Meeting of the Parliament (Hybrid)

Meeting date: Wednesday, September 21, 2022

Official Report 942KB pdf

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Out-of-hours General Practitioner Services

The final item of business is a members’ business debate on motion S6M-03899, in the name of Alexander Stewart, on national health service out-of-hours general practitioner services. The debate will be concluded without any question being put.

Motion debated,

That the Parliament acknowledges what it sees as the importance of NHS out-of-hours GP services; understands that, according to Healthcare Improvement Scotland, primary care out-of-hours services are a fundamental part of the healthcare service in Scotland; notes that the service provides support to those who require medical assistance outwith normal GP surgery hours; understands that this involves a number of healthcare professionals, agencies and support staff, such as drivers, working together to provide a high-quality and integrated service for patients, with many individuals going above and beyond their normal remit to ensure maximum quality of service; notes the view that Healthcare Improvement Scotland and many GPs have collectively acknowledged that the quality and safety of out-of-hours care, such as that available in Clackmannanshire, across the Mid Scotland and Fife region, and all over Scotland, is extremely important and that patients should have access to consistent, high-quality standards of care, and further notes the calls for all regions of NHS Scotland to do all that they can to maintain, sustain and retain their out-of-hours GP services.

17:11  

I am very grateful for the opportunity to open my members’ business debate. The importance of NHS out-of-hours GP services should not be underestimated. Indeed, according to Healthcare Improvement Scotland, primary care out-of-hours services are a fundamental part of our healthcare. The services provide support to those who require medical assistance outwith normal GP surgery hours and involve a number of healthcare professionals, agencies and support staff. They work together to provide a high quality of integrated service for patients, with many individuals going above and beyond their normal remit.

I said in my original motion for the debate that Healthcare Improvement Scotland and many GPs have collectively acknowledged that the quality and safety of out-of-hours care is extremely important. However about four years ago things appeared to slowly but surely be making an about-turn.

In April 2018, I lodged a motion with deep concern after the decision by the Fife health and social care partnership to close the Glenrothes hospital out-of-hours service. In May of that year, I sought assurances from the former health secretary that there would not be any further service reductions. The health secretary responded, indicating that recent changes were a short-term measure to ensure that appropriate levels of patient safety were maintained. I also took part in Jenny Gilruth’s members’ business debate on the very subject of Glenrothes, as well as participating in Willie Rennie’s members’ business debate about the St Andrews out-of-hours service.

The primary care emergency services at the hospitals in Glenrothes, Dunfermline and St Andrews all remained closed after they were forced to be suspended due to staff shortages in 2018. Meanwhile, NHS Forth Valley had been escalated to stage 3 on the NHS board performance escalation framework. All those concerns have sadly proved not to have been in vain as we are now facing grave issues in many of our out-of-hours services the length and breath of Scotland.

Assurances were sought from the constituency member for Clackmannanshire and Dunblane and the Clackmannanshire Council leader. In a press statement in December 2021, they indicated that they had received assurances from the health board that it was committed to providing services in Clackmannanshire. I have been contacted by a number of highly concerned, even frightened, individuals about what is taking place in Forth Valley’s out-of-hours service. I am shocked and dismayed to have received reports now that that is being dismantled slowly but surely.

Prior to NHS Forth Valley control, the Clacks emergency doctors service was working Monday to Friday and at weekends, with two doctors and three doctors overlapping, plus another doctor on standby and a receptionist, a car and a driver. The Falkirk doctors service was also working Monday to Friday and at weekends, with receptionists, drivers and two cars. The Stirling doctors service operated from Monday to Friday and at weekends, with rural Stirlingshire being covered by its own GPs.

When NHS Forth Valley took over the services, it had five GPs, supplemented with local GPs covering at high level with four GPs and four drivers. All centres were fully staffed seven days a week, apart from Clackmannanshire, which lost an overnight GP as soon as NHS Forth Valley took over and where the service started to be diminished. Months later, Clackmannanshire was reduced to one GP in the evenings, with many patients having to travel to other centres when the Clackmannanshire-based GP was on visits.

