Chamber and committees

Tackling health inequalities and the 'inverse care law' is one of our primary care outcomes, as published in a joint memorandum with the British Medical Association Scottish General Practitioner Committee (BMA SGPC) [http://www.gov.scot/Publications/2016/11/7258]. One way of delivering on this outcome as part of contractual change would be to adjust the Scottish Allocation Formula (SAF), which weights general practice funding by various factors that affect workload, including deprivation, rurality and age. The Scottish Government is clear that we need to look beyond the GP contract to other interventions and ways of supporting general practice in areas of high deprivation. Changes outwith the contract such as multidisciplinary working and the manifesto commitment to introduce 250 Links workers will be vital for supporting patients in deprived areas.

The Scottish Government and the SGPC agree, in principle, that we need better information and evidence to inform both accurate recompense of expenses and options for the long term overall development of GP pay in Scotland. To this end, we have commissioned a review of general practice funding, pay and expenses to provide a proper, robust evidence base for improved decision making. This is taking place in 2017, and inform options from 2018.

In the joint memorandum with the British Medical Association Scottish General Practitioner Committee (BMA SGPC) the Scottish Government undertook to extend the current pay stability agreement for GPs to April 2018, [http://www.gov.scot/Publications/2016/11/7258].

The Scottish Government and the SGPC agree, in principle, that we need better information and evidence to inform both accurate recompense of expenses and options for the long term overall development of GP pay in Scotland. To this end, we have commissioned a review of general practice funding, pay and expenses to provide a proper, robust evidence base for improved decision making. This review builds on and incorporates the findings of the Review of the Scottish Allocation Formula, and will inform options from 2018.

I refer the member to the answer to question S5W-08253 on 7 April 2017. All answers to written Parliamentary Questions are available on the Parliament's website, the search facility for which can be found at http://www.parliament.scot/parliamentarybusiness/28877.aspx

The Scottish Government, with the agreement of the Scottish General Practitioners’ Committee of the BMA, have commissioned a review of general practice funding, pay and expenses. The Review will gather and analyse earnings and expenses data from a range of practices, including in areas of high deprivation. It will also take advice from expert stakeholders on key considerations such as unmet need and high levels of multimorbidity. The Review is taking place in 2017 and will inform options from 2018.

The Scottish Government's vision is for GPs to fulfil the role of the Expert Medical Generalist in the community; focussed on complex care, undifferentiated presentation and local clinical leadership. The role will be supported by an expanded team of health professionals who can help patients to access the right treatment, by the right professional at the right time. In areas of high deprivation, this could include a multidisciplinary approach to patient care, including advanced nurse practitioners, mental health professionals, and links workers, who are dedicated individuals working in GP surgeries to support people one-to-one to address issues such as poverty, debt and isolation which are making them feel unwell. This multidisciplinary team approach will free up GP time to fulfil the Expert Medical Generalist role for more complex clinical care, including for patients with multi-morbidities living in deprived areas.

As part of this vision, in 2016-17 the Scottish Government introduced GP Clusters, small groups of practices working together to address the health needs of their local communities. This will be instrumental in addressing unmet need and improving care in areas of high deprivation.

The Scottish Government, with agreement of the Scottish General Practitioners’ Committee of the BMA, have commissioned Deloitte to review general practice funding, pay and expenses.

The remit of the review is to gather and analyse general practice earnings and expenses data, and consult with expert stakeholders to provide evidence for future mechanisms for the delivery of funding to general practice.

The Review will cost £95,260 (excluding VAT) and the relevant information will be published at an appropriate time following the successful conclusion of GMS contract negotiations.

A review on the legislation governing small landholdings was laid before Parliament on 30 March 2017 and published on the Scottish Government website on 31 March 2017 http://www.gov.scot/Publications/2017/03/4234

Consultant-led adult immunodeficiency and allergy services in Scotland are provided by Grampian, Tayside and Greater Glasgow and Clyde NHS Boards. An immunology service has been in place in NHS Lothian from early last year, following the recruitment by Scottish National Blood Transfusion Service and Edinburgh University of the Consultant Immunologist. For anyone in NHS Lothian requiring specialist anaesthetic allergy testing, this service is provided by NHS Tayside.

For some rare conditions where there are very small numbers of patients, highly specialised immunodeficiency and allergy services are provided outwith Scotland to ensure that the highly specialised care they need is as safe, effective and sustainable as possible.

The Scottish Government’s Home Energy Efficiency Programmes for Scotland: Area Based Schemes (HEEPS: ABS) are designed and delivered by local authorities, in conjunction with utility companies and local delivery partners, targeting fuel poor areas to provide energy efficiency measures to a large number of Scottish households and help reduce fuel poverty.

Responsibility for programme delivery falls to local authorities because they are best placed as the relevant strategic housing authority to understand local housing needs and prioritise provision across their area. Local authorities are expected to use a range of sources of information to target households whose properties have the lowest levels of energy efficiency and/or highest levels of fuel poverty. It is up to each local authority to define the areas within which projects will deliver and the detail of those projects.

The basis for distributing HEEPS: ABS funding is agreed with COSLA each year. In the current year all of the available funding for HEEPS: ABS is allocated on the basis of need, which takes into account levels of fuel poverty and reflects the different types of properties within those local areas. When submitting proposals for tackling fuel poverty Councils are asked to set out how these fit with existing national and local strategies, including Local Housing Strategies.

We are also working with local authorities to develop Scotland’s Energy Efficiency Programme (SEEP), including funding pilot projects to test new and innovative ways to improve the energy efficiency and decarbonise the heat supply of all Scotland’s buildings. And we are consulting on how we might design the detail of the policy and delivery framework, on the role that Local Heat and Energy Efficiency Strategies, and on regulation of district heating. The Scottish Government’s consultation on Scotland’s Energy Efficiency Programme runs until 30 May 2017 and the Local Heat and Energy Efficiency Strategies, and Regulation of District Heating is open until 18 April 2018. A series of workshops and events have been held to support this and numerous local authorities have been involved.

To support the overarching aims set out by indicators in the National Performance Framework, the Housing and Regeneration Outcomes Framework sets out more specific outcomes relating to its policy area. Progress on tackling fuel poverty is included in this: http://www.gov.scot/About/Performance/scotPerforms/partnerstories/HARO/Indicators

The “Evidence Review of the Potential Wider Impacts of Climate Change Mitigation Options: Built Environment Sector” published in 2017 to inform the draft Climate Change Plan http://www.gov.scot/Publications/2017/01/3358 found evidence that measures to improve the energy efficiency of homes, including by insulating them, can result in benefits to residents’ health, particularly among those living in fuel poverty. Physical health benefits can arise from warmer homes; and mental health benefits can arise from reduced energy bills and hence reduced stress.

In addition, GoWell, funded by Scottish Government, published research “Can housing improvements cure or prevent the onset of health conditions over time in deprived areas?” http://link.springer.com/article/10.1186/s12889-015-2524-5/fulltext.html in November 2015. This research indicated that receipt of fabric works was associated with higher likelihood of recovery from mental health problems and circulatory conditions. Receipt of central heating was also associated with higher likelihood of recovery form circulatory conditions. The research also noted that health gain from housing improvements appears most likely when targeted at those in greatest health need.

The Fuel Poverty Evidence Review published in 2012 by the Scottish Government examined evidence on the relationship between cold homes and poor health outcomes. It concluded that there was evidence suggesting that there was an association between thermal comfort and mental well-being, particularly among young people and children and that the risk of physical and mental health problems for children increased the longer they lived in cold homes.