Meeting of the Parliament

Meeting date: Tuesday, May 23, 2017

Official Report 785KB pdf

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Topical Question Time

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NHS Board-run General Practices

To ask the Scottish Government what action it will take in response to the reported increase in the number of GP practices being run directly by national health service boards. (S5T-00559)

Directly run practices are a legitimate way in which NHS boards can tailor services to meet local needs, ensuring that primary care services are provided to all patients. Wherever a practice hands back its contract, the local NHS board will ensure that primary care services will continue to be provided in the area and patients will be able to see a GP. If a practice cannot routinely accept new patients, boards must work with practices to help to manage the situation and to ensure that all patients are informed of the options that are being considered.

In support of general practice, I announced on 10 March investment of £71.6 million. The new funding forms the first stage of the Scottish Government’s commitment to provide an extra £250 million in direct support of general practice per year by 2021 and will increase the investment in primary care by £500 million. By the end of this parliamentary session, for the first time at least half of front-line NHS spending will go to community health services.

Further to the contributions that we have just heard, I put on record my thanks for everything that our health and emergency services do for us. They do heroic work in our communities every day and, as we saw so tragically overnight, during the darkest of moments as well. There will not be a soul in this building whose heart does not go out to those working today in the most testing of circumstances.

The emergency services deserve the full support of the chamber and the Government, but they do not always get it. Last year, doctors at East Craigs Parkgrove medical centre in my constituency attached letters to prescriptions asking their patients to contact me for help, such was the strain on the practice. Is the cabinet secretary confident that her Government is doing enough to identify and help surgeries that are in the early stages of distress, before they have to be taken under health board control?

I say to Alex Cole-Hamilton that our NHS has offered support to services in the NHS in the Manchester area, particularly in the plastic surgery and paediatrics specialties, which can be in short supply. I reassure the chamber that that offer has been made, as well as the offer of beds in Scottish hospitals if required. We are in touch with the services down there.

In reply to the question on the specifics of medical practices and support in the early stages, I say that I very much encourage boards to have early discussions—indeed, I encourage practices to have early discussions with the health board and to alert the board if they are entering difficulties—and to provide support in order to avoid some of the difficulties that we have seen.

Alex Cole-Hamilton will, I hope, be aware of the intensive work on the new GP contract negotiations. That will be important in providing a better future for primary care and for general practice within it, and providing a more attractive proposition in order to attract young doctors into general practice rather than other specialties. We also have the GP recruitment and retention fund, which we announced is increasing fivefold from £1 million to £5 million in 2017-18; that investment will enable us to expand and continue to explore the issues around GP recruitment and retention across Scotland that we know can be particularly challenging in certain areas. There are a lot of initiatives: the GP fellowships; the development of a locum pool of retired GPs in Lothian; the Royal College of General Practitioners recruitment programme; the GP returners scheme that is run by NHS Education for Scotland; the new national GP recruitment website; and local initiatives by boards. I hope that that reassures Alex Cole-Hamilton that, despite the difficulties, a lot is being done, and will be done, to encourage young doctors into general practice and, meanwhile, to support those practices that have challenges.

I am grateful for the information that the cabinet secretary has shared with the chamber, particularly in respect of the help that is being offered to Manchester by Scottish health boards.

One of the commitments of the Government’s recent mental health strategy was to hire 800 link workers for GP practices, accident and emergency departments, police stations and prisons. As the health secretary knows, my party has stated its view that, instead of link workers, we should seek to recruit talking therapists for GP surgeries, to offer early intervention and de-escalate crisis situations. One patient in four presents at a doctor’s appointment with an underlying mental health condition. Does the cabinet secretary agree, therefore, that having a talking therapist on hand in a surgery would be far more likely to reduce GP workload than a link worker, who may only be able to refer a patient to the back of a waiting list for psychiatric treatment?

Let me say a couple of things about that. First, the 800 staff that Alex Cole-Hamilton described, and that the First Minister has announced, will be particularly focused on A and E departments, GP surgeries and the police environment—not just around the cells but, potentially, when the police go out to a call that may involve someone with a mental health issue.

Link workers provide an important role in ensuring that a person gets access to the right resource, whether that is a mental health voluntary organisation or a mental health service in the NHS. Those 800 staff will have a variety of skills and backgrounds, which we will ensure are appropriate for the skills that are required in each setting.

Will the cabinet secretary outline any benefits for GP practices in being run directly by NHS boards?

When GP practices are run directly by boards, it connects those practices into a wider network of services and helps to ensure that patients continue to receive safe, effective and timely care. It can sometimes be a board’s contractual choice to run GP practices directly. For example, half of all practices in Orkney use 2C contracts, which means that they are run directly by the board. That has worked well for Orkney and allowed it to provide the types of services that are needed by the local population. There can be benefits for practices when they are run directly by boards—I hope that I have been able to give Ben Macpherson examples of that.

I associate myself with Alex Cole-Hamilton’s comments about last night’s events and, likewise, welcome the information that the cabinet secretary has given us about assistance.

One GP surgery in 20 is now under the control of a health board, which will inevitably lead to additional costs that will require to be borne by health boards. Has the Scottish Government quantified that expenditure and is the cabinet secretary satisfied that health boards are able to meet those costs?

