade arithmetic test and I wondered whether a Scottish Qualifications Authority marker would be available. I have not seen so many multiplication signs, division signs and fractions for a long time. The complexity of the formula is in its being totally number based—account is not taken of the geographical areas that are covered.
I recognise that improvements have been made. Information technology has been helpful, as has been the use of helicopters, particularly in the Highlands. The local health care co-operatives have also been referred to. In my area, we have Moray docs and G docs—meaning Grampian doctors—and they contribute substantially to ensuring that the co-operatives work. That does not mean that somebody will always see their own doctor in an emergency, but they will probably get the chance to see a doctor who has, at least, had some sleep.
Recruitment and retention must be considered seriously, as should as the formulae that are used, which take very little account of remoteness.
I, too, congratulate Tavish Scott on securing the debate. There is no doubt that GP provision is extremely important to people in rural and remote communities. For them, it is the front line of access to health care, and it is vital that the service meets their needs. I agree with a lot of the sentiment behind Tavish Scott's motion and I pay tribute to the work of the remote and rural resource centre at Raigmore hospital.
More work needs to be undertaken to consider the particular challenges of recruitment and retention of GPs in rural and remote areas. We need to highlight the benefits of rural practices to GPs and other health professionals. Such practices provide a better quality of life and work experience that is not available anywhere else. GPs in remote areas are at the front line of medical and emergency services, which gives them a range of skills that they could not attain anywhere else. If we are to give people access to GPs, high on-call commitments will always be part of working patterns in remote areas, but we should explore ways of compensating for that, such as using salaried GPs and allowing more time off by expanding the provision of locums.
I will concentrate on one local issue, which is the on-going dispute between Highland Primary Care NHS Trust and local residents in Helmsdale, about proposals to merge their GP services with the Brora practice. There is considerable frustration and anger among local residents about the way in which the proposals have been handled. There has been a series of public meetings, but far from rectifying the situation, they have added to the sense of frustration. Against the wishes of the community, the trust has now decided to extend the Brora practice so that it will also cover the Helmsdale area. The issue that is at the heart of the dispute is that Helmsdale residents want access to a local GP, but do not feel that the current proposals address that wish properly. They also believe that the trust has forced changes through without taking on board the views of the community.
I find it difficult to understand how trusts are influenced by Government policy. The thrust of the Government policy, as shown by the Arbuthnott recommendations, is to decentralise and in so doing to recognise the needs of rural and remote communities. The perception among residents in Helmsdale and elsewhere is precisely the opposite. The trust's decisions seem to run against the thrust of Executive policy. The lack of meaningful consultation and of implementation of Government policy on the ground need to be addressed. The issues need to be resolved to hold the confidence of communities.
I congratulate Tavish Scott, the member for Shetland, on securing the debate. As a Highlands and Islands MSP, I know the problems only too well.
The aptly titled "Crisis in Care: A GP Dossier", which was produced recently by the British Medical Association, paints a sad picture of the morale of GPs in the UK. It says that many doctors are leaving the profession or retiring early due to the intolerable burden of red tape that is imposed on them by the Government. Our doctors are losing heart because many of them know full well that the increasing burden of paperwork, red tape and targets means that they are failing their patients, which goes directly against the Hippocratic oath, which every doctor must swear.
The problem is exacerbated in rural and island areas, where doctors have to cope with the extra strains that are caused by extremity of location and blanket regulations that are often too broad to deal with specific situations. To put it in medical terms, general remedies do not generally cure specific ailments.
I have been closely connected with the recent problems that were faced by the doctor in the Dalmally practice. Sadly, the fact that she was refused an associate partner to cover her enormous work load led to her leaving the practice, much to the dismay of those who relied on her and had confidence in her as an excellent doctor. For some time, the area was served by four different locums, which led to a great deal of confusion and extra expense. Now Dalmally has an excellent new doctor, who has a locum for one week per month, but the problems have not changed. Surgery times have been shortened significantly, which has led to many people wanting to register in the nearby practice of Taynuilt. That is a sad and unsatisfactory situation.