A reply to a freedom of information request that was sent to me recently showed staffing levels fluctuating over the following years, with the Clacks centre being systematically run down from 2017. That began with the centre being closed on public holiday weekends due to shortages. The running down of the centre continued with the shortening of opening hours at weekends, followed by regular weekend closures, and now it is open only three evenings a fortnight.

Despite the claim in the FOI response that the health board would like to continue with the three centres, I am repeatedly informed that there has been a removal of drug bags, drivers, cars and receptionists from Clackmannanshire and Stirling over the past few months. NHS Forth Valley had five vehicles a few years ago, then it had four vehicles and then it was reduced to two vehicles at Larbert, with only one car operating on occasion. Moreover, on the days that Stirling and Alloa have a clinician, no driver or drug bags are available at those centres. Staffing levels are at a fraction of the initial levels that were indicated.

Calls to Forth Valley via the NHS 24 line are triaged into the following categories: a doctor to be phoned; patients to attend a centre within one hour, two hours or four hours; and patients to receive home visits within one hour, two hours or four hours. During Covid all those calls were triaged by NHS 24 and retriaged to NHS Forth Valley. That is still the case today, despite the pandemic being all but over. Now Forth Valley has adopted a policy of “comfort-calling” by non-clinical staff to apologise for the delays and to ask the patients whether they still want to remain on the list.

As we have seen historically, when Forth Valley goes into escalation that means that the standard diminishes. Indeed, on occasion, we have gone into the black level, which is the top priority, and there has been no service at all.

In conclusion, staffing levels and GPs’ co-operation are vitally important. Forth Valley assured their patients that they would have a good service, and they did have a good service at one point. Now we find only one clinician on duty for a population of around 300,000 patients. That is causing real concern and is compromising patient care. Clinicians, drivers and receptionists have all been cut despite there not being any drop in the demand. Indeed, Forth Valley call demand is such that, in reality, a quarter of calls cannot be answered because of the lack staff.

This is a wholly unacceptable situation and one that needs to be addressed by the cabinet secretary as a matter of urgency. I look forward to hearing his response in summing up

GP out-of-hours services are vitally important. Therefore, the Scottish Government and local health boards need to strive to ensure that they are maintained, retained and sustained. At the moment, they are failing patients and putting lives at risk.

17:18  

I welcome the opportunity to speak in the debate and thank my colleague Alexander Stewart for securing it. I supported the motion as it was quite positive, which is different from what we have just heard in the contribution. I want to start by paying tribute to all of Scotland’s GPs as well as their staff, the advanced nurse practitioners, NHS 24 call handlers and drivers. As Mr Stewart’s motion mentions, their work is crucial.

The primary care out-of-hours services are a fundamental part of our healthcare in Scotland and the service provides support to those who require medical assistance outwith normal GP surgery hours. Out-of-hours involves a number of agencies and healthcare professionals working together to provide an integrated service for patients. The quality and safety of out-of-hours care is extremely important and I agree that patients should have access to consistent, high-quality standards of care across the country.

The picture with out-of-hours care in Scotland is a comparatively good one compared to other United Kingdom nations. Each year across Scotland, about 870,000 patients use out-of-hours primary care services, resulting in just under a million consultations. Home visits account for one in five, which is about 187,000 contacts with out-of-hours primary care services, with over half of the contacts—57 per cent—taking place in a primary care emergency centre. Children under five, women in their 20s and people aged 75 and over are the most common age groups of patients contacting out-of-hours primary care services. Treatment was completed by out-of-hours primary care services for just over half the patients who were in contact with them Only 3 per cent of contacts with the services resulted in a referral to accident and emergency or a minor injury unit, showing how out-of-hours services are helping to reduce acute hospital admissions.

Those statistics are welcome and they show the importance of out-of-hours services as a way to reduce hospital admissions. They are also an important way of providing reassurance to the public that care will be provided outwith GP hours.

