Chamber and committees

It is unfortunate that it spent that money and did not get the contracts.

Did anyone in the Scottish Government advise ministers to directly award any of those contracts? For example, presumably it would have been in the interests of the yard to be given the small vessel replacement programme work. Did SCAD offer any advice to ministers about whether they should directly award that work and, if so, what was the ministers’ response?

Is that not strange, though? Would SCAD not want the yard to get work? Did you not make representations either to CMAL or to the transport division of the Scottish Government?

You talk about continuity and stability, but the yard is on its fourth chief executive since it was nationalised; that is not exactly stability.

I have a lot of ground to cover, so I will try to rattle through it. I am sorry if I revisit earlier subjects—that is just the nature of questions.

I have some unanswered questions on Ferguson Marine. Has anyone in the Scottish Government, particularly in your divisions, asked Ferguson Marine what exactly it needs £35 million for?

One thing that we have not gone into great detail on is satisfaction. You talked earlier about the health and care experience survey for 2023-24, which is detailed in exhibit 5. I found that to be one of the more shocking graphs in your report. Every single metric on which people were questioned in 2017-18 and again six years later—with the same set of questions—saw a decline in satisfaction, and some of those declines were quite stark. The starkest decline was in people’s overall rating of their care experience as good or excellent. It was at 69 per cent in 2023-24, having gone down by 14 percentage points in just six years. Two thirds of people believe that they are getting a good service, but the other third do not. That is pretty shocking.

Did anything that came out of that survey jump out at you as being an area of concern?

I will ask a question that may be more controversial. Do you think that there should be a top-down complete change to the system—in other words, to the GMS contract? BMA Scotland and those who represent GP practitioners believe that GPs are not getting paid enough for the work that they do. Their workload is increasing and they are having to take on ever more patients. On the other side of the phone, patient satisfaction is decreasing, and the public are not happy with the output. Is the whole system broken? Is the private practice model actually working in Scotland?

Is that good or bad, though? Is it a consolidation—is it better to have fewer, bigger practices? It is quite hard to tell what that number means. On the face of it, it looks like it is poor, because it means that there are fewer practices, and therefore there is much less local access to a GP.

We have talked about data and the lack of it, but there are things that we know and that have been made clear to us. I would like to look at two pieces of data: one is the ratio of GPs to population and the other is the number of GP practices in Scotland.

Please correct me if I am wrong, but my understanding is that the number of practices has fallen considerably over the past 10 years. On the patient per whole-time equivalent GP ratio—perhaps we can clarify for the benefit of people watching that that ratio is different from the GP head count; it is the number of patients that a GP has on average—the Scottish Government often claims that WTE GP to patient ratio is smaller in Scotland than elsewhere and that therefore people have easier access to a GP in Scotland than in other parts of the UK. However, your analysis seems to suggest that the WTE GP to patient ratio has decreased over many years, by some margin. It used to be 1,515 patients per WTE GP and it is now 1,735 patients per WTE GP. It is no wonder that people cannot get an appointment at 8 o’clock to see their GP; far more people are registered with GPs.

We do not have a huge amount of time left to consider this issue, but I have a final question on the fact that there is no specific target or commitment to increase the number of GP nurses. We are looking at a multidisciplinary team-type model or one in which primary care can be provided by nurses rather than GPs to ensure that it is easier and quicker for people to get an appointment, and there are some good examples of where that is working well. That requires an increase in the number of GP nurses, but my understanding is that the number has decreased in recent years. I think that your report says that it has flatlined, but I will check that. In any case, there is no clear target to increase the number.

If we cannot increase GP numbers by 800—the Royal College of General Practitioners and the British Medical Association say that there should be an increase of 1,500, but we are going in the wrong direction—that is a worry, and the lack of an increase in GP nurse numbers is another worry. Who on earth will deliver for all the increased demand?

A good example of that is the ScotGEM project to try to recruit rural GPs—that was when the Government had a strategy. I read a news report about that recently. In one year, there were 52 graduates, of whom only 10 went on to become GPs, and only two of those went to the north of Scotland to fulfil GP vacancies in rural areas. That is a drop in the ocean compared with what is required in rural and island communities, where there are generally huge issues in recruiting, retaining and attracting GPs. Despite the incentives to get GPs into rural areas—such as golden handshakes, fast-track schemes and specialist four-year programmes with specific rural medical training—we still cannot fill those gaps, as a result of which those regional inequalities are surely exacerbated.