As the debate is also about islands, I offer the example of people who are members of the Appin practice in Argyll who live on the island of Lismore. Four years ago, Sam Galbraith—then minister with responsibility for health—generously allowed them a 15-year-old Renault Espace to transport patients along the bumpy roads of Lismore to the point where they could be transferred to a passenger ferry to Port Appin, where they could be picked up by an ambulance. Surely, in 2001, those people should be served better, or are they simply to be forgotten? I admit that a helicopter could be used, but experience has shown that the average waiting time for a helicopter is two and a half hours—a patient can easily die within that time. Often, a Land Rover must be used if the Espace has broken down, which is not good enough. A proper ambulance with a retained ambulance man should be available, in a similar way to a retained fireman.
Those of us who are old enough to remember the excellent television series "Dr Finlay's Casebook" will remember the high esteem in which rural doctors were held. I know that times change, but surely rural practices should improve for rural patients, rather than decline? One cannot base people's needs purely on statistics, because the geographical spread in rural areas dilutes all the effort. No consideration is given to the size of the area. As a result of the lack of public transport in rural areas, doctors are called out more often than they are in urban areas.
Dalmally has a single manned ambulance that cannot attend a road traffic accident, so the doctor must attend, which means extra work for the doctor. The ambulance can be used only as a taxi between homes and hospitals. Another example is that of the midwives who are based in Oban, which is 30 miles from Dalmally. Given the distance, the doctor often attends instead of a midwife—again, more work for the doctor. There is a tourist hotel that, over the year, produces 6,000 pensioner bed nights. Because the hotel's guests are frail, they often need a doctor—at any time of the day or night—which is also extra work for the local doctor. No account is taken of those extra pressures. Is it any wonder that we are told that doctors no longer want to practice in single-doctor practices?
It is heartbreaking for those who find it impossible to produce a reasonable service for patients in the present conditions. However, I was glad to hear that in February, the Minister for Health and Community Care, Susan Deacon, promised 50 new doctors and 50 new nurses for rural practices. I urge her to make certain that some of those doctors go to single-doctor practices, so that the work load drops from the present 112-hour week to only 84 hours a week. That is still a fairly onerous work load by anybody's standards, but it would at least be an improvement.
More medical services are being offered, but we must have the personnel to dispense those services. I cannot express strongly enough how important it is to country people to know their doctor personally and to have faith in him or her.
Come to a close please, Mr McGrigor.
I am just finishing, Presiding Officer.
After all, confidence is half of what it takes to recover from illness. People in rural areas deserve health cover that is equal to that which is provided in urban areas. There should be no second-class patients and no two-tier system. It is necessary for us to reverse the decline in rural practices and to make them attractive enough so that those whose vocation is the medical profession will work in, make their homes in, and become pillars of rural communities, as they were in the past.
I, too, congratulate Tavish Scott on securing the debate and I thank Rhoda Grant for her supportive remarks about the village of Helmsdale, which is in my constituency. I imagine that the people of Helmsdale little expected to receive as much coverage as they are receiving this evening. Nevertheless, their situation merits such coverage. If I say that the situation is peculiarly poisoned, members will understand what I mean.
Rhoda Grant painted the background to that situation, which should be of interest to the Scottish Executive because, in a small way, it illustrates precisely what is going wrong on the ground, despite the Executive's laudable intentions. Between Edinburgh and a remote village in the Highlands, communication channels are being broken, to say the least.
Dr Singh left the village of Helmsdale before Christmas. Shortly after Christmas, the Highland Primary Care NHS Trust announced that it was not going to replace Dr Singh. If any consultation took place with the community, it was derisory—the impression is that there was no serious effort to consult the people. The question of an advertisement arose, but the advertisement that appeared in the appropriate press was a joke. It was very small—one would need a magnifying glass to read it—and it was deeply discouraging, putting any would-be applicants off applying for the job. In comparison with advertisements on the same page for jobs in other areas in Scotland or the UK, it was particularly bad.