Andrew Buist, the chair of the British Medical Association’s Scottish general practitioners committee, recently wrote a blog reflecting on NHS out-of-hours care in Scotland now compared with the model in 2004. In the blog, Dr Buist remarked how out-of-hours services, which previously were solely doctor based and involved doctors in long on-call hours, often driving themselves, have now been transformed into a more slick operation in which the primary care sector works together. Dr Buist said in his blog:

“When I think back to what out-of-hours was like before 2004 then what a luxury it feels like now to have a driver.”

He just sits back, having read the patient’s notes. He lets someone else worry about finding the right house, safe in the knowledge that, when he is on the call, there is someone outside waiting on him. Dr Buist continued:

“You work at your own pace alongside other GPs and nurse practitioners all picking from a pool of patients who have been triaged by NHS 24 and given an appointment time slot. The cases were all appropriate, a mixture of children, coughs, urinary symptoms, with the occasional rash, chest pain or alcohol withdrawal. Compared to daytime general practice, it was so much more straightforward. There was no shopping lists ... no paperwork.”

Dr Buist said also:

“Out of hours is part of general practice. We as GPs need to support it and not give it over to hospital care.”

Those words speak for themselves and, although there is, of course, room for improvement in the out-of-hours service, as there is in other parts of our healthcare system, I want to recognise the hard work of all the staff involved to make it what it is today.

That is in contrast to the latest ask of the new UK Government health secretary, Thérèse Coffey, by the Doctors Association UK. DAUK is asking for urgent action to address GP retention, as it is predicting that 16 million people in the UK could lose access to a GP within a decade.

In closing, again I welcome the debate and the opportunity to speak highly about Scotland’s out-of-hours sector.

17:23  

I thank Alexander Stewart for securing this members’ business debate on out-of-hours GP services. It helps to bring into focus how pivotal those services are in delivering primary care when GP surgeries are closed during evenings, weekends, festive periods and public holidays. That can be as much as 70 per cent of the week, which is a reminder that general practice services are available not just between 8 am and 6.30 pm, but 24/7.

It is important to emphasise at the outset that out-of-hours GP services deal with nearly 1 million patient consultations each year. Those patients include people with long-term conditions, palliative care needs and mental health problems. For parents with babies and young children and for over-75s, the service is especially invaluable, as it is for those in rural areas.

In many parts of Scotland, the service is also desperately overstretched. Even before the pandemic, the chair of the British Medical Association’s Scottish GP committee argued that

“the root cause of this is simply the fact that there are not enough GPs working in Scotland—and those who are, face such demanding workloads that adding out of hours is just a step too far.”

That is an all-too-familiar theme. In 2015, the independent review of primary care out-of-hours services stated that

“serious GP shortages were compromising the sustainability of OOH services, which remain fragile and may worsen without resolute and urgent action.”

Time and again, the Scottish Government has been warned about NHS workforce planning, by political parties and, more importantly, by the people who matter on the front line. Kemnay medical group in Aberdeenshire has lost four GPs. In the Kemnay community newsletter, staff from the surgery described

“a creaking system where the pressures on clinicians have continued to grow, the demand for our time has rocketed and political promises of help have failed to materialise”.

They added that the national GP shortage is felt across Scotland but particularly in the north-east.

Does Tess White agree that the ScotGEM—Scottish graduate entry medicine—programme, which is focusing on rural recruitment for GPs and is unique to Scotland, is helping us to get rural GPs?

Yesterday, in the Health, Social Care and Sport Committee, we heard evidence that it is a step in the right direction but is really only scratching the surface. It is still not good enough—we cannot get enough GPs.

For example, Brechin medical practice is surviving with two GPs and regular locums, at significant cost; Inverbervie medical practice is struggling to meet demand; and some surgeries have not survived at all. I recently raised with the cabinet secretary the example of Friockheim health centre in Angus. The GP surgery achieved a 95.46 per cent positive score in the latest health and care experience survey, which was the highest across Tayside, yet it closed in May this year, displacing more than 3,000 patients. What was the reason for the closure? NHS Tayside wrote to patients to say:

“the main issue that is facing primary care and GP services is that there are not enough GPs.”

