Chamber and committees

I have previously raised in the chamber the pressure that is being put on out-of-hours GP services. Is the cabinet secretary concerned that people who are faced with long waits at A and E or for ambulances might turn to out-of-hours general practice, putting further strain on a service that is already under extreme pressure? What impact does the cabinet secretary think that the increased demand for out-of-hours and emergency services will have on out-of-hours GPs? Will a similar package of support be put in place for out-of-hours practitioners and services?

On a point of order, Presiding Officer. My app looks like it has crashed and I would have voted yes.

For those who find themselves needing further treatment, that could be a traumatising event. What other, wider support, such as mental health support, is available for those who need it?

I, too, pay tribute to Scotland’s incredible GPs, who have worked in extremely pressured and fast-changing conditions during the pandemic. The contribution of all practice staff has been immeasurable, so they deserve our sincere thanks.

They do not deserve the suggestions that general practice has been closed during the pandemic and that GPs have not been offering face-to-face appointments. I am seriously concerned about the tone of the Conservative motion in that respect. GPs have continued to deliver a 24/7 service, including out of hours services, and have always offered face-to-face appointments when they have been clinically necessary.

As the Government amendment notes, GPs

“were asked to change the way that they worked”

due to Covid and they rose to that challenge. They rapidly adapted their ways of working while also stepping in to help with vaccine roll-out and staffing at Covid assessment centres.

There were GP workforce shortages prior to the pandemic and, as we know, demand for GP services has risen considerably in recent months. People are now coming forward with conditions that emerged during lockdown and GPs are caring for patients who are on long waiting lists for secondary care. Contrary to what some people might think, remote working does not reduce people’s workload. Practice staff are tired, overstretched and demoralised, so I am seriously concerned about the impact of the debate on their morale.

We cannot afford to undermine GP recruitment and retention, but the Conservative motion has the potential to do just that. Instead of demanding that GPs return to doing something that they have been doing throughout the pandemic, we should be talking about how we can recruit more GPs and other members of the primary care team, and how we can best support practice teams’ mental and physical wellbeing in order that they can continue to deliver excellent patient care in difficult circumstances.

In recent months, there have been a number of serious incidents at Polmont young offenders institution, including a riot and an inmate being scalded. How is the Scottish Government working with the Scottish Prison Service to ensure the safety and wellbeing of young people in Polmont?

I absolutely accept that, and I thank Emma Harper for that intervention.

Of course, patients should be able to get a GP appointment when they need one, and that appointment should be face to face if that is clinically appropriate. No one is denying that. Remote consultations are not appropriate in all circumstances, which is recognised by GPs. However, for many patients, they offer more flexibility and reduce the need to travel.

According to the BMA, before the pandemic approximately 20 per cent of GP appointments were by telephone or video, so the presumption that a return to normal equates to a return to all appointments being face to face does not reflect the reality of general practice before Covid. There should not be a one-size-fits-all approach, and the Royal College of General Practitioners Scotland is clear that a mix of telephone, face-to-face and virtual appointments is the future of general practice.

We must also acknowledge that, due to on-going Covid protections, the physical capacity within general practices is limited. If we rapidly increase face-to-face appointments, patients could face longer waits for appointments due to reduced numbers of people being able to enter the building.

Patient safety is a serious consideration. For example, Asthma UK and the British Lung Foundation in Scotland do not support setting a target date for a return to majority face-to-face appointments because of the on-going risk from Covid-19 to people who are living with lung conditions. They have said that being worried about mixing with others in waiting rooms could force people to miss out on treatment.

I will end with a quote from a GP that has been provided by the BMA, which I think sums up why I have such serious concerns about the motion. The GP said that they have had a

“barrage of negativity from policy makers and smears from the media. General practice has been open all throughout the pandemic and yes, we are seeing patients face to face every day—examining, investigating, immunising, and treating.”

GPs deserve better and so do patients. They need us to be honest about the pressure that general practice is under and about why services are being delivered as they are. I hope that members will reflect on that at decision time.

To ask the Scottish Government how it supports vulnerable people in the prison system. (S6O-00134)

I have a quick question this time. People who use drugs may be subject to multiple stigmas, not just that related to their drug use. That can include stigma relating to homelessness, mental health and, for some, HIV status. How will the Government ensure that the multiple stigmas are tackled within systems used by people who use drugs, and not just in relation to their drug use and the stigma surrounding it?

I want to pick up on an earlier point about access to rehab. There was a greater discussion about how residential rehab interacts with the rest of the mix of treatment options, but many people might be afraid of losing their tenancy if they enter rehab or they might have caring responsibilities, as the convener pointed out earlier. Some people have unplanned discharges from treatment, and there is the matter of the police and hopefully the wider public carrying naloxone.

You have touched on the issue slightly, but how do you see integration across various areas of Government, in relation to supporting people in their tenancies or encouraging more people to take up carrying naloxone? That could be used to support those people who find themselves in a period of homelessness in particular, as many people with drug and alcohol addiction do.

People who leave residential rehabilitation are at increased risk of overdoses, because the period of abstinence lowers their tolerance to drugs. It is important that we recognise that people do not leave rehab cured and that they often need on-going treatment and support. How will the Government ensure that residential rehab services are well integrated with other health and care services and that follow-up support is provided to those who leave rehab?