Chamber and committees

I agree. I wonder whether that is the same person from Aberdeenshire whom I met—I will not say their name. I heard about a very similar experience from a young person in Aberdeenshire who felt that their GP was dismissive. I have heard that experience from people not just in Aberdeenshire but in many other parts of the country.

That is why not only the National Institute for Health and Care Excellence guideline but the implementation support note, on which we can give the committee further detail in writing through the convener, if it wants that, give a level of detail on the referral pathways that are available, and why we have put so much work, through the strategic network, into the education tools that are available for GPs.

I highlight the written evidence that the Royal College of General Practitioners gave to the committee, in which it stated that it believes that primary care and GPs are the first port of call and are “best placed” to give a holistic assessment before onward referral. I agree with it.

I would be more than happy to provide more detail on that in writing, but that is why so much work has gone into assisting our GP colleagues, who are facing a number of challenges from the pandemic around where those referral pathways are.

We have the implementation support note and an education strategy to raise awareness of long Covid. NHS Education for Scotland also has its learning platform, and I suspect that members will know that it contains a video and webinar content on long Covid. There is a lot in that space, and we are working closely with our primary care and GP colleagues to make sure that they know about the pathways that are available.

No. The money was distributed before the letter was sent to you.

That is not quite what I said.

We would have to do a further assessment of long Covid services to answer that, but I accept entirely the premise that you cannot reprofile money from one area to another without that having an impact, particularly given that I had to reprofile £400 million of funding within the health and social care budget. That clearly had an impact, and it would be foolish, and I would be insulting your intelligence and the intelligence of other people listening and watching, if I said that that was not the case. I know that Jackie Baillie understands that those decisions were made because our budget was so badly impacted by peak inflation. At that point, that made the health and social care budget worth about £1.2 billion less.

We also wanted to ensure that we gave a fair pay deal to our NHS workers. I know that Jackie Baillie fully supports that. To do that, we had to reprofile. That is why I was very keen to ensure that, when we set the budget for 2023-24, we put that money back into primary care. However, it is absolutely the case that, when we reprofile that amount of money, although we try to do it in a way that has a minimal impact, it will, of course, have an impact.

That is exactly why the strategic network is so important—it has those dedicated workstreams and brings them all together at the national level. Where we are trying to improve services for adults and children, we make sure that there are no gaps between services for young people who are in that transitionary phase. As you would imagine, that issue presents itself in many other parts of the health and social care system, but it has not been raised with me specifically in relation to long Covid. However, I am happy to take that issue up with Long Covid Scotland and Long Covid Kids.

That is such a good question. I have been engaging with the British Medical Association and the RCGP on that issue for quite some time. As Brian Whittle will know, before the pandemic, many GP practices would traditionally close on Friday afternoons and would have an agreement with NHS 24 that it would pick up any calls or inquiries that came in after that. That approach gave practices the flexibility to do CPD and it meant that their patients had the confidence of knowing that their calls would be picked up by someone else.

In the course of the pandemic, practices were not able to do that. I suspect that I do not need to tell Mr Whittle how much pressure NHS 24 is still under, so we have to find another model. We are working on that with the BMA and the RCGP. For me, practitioners having protected learning time for CPD is absolutely pivotal. It is important for all of them, but it is especially important in giving our trainee doctors the confidence to progress in their roles as general practitioners. We are working on that.

At the moment, because of the pressure that NHS 24 is under, practices are approaching matters in a way that suits them, as opposed to using the previous model, which involved NHS 24. For example, in a practice that I visited, which is not far from the Parliament, GPs are having to use half an hour in the morning to go through their educational or CPD material, which is not ideal. I give my commitment to the RCGP and the BMA to see what more we can do to support them in that regard.

That is a fair question to ask. Of course I would look to see where we can provide even more support. I make the point, which I know is well understood by colleagues around the table, that the long Covid fund is on top of the £18 billion in this financial year and £19 billion in the next financial year that we are giving to the NHS and social care, a chunk of which is given to our health boards. It is worth saying that our front-line spend per head is higher in Scotland than it is in other parts of the UK. It is £323 per person higher than it is in England, for example.

I keep going back to the Lanarkshire model because I have seen it first hand, and I have spoken to some people who have benefited from that service. When that rehabilitation service was up and running, people did not wait for the allocation from the £10 million long Covid fund; they used their health board allocation to create that team—to recruit and hire those multidisciplinary team members who are providing that support to long Covid sufferers. I hope that that gives you some reassurance.

Agreed.

We have looked at other long Covid clinic models around the UK, such as the Hertfordshire model, which Dr Sandesh Gulhane has mentioned previously. I go back to the Scottish intercollegiate guidelines network and NICE guidelines on long Covid, which say that one model would not fit all areas. I think that we all accept that.

I agree strongly with the RCGP’s written evidence to the committee on that. I will quote it directly. It says that long Covid

“often requires generalists skills to treat, but most can be fully managed in primary care, and the GP is best placed to provide this holistic approach.”

It goes on to say:

“there is an increased risk that patients presenting with Long Covid symptoms may have instead another cardiac or respiratory condition which may have similar or even identical symptoms. Patients need a GP assessment and investigation”—

this is the important part—

“rather than being funnelled inappropriately into a clinic that is designed for one condition, and then require further investigation and alternative management.”

I have never been opposed in principle to long Covid clinics—I have said that from day 1. That is why I have asked my team to look at the Hertfordshire model, for example. In effect, they try to cut out the middle person. We have GPs and, if they have the appropriate referral pathways through the implementation support note that take people directly to a Covid rehabilitation service in, for example, Lanarkshire—that is the example that I keep using—that is a better model than a GP having to refer someone to a long Covid clinic that would then have to refer them on to another pathway. I am not opposed to long Covid clinics in principle; I am trying to allow local health boards to design services to meet their local need.

It will be reprofiled over the next few years.