People in the north-east and across Scotland are paying the price for years of poor workforce planning by the Scottish National Party Government. Now, the Government is playing catch-up, pledging 800 more GPs by 2027 in various phases, but it is abundantly clear that the NHS needs more GPs now to fill existing vacancies and to cope with increasing workload demands. The health secretary says that he is working relentlessly on the issue but, frankly, we are tired of his relentless excuses.

17:27  

I thank Alexander Stewart for bringing the debate to the chamber. It is right that we recognise the vital contribution that out-of-hours GP services make to healthcare provision across Scotland. It is also right that we stress how important it is for all regions of NHS Scotland, supported by the Scottish Government, to ensure that out-of-hours GP services not only continue to operate but continue to provide the highest levels of care. If members are absolutely honest and if they look at their inboxes, they will know that constituents are telling us that there is strain on GP services and GP out-of-hours services.

However, it is important to note the excellent work of our NHS staff in hospitals, primary care settings and the community. The work that they do always goes above and beyond expectation, particularly in recent times when people have needed that bit of extra help. As mentioned in the motion, the contribution of healthcare professionals, support staff, drivers and others must not be understated.

Primary care out-of-hours services are now embedded as a fundamental part of our healthcare provision in Scotland. Many of us remember our local GPs providing 24-hour cover. A variety of models were used but, for people like me who lived in a rural area, their own GP or GP practice staff attended if they called out a GP overnight. Of course, since then, there has been a wide variety of changes, with out-of-hours services coming under the control of the health boards in 2004. As we have heard from other members, that was in large part because of the increasing demand for services out of hours, with which the traditional models of provision could not cope.

However, it is important that we learn from the past. In my region, in Mauchline and Catrine, where I live, GP services such as Ballochmyle medical practice face significant challenges. A number of residents have contacted me who are waiting significant lengths of time for an appointment, who face challenges with the administration of prescriptions and lengthy telephone queues when they phone up, or who cannot get an appointment with a GP. Residents are finding it difficult to balance their lives with getting a GP appointment.

The pressure on day-to-day GP services is severe. Despite the best efforts of our workforce, they clearly need to be more supported. We must ensure that that pressure does not spill over further into out-of-hours services, on which there is now a significant reliance to get some treatments. I repeat that we cannot forget the lessons of the past. We must ensure that there are sufficient resources to meet demand and that patients can access high-quality care in GP and out-of-hours GP services.

In the short time that I have left, I will focus on the work and commitment of all the staff groups that are under enormous pressure, which cannot be overstated. During the summer, I visited a number of services and staff groups across my South Scotland region who work in a variety of settings in the NHS. It is not an exaggeration to say that NHS staff across the board, from nursing staff, porters, caterers and cleaners to those working in GP practices, are exhausted and demoralised and feel undervalued by the current Government and the structures that are in place. Staff need a proper plan for pay, recruitment and wellbeing provision, and that includes those working in out-of-hours services. If the Government truly values our NHS and NHS staff, it will act.

In conclusion, I once again thank all those who contribute to the delivery of our out-of-hours GP services in my region of South Scotland and beyond. The work that they do is invaluable to ensure that people’s medical needs are met in hours when others are perhaps not at work. I thank the member for bringing the debate to the chamber.

17:32  

I thank my colleague Alexander Stewart for bringing this crucial and timely debate to the chamber.

It would be easy for me to take this opportunity to have a pop at the cabinet secretary and the Scottish Government and then just sit down. However, this crisis goes beyond politicking and point scoring. I will highlight what is happening at the coalface, which will not be easy listening for the cabinet secretary because I am sure that he is fully aware of the acute nature of the challenges that the health service faces and, therefore, he faces.

The level of GP services across Scotland is not uniform. In my area, I have reports of good levels of GP access in Troon, for example, but I am extremely worried about people’s inability to see a GP in parts of South Lanarkshire. I know of people attempting to see a GP at certain practices who, after calling to make an appointment and being asked the nature of the issue, are told that a doctor will call them back, only to get a text later saying that they are seeing only emergency cases. I also know of a constituent who has been attempting to access a blood test for more than three months because of a persistent worrying symptom but who has yet to speak to a healthcare professional.