We have argued time and again with the powers that be, saying, "Look. Show good faith in the community. Why not readvertise just once? If you don't get a doctor after readvertising, we will accept that and we will have to amalgamate." In fact, in a private meeting between Mrs Alison Magee, who is the vice convener of the Highland Council, Rita Finlayson, who is the local councillor, Edward Mackay, who is a member of Helmsdale community council, and me, an undertaking was given to readvertise the post. However, the trust reneged on that agreement and said that no such undertaking had been given. With parliamentary privilege, I tell members that such an undertaking certainly was given. That leaves a very big question mark in my mind over the competence and integrity of the management of that trust. I choose my words very carefully.
Worse than that, there is an issue of distance in that area of the Highlands. The distances are impossible. If a practice in an area such as Brora is combined with one in Helmsdale and carries right on up the Strath of Kildonan, there must be a doctor who is locally based. If someone takes poorly right at the end of the strath, there is not nearly enough time to drive up to attend to that person.
During last winter, the severity of the weather in the Highlands was amply demonstrated. Roads were blocked, a train was blocked in and aircraft were unable to take off from Wick. That, too, seems to have been blithely missed by the health trust.
Mrs Alison Magee, the vice-convener of Highland Council, made the point at the meeting with the health trust that health in Scotland, the Highlands, and everywhere is—first and foremost—about patients and access to health. If there is a problem with doctors—if the job is unattractive and there is not enough pay or support, for example—that begs questions for the health authorities and for those in Government in Edinburgh. However, no such messages have come back from the health trust. As I said, the trust seems to be doing its own thing and ignoring the expressed wishes of and guidance—indeed, stronger than that, the cash encouragement—from the Executive to address matters of rural service.
I said at the outset that the situation is poisoned. The issue is serious in the area. I can do no more than say to the minister that I appreciate that the matter lies in the hands of the health authority, but I would be very grateful—many people in that remote area would be very grateful—if a watching brief at least could be taken at this stage, and perhaps an audit done of how the trust is conducting itself.
I want to quote from a letter from Helmsdale community council to Susan Deacon on the conduct of Highland Primary Care NHS Trust. It sums up things nicely. It states:
"The Helmsdale and District Community Council wish to express their serious disapproval and extreme concern over the conduct of the primary health care NHS trust in the filling of the GP vacancy in Helmsdale. The council also wishes to bring to your attention the sheer lack of professionalism shown by Ms Heather Sheerin, the chairman."
The situation is serious. Relations are poisoned and it will be hard to build them up again. The area seems far away from here, but the issue is important for a very special part of the world.
I congratulate Tavish Scott on securing the debate.
I should declare that I am a member of the Royal College of General Practitioners and the British Medical Association. I have experience of working in a locality that stretched from Stirling to Oban and covered a very large geographic area—a locality that consisted of six practices. It was interesting because the practices represented the gradation from the suburban practice right through to the rural practice.
The problem is not in finite bits. There are particular problems for the islands and for some of the very remote communities that Jamie Stone referred to. The problem comes right through into less urban areas or geographically disparate areas. For example, the recruitment and retention problems in areas such as Kinross and Milnathort in my constituency are exacerbated by the fact that they are not in an out-of-hours co-operative. Over 80 per cent of Scottish GPs now work in out-of-hours co-operatives. Frankly, the out-of-hours co-operative movement saved primary care from disaster in the mid-1990s, when morale was at an all-time low, although some of my GP colleagues have forgotten that.
We need to examine carefully the problems for doctors in rural and island areas. I have already suggested that out-of-hours practice is a problem, but getting time off for training is also problematic. The clinical governance requirements in primary care are increasing substantially and GPs who work in isolation need to keep up to date. If there are three or four partners, the GP can share information with them and discuss problems and worries, but it is difficult if the GP is isolated.
