Chamber and committees

I, too, thought that Jeff Ace gave a good answer, but my question is to Dr Coldwells.

NHS Grampian has record staffing numbers, but there is a shortage of staff to keep the community hospitals open. A recent example is Aboyne hospital. What is going wrong, and what can NHS Grampian do to improve the current situation? We know that, in rural areas, there are issues with falls, which will create further pressure on local units.

The retention rates are a serious issue, so can you talk about that, briefly?

I want to touch on the issues of vacancies and retention rates. Nursing vacancies, for example, are up 25 per cent on last year, and there seems to be an issue with students at the front end. Retention also seems to be a serious issue, with 15,000 NHS workers leaving the service in the year to March 2022, which is the highest figure for a decade. So, there is an issue with the inflow and an issue with the students but there are also poor retention rates. Can you comment on that?

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.

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.

I have a follow-up question. We can look backwards, but I want to look forwards. What levers can we pull to change the situation?

Thank you.

It is almost as if the balance is between whether to put the wheels on the bus, because the bus is not moving, or to decide, strategically, where the bus is going. Have I heard that correctly?

I declare that I am a fellow of the Chartered Institute of Personnel and Development. I always look at things through that lens before thinking about politics.

My question is for Professor Bell first. I have two points. There is a 0.6 per cent planned increase in NHS spending. There are huge pressures on the NHS, but we are talking about a small increase. We have statistics that show that only 63.5 per cent of patients are being seen within four hours. That is the lowest percentage ever recorded. You made the point that it is not possible to deliver any form of workforce plan if there is very short-term planning of not more than a year. I know that you have looked at labour economics. The issue seems to be more than money: there is an inability to plan the workforce.

My question, which is around conflicting priorities and balancing outcomes, is for the whole panel, but I will start with Professor Bell. There are increased labour and drug costs, and capital costs, but there is also an immediate need to reduce waiting times and improve treatment times. How do you balance those immediate needs and outcomes with the longer-term outcomes?