There is a chronic lack of GPs in certain areas, which, of course, has a huge knock-on effect for the out-of-hours GP service. If GPs cannot cover daytime surgeries, how can they be expected to deliver an effective out-of-hours service? Furthermore, the private sector is reporting that its waiting lists are growing ever longer, which is a symptom of those turning to that sector because of a lack of access to NHS services. What about those who do not have that route open to them, especially post-Covid, which has led to an inevitable backlog in non-Covid-related conditions such as cancers, elective surgery, dementia and so on? It is no wonder that A&E departments are under such pressure as the last resort to access healthcare.

This morning, I listened to the cabinet secretary on the radio suggesting that one of the issues with A&E waiting times is that people are arriving sicker than they did before. That is a symptom of not being able to access healthcare when their conditions were less acute. It is not just that, though. When we consider that Scotland has been the unhealthiest nation in Europe for some time, with the highest levels of obesity, drug and alcohol deaths, diabetes, heart conditions, reducing life expectancy and so on, it must be a concern that, in the cabinet secretary’s own words, patients are getting even sicker.

The issues today are a symptom of policy decisions that were taken a decade or so ago. We have to accept that, given the cuts to nurse and midwife places, as well as the cap on Scottish applicants for medical school, which, of course, speaks to the shortage of GPs.

The reality is that there are no quick fixes either. There are many things that we could do to improve the situation while we look at a long-term strategy to support our NHS. That includes looking at workforce planning, which has been a recurring issue ever since I have been an MSP, improving the working environment and conditions, and helping our NHS staff to have the options of a healthier and more active lifestyle.

I have been a long-term advocate of planning to gradually move investment upstream into the more preventative agenda, thus improving the health of the nation, with all the benefits to communities and society that that would bring. That is not about saving money; it is about gradually redistributing money into other areas of healthcare as progress is made. The problem is that deploying that strategy takes much longer than a session of Parliament, which is something that Parliaments are just not good at dealing with. It is the biggest failing of this place, in my opinion. The Scottish Government has complete control over health, with the ability to do things differently and to innovate, yet our Governments have failed to do so.

The strain that GPs are under trying to deliver out-of-hours service is a symptom of that short-termism. Perhaps this is an opportunity for the cabinet secretary to look at the long-term view for once to the benefit and sustainability of our NHS.

17:36  

I will start by thanking Brian Whittle. When I bumped into him earlier today, he told me that this debate was happening. I was not due to speak as I have another event tonight. However, for every single member of this Parliament, the issue is at the heart of our inboxes, as Carol Mochan has said. It is what people come to our surgeries about and, frankly, it is something that we are all fearful about, because we and our families all rely on the NHS. I have been grateful to have care from my GP during the pandemic and in recent months, but I know many people have found it very hard to get face-to-face contact or even to get through on the phone.

I want to take the opportunity, like others have done, including Emma Harper, to thank everyone working across health and social care, including everyone in primary care, from the receptionist to the practice nurse and the GP. The NHS is a family and every part of it needs to be nurtured and looked after. We have a duty in Parliament to give people confidence and to show that we value the workforce. We certainly should not scare people or give people a sense that they will not get support from the NHS. However, we all know constituents who have had to endure long waits for ambulances and others who have waited on the phone trying—dozens and sometimes hundreds of times—to get through to out-of-hours services and NHS 24.

That is the reality. It would be good to keep it all positive, but we are living in scary times. We all do local press and use social media. The word “crisis” is perhaps overused, but I fear that what we are seeing right now in our NHS has become the new normal. We have become so desensitised to words such as “crisis” and “catastrophe” that it is hard to come to this place and feel that our words have meaning.