Holiday leave is also increasingly difficult for rural and island GPs, because availability of locums has decreased. Locums are hard to get even in urban settings, but they are almost impossible in more rural settings. Rural GPs are also not able easily to participate in their local health care co-operative, which is the main thrust of development of primary care and is our main engine for change.
Of course, there are advantages to working in a rural or island practice—I will not repeat Rhoda Grant's speech—but GPs have to be able to take a multiskilled approach in primary care in such settings. For example, the need for good work in accident and emergency is important.
The minister will not be surprised to learn that I have a number of suggestions. We need to look again at the model that is used in the Australian outback, where young graduates are encouraged to take up posts that are hard to fill and, after a period of time, are given a bonus that helps them if they want to move back into urban settings. For example, although I was fortunate enough to work in the village of Bridge of Allan and obtain a house when property prices were cheap, no GP could now afford to acquire a property in certain parts of that area. That is also true of some of the large cities. Doctors who might wish to practise in such areas may be prepared to spend some time in more difficult places. In that regard, I suggest that we need to consider golden handshakes and to consider paying the student loans for such doctors. Doctors' courses are longer than most graduate courses and a young doctor's debt is now very substantial. If that were done over a period of years, it would encourage people to move.
Relocation costs, which Tavish Scott referred to, need also to be examined. Why should primary care doctors be treated differently from other doctors? I see no reason for that. The issue should be re-examined.
Local health care co-operatives and primary care trusts should be strongly encouraged to employ young registrar doctors—that is, newly qualified GPs—to act as locums. That would give them enormous experience of working in the Highlands and might allow some to develop an appetite to experience the quality of life that comes from serving a community in the way that Jamie McGrigor mentioned. Such service gives enormous satisfaction, but unless one has tasted it and understood it, going to a remote community might be quite a fearful thing.
We also need to look at the use of NHS Direct. One of the things that we did for one of our more rural practices was to provide nurse and doctor triage so that any calls that were received were already known to be calls that were definitely valid and would not be problematic.
Wind up, please.
I am on my last sentences.
We are in the process of beginning to renegotiate the general medical services contract. I urge the Executive to join our Welsh colleagues, who have similar problems, in examining closely whether it would not be better to have specific contracts for rural, island and other disparate geographical communities.
Tavish Scott's motion raises rural and island issues in relation to GPs. However, as a member for the Highlands and a member of the Health and Community Care Committee, I want to point out that the motion simply highlights the surface of a more deeply rooted problem, which is undoubtedly exacerbated by remote and rural issues.
Tavish Scott mentioned the need for a package of measures. Top of the list should be the inclusion of GPs in consultation, listening and working together throughout the health plan. Reading "Our National Health" is a case of spot the references to GPs. Section 9, entitled "Working together", does not even mention GPs in the list of key stakeholders. We must engage and work with our GPs.
Tavish Scott mentioned the remoteness of the Highlands and the difficulties of access caused by single-track roads. I point out to Tavish Scott that that is not something new; those areas have always been remote and the problems have been there for centuries. However, the problem that we face today is new and has recently come to the attention of many members within the Highlands. NHS 24 is one of the answers, although it cannot be the whole answer. Nevertheless, I look forward to the implementation of NHS 24, which will be helpful in remote and rural areas.
Recent articles in The Herald highlighted the fact that GPs are walking away from practices in Dundee, Glasgow and other cities in Scotland. The problems of recruitment and retention are not simply related to remoteness and rurality.
Tavish Scott mentioned the remote and rural resource centre at Raigmore hospital. I understand that that centre is considering 200 small projects instead of concentrating on the serious projects that Tavish has raised today and on the serious pressures affecting health care and access in remote and rural areas. The real issues are more GPs, more practice nurses, more professions allied to medicine, a more accessible service and the problems with out-of-hours services. One GP commented that the activity of the centre is spread so thin as to be invisible.
