Chamber and committees

The national treatment centre in your area of Fife is helping to deliver on-going improvements in the delivery of orthopaedic and ophthalmology services, which will help to reduce the waits. I do not know the exact data for Fife, but I know that the Highland NTC is ahead of schedule with its programme, which is helping to reduce waits for patients in that health board area and will support NHS Grampian, too, because its patients will go to Highland NTC as well. Once we bring on phase 2, the NTCs at the NHS Golden Jubilee and at the Forth Valley hospital will give us additional capacity, which will help to reduce waiting times in those individual board areas. However, that work is taking place in the wider context of the increase in demand that we are facing.

On the impact that NTCs will have on unscheduled care, one of the challenges that one always has is that acute priorities can often displace elective work. The benefit of having NTCs is that they are a protected environment and are for elective purposes, which gives greater certainty around the amount of elective work that can be taken forward, as it can otherwise be buffeted around in the general setting of acute priorities, where unscheduled work is having to take priority over elective procedures for clinical reasons. The NTC environment gives us a level of protection in the system, which will assist boards much more effectively with their planning not just over months but over a whole year.

NHS Education for Scotland will take forward work on the centre, which was announced last week. Given some of the specific challenges that we have in rural areas around the delivery and sustainability of primary care, as Tess White talked about this morning, the first two years of the programme will focus on primary care, which will be the centre’s initial priority. The centre will start that work as of October.

Is this in relation to people with long Covid not having access to—

Do you mean for long Covid?

We are on a path to understanding long Covid much more effectively. You might be aware that quite a bit of global research is taking place to understand the impact of long Covid and the most appropriate treatments for it.

My understanding is that, as it stands, no single treatment type is appropriate for long Covid patients. We often have to try to provide a holistic form of treatment. For example, the service that is being offered in Glasgow—the long Covid pathway—has a range of different clinical inputs, from physiotherapy, through occupational therapy to psychological services. All of those are about trying to address some of the issues that can present with patients who experience long Covid.

It is fair to say that we are in a learning environment on how we treat long Covid. From some of the patients with long Covid whom I have met, I know that its presentation is variable and they often have different needs. That is why some of our NHS boards look to provide services much more holistically with a range of different supports that can be provided to patients and to tailor those to best reflect patients’ circumstances.

We are all learning more about long Covid. That will continue to influence how we intend to deliver services for patients with long Covid in the future.

I am not familiar with the amendments that you are referring to, but I am more than happy to have a look at them and to consider how they will work in relation to safe staffing levels.

Do you want to say something about that, Ms Minto?

Going back to my earlier point, I make it clear that the clinical advice not just at a Scottish and UK levels but at the global level is that Covid-19 should now be managed as a seasonal infection and in the way that we manage other seasonal infections such as flu, because the level of vaccinations that have now been provided to the population gives us much greater protection. Our intention is to continue to manage Covid-19 on that basis.

If the clinical advice changes at some point and we have to take further action, we will respond to that. However, the present advice is that we should continue to manage things as we are managing them and in the way that we manage other seasonal infections.

The majority of health boards have those pathways in place now. Those that do not are carrying out the work at the moment and I would expect those pathways to be in place this year. The funding has been made available for them this year as part of the £10 million programme so there is no reason for the boards not to achieve that. We will continue to monitor their progress.

First, I will just correct you. We are not struggling to find 800 GPs—we are ahead of the trajectory to recruit that number. Also, in relation to recruiting to GP specialty training, this year, we not only reached 100 per cent but even more applied for the training than the spaces that were available.

We are in a strong position to deliver on our commitment to recruit 800 GPs during this parliamentary session and to increase the number of GPs in training. I note that, this year, all specialty options were taken.

In addition, we have been expanding medical training places. We have made a commitment to increase the number of medical students in Scottish medical schools by 500. This year, we have increased that by 300 places and we are on target to increase places by another 200. Believe it or not, the BMA has asked us to slow down a bit, to make sure that there is capacity in the system to train those medical students.

We face challenges in relation to our medical workforce—I would not want to give people the impression that we do not—but it would be wrong to give the impression that we are struggling, because we have been able to recruit to the places that have been made available for general practice and for the training programmes.

However, we must continue to do more, because general practice is under huge pressure. A big part of that is not just the GP workforce but the multidisciplinary team that we have in primary care. A key part of what we must do in primary care is to ensure that we have a broad range of healthcare professionals that can meet patients’ needs and can meet the increasing demands that primary care will face. Having that combination will be key to ensuring that we meet those demands as best we can.

I will deal with those issues in turn. There are challenges in rural general practice—there have been for many years, particularly in single-handed practices. When GPs in such practices choose to leave or to retire, it can be difficult to recruit replacements. That can be for a variety of different reasons, but I agree and accept that there is a challenge in some parts of rural Scotland.

On what we are doing to address some of those issues, first, we have the Scottish graduate entry medicine—ScotGEM—programme, which is about recruiting and encouraging doctors to work in our rural environments. We also have the bursary programme—I wrongly called it the “golden hello”, but that is not what it is—which is, again, about supporting individuals, who may be GPs, to work in rural areas by giving them financial support, or a financial incentive, as part of the programme. The third thing that we are doing is—as the committee will be aware—setting up the centre for remote and rural healthcare, which is a programme designed to consider specifically how we can create and deliver greater resilience, in particular in primary care, to deal with the systemic challenges that we have in recruiting people into our rural areas. That combination of programmes to retain and support people in rural settings, and the creation of those financial incentives, is all aimed at supporting getting people into general practice in our remote and rural areas.

On the point around the number of practices that are now in the NHS, that has happened historically. Over the years, some people give up their contract, which is taken over by the NHS. That happens in urban as well as in rural areas.

Yesterday I had a meeting with the health and social care partnership in Grampian and the chairs of the integration joint boards, so I know that they are taking forward a programme of work to look at creating a much more sustainable approach to the delivery of primary care within the NHS Grampian area, and that they have a plan to deal with some of the very specific issues that they are experiencing within the NHS Grampian area. They expect to have that programme of work completed by the end of this year. I have explained to them that I want them to look at how they can work in an innovative way using the existing system to deal with some of the particular challenges that they have in their area.