As someone who lives in and represents Lanarkshire, I worry that code black status is becoming the new normal for that area. We cannot allow that to happen. The cabinet secretary knows that I will work with him and his team and colleagues from all parties. Frankly, I do not care what party people belong to—the issue is bigger than any party, logo or soundbite, because the reality is that many of us fear getting ill. Many of my constituents cannot afford to go private and bypass the NHS. We have to fix things.

There are immediate things that we can do and there are longer-term things. We must show our constituents and the wider public in Scotland that we have a plan.

Does the member agree that the new triage models that GPs are introducing, which include the use of advanced nurse practitioners, for example, are stabilising daytime services in a GP practice and go some way to reducing the pressures on out-of-hours services? A GP in my constituency highlighted that to me recently.

Absolutely. It is important to hear about good practice and what is working well. However, when I listen to my constituents and people in my family who work in the NHS, it is clear that staff do not have time to go for a pee, never mind go to do extra training. There are people who want to advance and stay in our NHS, but they do not feel valued and they feel burned out. Although we have heard about additional recruitment and finding new people, we are losing people. We are not retaining the talent and the good people that we already have. I think that we all share those concerns.

I will finish by reminding the cabinet secretary that I emailed him again recently about the code black status in Lanarkshire in which I made an offer, on behalf of my constituents, to work with him and his team. We need to pull people together. I hope that, when the cabinet secretary makes his closing speech, we will hear that a date is in his diary and that that will be shared with colleagues soon.

17:41  

I thank Alexander Stewart for bringing the debate to the chamber and I thank members for their contributions. I will try my best to get through as many of the concerns that have been raised as I can. I will start where most members did, and thank all of our GPs and all those involved in out-of-hours GP services right across the country—GPs, receptionists, allied health professionals and all the people who make up the multidisciplinary teams up and down the country.

I am pleased that Monica Lennon mentioned receptionists, because we know that they have had a particularly tough time in GP practices. That is why we ran the GP receptionist campaign. Receptionists are not gatekeepers trying to keep people away from their GPs; they are asking questions to direct people to the right places. I know that can be a really difficult job and receptionists have done it fantastically well.

I will address the specific issues that Alexander Stewart raised about NHS Forth Valley in a second, but first I will pick up on some of the more general comments.

Emma Harper was absolutely right to put some context around this debate on out-of-hours GP services. There has been a transformation in out-of-hours services, as described by Dr Buist in his excellent blog, which is worth a read. That is not to say that we should sit on our hands and say that everything is rosy—I am not suggesting that. People in this chamber know me well enough and have heard me say publicly enough times, whether this morning on the radio or in this chamber on many occasions, that I completely understand the level and depth of the significant challenge that our NHS in its broadest possible sense—and indeed social care—is currently under. Nobody in the Government—neither me nor the First Minister, in the many conversations that I have with her about the NHS—are under any illusion that somehow things are all rosy in the park. We know that there are significant challenges, including in out-of-hours services. That context is important.

I will turn to the specific points that Alexander Stewart asked about. I will be absolutely candid and up front: the out-of-hours service provided in Forth Valley is not good enough, and that is why, at the Forth Valley chief executive officer’s invitation, Sir Lewis Ritchie—who is an expert on out-of-hours services—has been asked to review that service. The review is due to start early next month—on, I think, 5 October—and I will be pleased to furnish Alexander Stewart with more detail in writing once that review begins to kick in. I know Sir Lewis Ritchie well, and his approach with elected members has always been a very open one. I am sure that he would be happy to furnish Alexander Stewart with details of that review.

On action that has been taken, Forth Valley has an improvement plan in place, and we are monitoring all those actions very closely. It has recruited a GP to the out-of-hours service and an additional two GPs to the staff bank who will support the out-of-hours service. They are not site specific and will work across three sites in Forth Valley. It also has a GP on call to support the service.

However, it is important to note that the issue is not just about the GPs. It is clearly an out-of-hours service, so Forth Valley has recruited an advanced nurse practitioner and is looking to recruit another ANP. It is also working with the Scottish Ambulance Service, which now provides a paramedic to support the out-of-hours service on Saturdays and Sundays. Paramedic support for home visits in Forth Valley is working with SAS on advanced paramedic practitioner appointments. Lastly on the Forth Valley improvement plan, I note that from 3 October—just under a fortnight’s time—a pool of drivers will be available to take patients to the out-of-hours service, most notably to support people from socially deprived areas who have no transport.