Tavish Scott mentioned that GPs in Shetland are retiring prematurely. That is the case throughout Scotland. In Fort William, three GPs recently retired early. That represents 25 per cent of the practitioners. At a recent meeting with GPs in Thurso, I was told that an excellent and much-respected young GP had decided that unemployment was preferable to her job as a GP. We cannot look only at GP services. In the maternity services in Caithness, the threat of downgrading puts additional stress on GPs.
I have often mentioned the Arbuthnott funding. It is there to address poverty, rurality, deprivation and access to services, but not one penny has gone to GPs in Caithness, Sutherland and other parts of the Highlands. Enough has been said about Helmsdale tonight, but it is incredible that, after the doctor walked out of Dalmally, the doctor from Helmsdale found that Dalmally was preferable to the stresses and strains of working in Helmsdale.
The BMA has recently remarked on the problems of recruitment and retention. It said that 82 per cent of GPs reported that stress had increased; that 65 per cent had reported more bureaucracy; and that 76 per cent had reported that there was no sense of involvement in NHS changes. It is little wonder that all GPs in Scotland are being balloted at the end of this month, to highlight their plight and their strength of feeling over the resignation of their NHS contract by next year.
Much has been said about local health care co-operatives and the previous practice of fundholding. Whatever the rights and wrongs of fundholding, we did not put anything in its place to engage with the best practice of doctors.
GPs are being asked to do more and more, to provide more and more services to patients, but with less and less support. It is shocking that around 30 per cent of visits to GPs have a mental health component and that about 95 per cent of mental health care now takes place in the primary care setting.
At the top of the list of measures that Tavish Scott mentioned, I would like to see partnership, consultation and working together. The despicable things that have happened between the primary health care trust and the people of Helmsdale are absolutely ridiculous. At Scottish Executive level, we should be showing that the health department engages with our GPs, to show them how consultation and working together should be done.
I congratulate Tavish Scott on securing this debate. I have no difficulty in offering my full endorsement of the terms of his motion. I very much agree that primary care professionals who provide a service in rural, remote and islands areas face particular pressures when compared with their colleagues in urban settings. Those challenges are being addressed in a number of ways, through measures that have been in place for some time and through new measures that we have introduced more recently. I will speak later about the work of the remote and rural resource centre that was set up by this Administration. In so doing, I will say more about recruitment and retention in remote and rural areas.
Before that, I want to say a little about primary care in general and something about the court ruling with reference to which Tavish Scott began his speech. Clearly, that ruling may impact on remote and rural small practices—although it will not affect many other localities if there are not larger premises nearby. It will be an important issue for consideration as part of the current consultation on a pharmacy strategy for Scotland and will have to be discussed with the Scottish Pharmaceutical General Council as part of the negotiations on pharmacy pay.
Our overall commitment to primary care is clear. "Our National Health: A plan for action, a plan for change" highlights the paradox that although public attention focuses on hospitals, 90 per cent of contacts with the NHS begin and end in primary care. Contrary to what Mary Scanlon suggested, "Our National Health" underlines the importance of primary care. It commits us to continue to develop a range of service improvements, which will make primary care more accessible and flexible.
To do that, we have introduced a range of measures—there are many more in the pipeline—to improve primary care. They include the recently announced additional £18.5 million for personal medical services, about which I will say more in a minute; the £33 million that is being invested in new primary care premises through the primary care modernisation fund; the significant expansion of information technology, to which Margaret Ewing referred; the development of NHS 24, in close co-operation with GPs, which was welcomed by Mary Scanlon and Richard Simpson; and £10.8 million for a public health practitioner in each local health care co-operative. Work will be done on access to primary care services and the strategy on LHCCs is imminent. I could say more on primary care in general, but I must move on to the specific issues facing GPs in rural areas.
