Chamber and committees

Does Tess White agree that the ScotGEM—Scottish graduate entry medicine—programme, which is focusing on rural recruitment for GPs and is unique to Scotland, is helping us to get rural GPs?

I welcome the opportunity to speak in the debate and thank my colleague Alexander Stewart for securing it. I supported the motion as it was quite positive, which is different from what we have just heard in the contribution. I want to start by paying tribute to all of Scotland’s GPs as well as their staff, the advanced nurse practitioners, NHS 24 call handlers and drivers. As Mr Stewart’s motion mentions, their work is crucial.

The primary care out-of-hours services are a fundamental part of our healthcare in Scotland and the service provides support to those who require medical assistance outwith normal GP surgery hours. Out-of-hours involves a number of agencies and healthcare professionals working together to provide an integrated service for patients. The quality and safety of out-of-hours care is extremely important and I agree that patients should have access to consistent, high-quality standards of care across the country.

The picture with out-of-hours care in Scotland is a comparatively good one compared to other United Kingdom nations. Each year across Scotland, about 870,000 patients use out-of-hours primary care services, resulting in just under a million consultations. Home visits account for one in five, which is about 187,000 contacts with out-of-hours primary care services, with over half of the contacts—57 per cent—taking place in a primary care emergency centre. Children under five, women in their 20s and people aged 75 and over are the most common age groups of patients contacting out-of-hours primary care services. Treatment was completed by out-of-hours primary care services for just over half the patients who were in contact with them Only 3 per cent of contacts with the services resulted in a referral to accident and emergency or a minor injury unit, showing how out-of-hours services are helping to reduce acute hospital admissions.

Those statistics are welcome and they show the importance of out-of-hours services as a way to reduce hospital admissions. They are also an important way of providing reassurance to the public that care will be provided outwith GP hours.

Andrew Buist, the chair of the British Medical Association’s Scottish general practitioners committee, recently wrote a blog reflecting on NHS out-of-hours care in Scotland now compared with the model in 2004. In the blog, Dr Buist remarked how out-of-hours services, which previously were solely doctor based and involved doctors in long on-call hours, often driving themselves, have now been transformed into a more slick operation in which the primary care sector works together. Dr Buist said in his blog:

“When I think back to what out-of-hours was like before 2004 then what a luxury it feels like now to have a driver.”

He just sits back, having read the patient’s notes. He lets someone else worry about finding the right house, safe in the knowledge that, when he is on the call, there is someone outside waiting on him. Dr Buist continued:

“You work at your own pace alongside other GPs and nurse practitioners all picking from a pool of patients who have been triaged by NHS 24 and given an appointment time slot. The cases were all appropriate, a mixture of children, coughs, urinary symptoms, with the occasional rash, chest pain or alcohol withdrawal. Compared to daytime general practice, it was so much more straightforward. There was no shopping lists ... no paperwork.”

Dr Buist said also:

“Out of hours is part of general practice. We as GPs need to support it and not give it over to hospital care.”

Those words speak for themselves and, although there is, of course, room for improvement in the out-of-hours service, as there is in other parts of our healthcare system, I want to recognise the hard work of all the staff involved to make it what it is today.

That is in contrast to the latest ask of the new UK Government health secretary, Thérèse Coffey, by the Doctors Association UK. DAUK is asking for urgent action to address GP retention, as it is predicting that 16 million people in the UK could lose access to a GP within a decade.

In closing, again I welcome the debate and the opportunity to speak highly about Scotland’s out-of-hours sector.

Since we got our papers last week, I have been doing a bit of reading about the NHS estate and sustainability, and how the NHS can achieve net zero by 2040.

I am interested in what the panel thinks about 20 million miles per annum being saved during the pandemic through the implementation of NHS Near Me. That shows that mileage reduction can be achieved—it is a hefty figure. When calculated as CO₂ emissions saved, it is in the billions of milligrams.

Another issue relates to remote virtual clinics and using telemedicine so that, for example, blood pressure readings can be obtained remotely and then analysed by a GP, who can see the results without seeing the patient.

How do we marry up the technologies? How do we get the biggest bang for our buck in saving emissions in our NHS estate? I will go to Professor Bell first, as he is in front of me.

Yes. Thank you, convener. I am sorry to keep coming in.

Leigh Johnston mentioned that data or other information was missing from general practices. Why is that? Is there a plan to get that data? Is that in process, as Audit Scotland has highlighted that that data is missing?

Journeys will still need to be made in relation to NHS travel. The Scottish Government has a switched-on fleets fund of £20 million. NHS Lothian is using it and Aberdeenshire Council has added 20 new zero-emission vehicles using that funding. We can measure those journeys and we know the mileage for NHS employees’ travel.

However, I am thinking also about dialysis patients. They have very predictable journeys if they use taxis, which many of them do. We know the start point of the journey and the end point. We know that those journeys happen on Monday, Wednesday and Friday or Tuesday, Thursday and Saturday. The same patients have the same appointments every week. If Audit Scotland is looking for data to measure emissions reduction by replacing diesel-driven vehicles with electric vehicles, those journeys would be very measurable.

Should we consider doing that? Would we be able to get a big win if we rapidly adopt electric vehicles for patient journeys that we can measure and for which we can demonstrate emissions reduction?

Okay—thank you.

We have talked about preventative spend, better outcomes and better health overall.

An example that comes to mind is how we keep people out of hospital in relation to asthma attacks or chronic obstructive pulmonary disease exacerbation. An overnight stay in hospital costs a minimum of £1,100. However, renewing a person’s annual asthma plan and ensuring that people use their inhalers appropriately—whether they have COPD or asthma—can help to keep people out of hospital. Such support from a practice nurse or specialist in airway management and respiratory issues has to happen in primary care. Does that mean that we must take money away from secondary care and give it to primary care? Do we get an extra pot of money from somewhere?

Do we have a wee borrowing pot? Oh no, we do not, because we cannae borrow in Scotland. What is the best way to divvy up a pot of money?

On the back of Tess White’s question for Professor Bell—I will be quick—I have a question about recruitment and retention, and the plans for clinical training and career pathways for health and social care workers. The Scottish Government has introduced bursaries for training of nurses, midwives and paramedics, and there is free university tuition in Scotland. I think that that will help recruitment, as well. Should anything else be done or introduced, in addition to the bursaries that have been introduced already, to support further recruitment and retention, and to encourage some of the people who have left the healthcare environment to return?

I picked up from Dr Bell’s submission that a review is being undertaken of the NHS Scotland resource allocation committee—NRAC—formula and that certain recommendations have been asked for in relation to the way in which funding is allocated. I am thinking about remote and rural areas, whether those are in the Highlands and Islands or in the south of Scotland. What, if anything, needs to be changed in the NRAC formula?

Okay. Thanks for that. I will halt there.