I hope that that gives a flavour of what is happening and at least some level of comfort and reassurance that nobody is sitting back and accepting the position in Forth Valley. Action is being taken. I am happy to talk offline to Mr Stewart about more detail of what is happening in Forth Valley, if he wishes.

On GPs more generally, nobody will get an argument from me when they talk about the issues of access to primary care that they are hearing from their constituents. I get that from constituents, family members and friends of mine. I know that access was an issue particularly when we were in the grip of the very difficult phases of the pandemic, when infection prevention control was at its highest and, therefore, there were real challenges in accessing GPs.

There are still challenges, and I raised this issue this morning when I met Dr Kennedy, the new chair of the BMA. We will have a broader meeting with more of his council members at a later date. He absolutely accepted that we will work collaboratively to increase, where clinically appropriate, more face-to-face services, although I think that we all agree that that should be part of a hybrid model. We should retain video consultation and phone consultation for those who want it. I prefer to use a phone consultation and have used it the past couple of times when I have been in contact with my GP. It means less inconvenience for me and less disruption to my day. However, that does not suit everybody, by any stretch of the imagination, so face-to-face appointments are very important indeed.

In response to a question from Kenneth Gibson a couple of weeks ago, I made the point that there is more work to be done with GP practices on pre-bookable appointments, which could make a significant difference. I note that the Secretary of State for Health and Social Care in England said something similar, so the problems are shared right across the United Kingdom.

On Scotland’s own record on GPs, I would not disagree that we need more. That is why we have the 800 recruitment target, but we are not waiting until 2027 for that 800. We are now recruiting, and we have recruited 277 GPs.

I think that the cabinet secretary knows that in the previous parliamentary session, I had the health portfolio and was on the Health and Sport Committee. Back then, we were 860-odd GPs short, and the previous cabinet secretary came up with the target to recruit 800 new GPs within the next decade. Audit Scotland said then that that did not take into account those who would retire, and that after those 10 years we would still be more than 650 GPs short. I suggest that that is going to be worse now, so perhaps it is time to reflect on that plan and look at it again.

Brian Whittle makes a good point, and I thought that his contribution was very good. The issue is not just about recruitment; it is about retention, which a couple of members referenced. There is no point recruiting 800 into a leaky bucket and losing people at the other end. A lot of my conversation with Dr Kennedy this morning was about retention. I will say more in the coming couple of weeks, when I have a ministerial statement due, on retention in particular and what we can do to support retention of GPs. Scotland does comparatively well: we have 95 GPs per 100,000 people, in comparison to 78 in England, 80 in Wales and 75 in Northern Ireland.

I am aware that I am over time. I will end by responding to Carol Mochan’s very important points about pay, staff burnout and wellbeing. Those things are of the highest priority. I am getting around the table with trade unions and I want to give a fair settlement—one that is affordable within our health budget, as of course it has to be—but I accept that their members have rejected our 5 per cent offer, so it is incumbent on us to come forward with an improved offer. Wellbeing is very high up on our agenda.

On Monica Lennon’s point—I promise that I will end on this, Presiding Officer—multidisciplinary teams are very important, and we have recruited more than 3,000 staff since 2018 into multidisciplinary teams. Code black can never be the new normal and I will not allow it to be the new normal. Therefore, the exit plan for Lanarkshire out of code black is exceptionally important. I ask Ms Lennon to forgive me if a date has not been given to her. There has obviously been a disruption because of recent events, but I would expect that meeting to take place and a date to be sent to her and other Lanarkshire MSPs very soon. I know that she wants to work collaboratively on the matter.

I will end by thanking our GPs and all the staff involved in GP out-of-hours services for the phenomenal work that they do and the lives that they save. They have not only this Government’s full attention but our appreciation.

Meeting closed at 17:50.