GPs serving rural communities receive the same fees and allowances as their urban counterparts. They also receive support through additional payments and schemes, which have been introduced over the years in recognition of the particular circumstances of practice in rural areas. First, the long-standing payment inducement scheme provides extra support to medical practices in the most remote rural and island areas. Secondly, the Scottish rural practice fund helps to compensate GPs whose patients are scattered over a wide area. Thirdly, the associate allowance enables single-handed rural GPs to employ an associate GP. Fourthly, rural GPs can apply for special locum allowances to cover the time that they spend away from practice to attend educational courses and to assist with the cost of out-of-hours cover.
Personal medical services, to which Tavish Scott referred, can also help to address recruitment and retention difficulties within primary care teams. An additional £18.5 million over three years for PMS was announced earlier this year. I emphasise that those are extra resources over and above the extra money to which I have already referred and the current enormous expansion in health budgets.
More than one member referred to the recruitment issue in Helmsdale. I visited the Highlands on Monday and was pleased to meet various people from community councils in Sutherland who drew the issue, among other matters, to my attention. Arrangements to fill the vacancy at Helmsdale are a matter in the first instance for the Scottish Medical Practices Committee and in the second instance for Highland Primary Care NHS Trust. It is a complex issue, which I cannot go into, but I assure members that we are putting in place new accountability review procedures, so when I say that it is the primary responsibility of those organisations, that does not mean that we are not taking an interest in that matter and in others.
One of the key issues is the high on-call commitment, to which Tavish Scott referred. Richard Simpson highlighted the importance of out-of-hours co-operatives. A review of out-of-hours services in Scotland was completed in October 1998 and a number of key recommendations have been implemented since. Funding was allocated for further research and we are now considering the subsequent report. The report of the out-of-hours review identified the need for additional support for rural GPs out of hours. The Highlands and the Western Isles were two of the areas that benefited from additional funding.
The motion supports the remote and rural resource centre that is based at Raigmore hospital in Inverness. As I indicated, I have no hesitation in offering my endorsement of it. There has long been a need for a body to handle specific solutions to the problems that are associated with delivering health care in the less populated parts of Scotland. That need was reinforced in the chief medical officer for Scotland's 1998 acute services review.
We have made the vision that is outlined in that review a reality by providing £8 million over three years to establish the remote and rural areas resource initiative. It has been operational for more than a year and is making its presence felt across a wide range of issues affecting remote and rural services. The recruitment and retention of staff and education and training tailored to their needs feature strongly, as does the development of new rural service models. One example is a pilot project that involves rural paramedics and GPs administering medication to prevent thrombosis. The value of that in rural areas is evident when we consider that a 30-minute delay is equivalent to the loss of a year's life expectancy.
Following consultation with the Executive, the initiative is also establishing a solutions group, whose remit is to explore and facilitate the introduction of innovative methods of delivering health care in remote and rural areas. The solutions group will consider options for redesigning primary care and community services in remote and rural areas and will consider such matters as PMS models, out-of-hours provision and the introduction of family health nurses.
Will Mr Chisholm take an intervention?
Am I allowed to?
As long as you are both brief.
I will be brief. Does Mr Chisholm accept that the initiative can consider those issues, but that the primary issue relates to people, and so careful consideration should be given not only to imaginative solutions involving PMS, but to practical ways of placing additional staff in those practices?
Tavish Scott referred to some matters with which I have not dealt. I will want to reflect on issues such as relocation costs.
My time is almost up. I referred to the family health nurse. We should be proud of the fact that we are piloting that new model of community nursing practice alongside the World Health Organisation and 16 other European countries. The Scottish pilot is examining the role of the family health nurse in remote and rural areas, with pilot sites in Highland, Orkney and the Western Isles. That innovative new model will prepare nurses to work alongside their GP colleagues better to meet the needs of our rural communities. We are all aware of the idea of the primary care team as an advance in primary care.
I thank Tavish Scott for drawing these matters to the chamber's attention. Much has been done, but I will reflect on the points that he and other members raised to discover what further progress can be made.
Meeting closed at 17:52.