Yes, we are satisfied that health boards are able to meet those costs. We have been expanding the resources that are going into primary care. In my initial answer, I described investment of an additional £71.6 million for 2017-18. That is the first stage of a commitment to provide an extra £250 million per year by 2021 in direct support of general practice, as part of a wider £500 million investment.

Health boards would be contracting with the GPs to provide those services if they had independent contractor status, so they would be funding the same services through a different route. I hope that I can assure Donald Cameron that we are working with boards to ensure that, whether it is through independent contracting or direct provision, every community has access to good-quality primary care services.

My son is eight years old. I have seen the joy on his face at a concert, and I can only begin to imagine the tragedy that every family in Manchester is going through. I want to put on record our thanks to all our amazing NHS first responders. People naturally run away from danger, but first responders run towards danger, to help and care for their fellow citizens.

GPs regularly raise the obligations that they feel that they have as a result of running a business practice, rather than purely caring for patients. One of those obligations is looking after a property. GPs often ask whether, through the GP contract process, health boards can take responsibility for GP properties and let GPs get on with running the practice. Has that been actively considered as part of the GP contract process?

I thank Anas Sarwar for his initial remarks and for his question. He may be aware that the GP premises short-life working group reported in December. It recommended that the Scottish Government recognise and support a long-term shift that moves general practice towards a model that does not presume that GPs own their practice premises. We are implementing the group’s recommendations and we are moving to that service model. We will issue a code of practice to guide health boards when deciding to purchase a GP-owned property or take on some or all of the contractor’s responsibilities under an existing lease. We will issue revised premises directions and carry out a nationwide survey of all GP premises to better understand the challenges that the estate faces.

We very much recognise the issue and we are working closely with the British Medical Association to move it forward.

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Cycling Infrastructure (Road Safety)

To ask the Scottish Government what action it is taking to improve cycling infrastructure, in light of recent research by Sustrans Scotland, which highlighted that T-junctions and roundabouts possess the highest number of collisions. (S5T-00560)

Transport Scotland welcomes the report, which helps to inform our partnership work with local authorities and Sustrans to make our roads and cycle network safer by tackling dangerous roundabouts and junctions. Local authorities are funded through the cycling, walking and safer streets fund, and they are encouraged to apply to Sustrans Scotland for further Scottish Government funding through the community links and street design projects for exactly those types of junctions and roundabouts.

Our “Scotland’s Road Safety Framework to 2020” mid-term review identified cyclists as a key priority area. Through our programme for government, we are committed to maintaining the record levels of funding in active travel, which includes capital funding for improving infrastructure.

The minister will be aware that in my region of Mid Scotland and Fife, Dunfermline and Perth have been named as two of the top 20 cycling collision hotspots in Scotland. Why is the Scottish Government overseeing cuts to cycling infrastructure?

I must clarify that that is misinformation from Alexander Stewart; I am sure that it was unintentional. As I said in my previous answer, we are making available record levels of funding to active travel: £39.2 million per year to 2021. There is a record level of investment. Other members will no doubt want us to go further than that sometimes, and where additional money can be spent on active travel, I will certainly do that.

It is worth highlighting some of the successful projects in the region that Alexander Stewart represents that have been funded, many of them through Sustrans, which we help to fund. In Cowdenbeath there is the placemaking scheme, through which redesigned town centre junctions will improve access. Rothes Road has been improved with a toucan crossing, which got money from Sustrans and community links funding of £870,000. There is the Carnegie Avenue shared-use path—1.2km of new 2.5m-to-3m shared-use path—and further extension of the cycle Dunfermline network.

A lot of funding is going into Mid Scotland and Fife. I would encourage local authorities—many of which have new administrations, although of course many have existing administrations—to work with Sustrans where, on the basis of the Sustrans report, there needs to be an improvement, and to bid for the community links funding that is available.

I thank the minister for identifying areas around my region that are being tackled, but there are still some areas that require to be tackled. Additional support such as traffic lights and other quality infrastructure around roundabouts and T-junctions have been proven to reduce accidents and fatalities. Many cyclists have endured serious injury or even death as a result of the infrastructure. Will the minister clarify what the Scottish Government is attempting to bring forward? As he said, it seems to be working in some parts but not in others.

The report was commissioned because, although we had good analysis and good data on where the cycling injury hot spots were on our trunk road network, we did not have such data for local roads. Sustrans thought that it was eminently sensible to gather that data. That was the whole purpose of conducting the exercise.

Now that we have the evidence, we are in discussions with Sustrans about schemes other than the community link scheme that I talked about and, for example, about whether there would be merit in having a community links junction improvement scheme, which might be of interest to local authorities.

My strongest advice to the member is to continue to engage with the local authority that he knows well, to look at the evidence base that Sustrans has provided, and to continue to apply to the current programme of funding that exists for such infrastructure. If there are other funds available, I will make sure that the member is made fully aware of them. However, there is a pot of funding available to help and, with the evidence base that the report helpfully gives us, that will make cases very strong.

I apologise: there is not enough time for additional supplementary questions.