Chamber and committees

The Chief Medical Officer’s vision is that by 2025, all healthcare professionals will demonstrate realistic medicine principles and values through their professionalism.

The posters that have been developed and displayed by NHS Borders support one of the key principles of Realistic Medicine, which is to strengthen the relationships between healthcare professionals by encouraging people to ask their healthcare professionals questions that will support shared decision-making and giving people informed choices about their treatment and care.

The NHS Borders poster initiative is highlighted in the Chief Medical Officer’s annual report, Realising Realistic Medicine and NHS Dumfries and Galloway, NHS Lanarkshire and NHS Forth Valley are now piloting similar posters. We would encourage all NHS Boards to consider adopting this person centred approach.

The Scottish Government supports improvement of foot care service delivery through nationally produced tools and resources including the Traffic Light tool and CPR for feet.

We understand that, NHS Valley are at present piloting a fast track referral/triage system to improve service delivery in a standardised manner and reduce variation in practice within their Board. The results will be discussed with our Scottish Diabetes Foot Action Group so that best practice can be shared nationally.

On 29 August, the creation of an expert group which will provide support to transform scheduled care and put services on a sustainable footing was announced. The Elective Access Collaborative Programme will bring together experts from the Scottish Government, NHS Scotland and the Presidents and Chairs of the Royal Colleges – to provide support to health boards in improving the way elective services are configured.

The work of this group is supported by additional investment of £50 million which is being made available to Boards to improve waiting times for all parts of the patient journey, and £5 million confirmed on 5 October 2017 to support winter planning and enhance resilience across the services, making sure patients are seen quickly, efficiently and without delay.

The Scottish Government is also investing £200 million in five new elective treatment centres and the expansion of the existing Golden Jubilee National Hospital.

The Scottish Government expects all Boards to take all reasonable steps to live within their means and make best use of the available resources as part of a balanced approach to performance. Within this context, the Scottish Government continues to follow the twin approach of investment and reform, and shifting the balance of care to community health services.

The Chief Medical Officer’s second annual report, Realising Realistic Medicine sets out the need to strengthen relationships between professionals and individuals, with the person at the centre of all decisions and the need to tackle unwarranted variation. The report can be accessed here: http://www.gov.scot/Publications/2017/02/3336/downloads#res-1

The Chief Medical Officer’s vision is that by 2025, all healthcare professionals will demonstrate realistic medicine principles and values through their professionalism.

Different types of variation exist within the health and care system. Variation in health practices and outcomes exist, as well as variation in the volume of procedures carried out. There is a range of work, either planned or under way, that aims to strengthen person centred approaches and shared decision making to help tackle unwarranted variation. The Health & Social Care Delivery Plan which contains a series of priority actions that will begin to help embed Realistic Medicine across Scotland. They include:

• Refreshing our Health Literacy Plan, to support everyone in Scotland to have the confidence, knowledge, understanding and skills we need to live well with any health condition;

• Reviewing the consent process for patients in Scotland with the General Medical Council and Academy of Medical Royal Colleges and make recommendations for implementation. This is a key element in transforming the relationship between individuals and medical professionals;

• Commissioning a collaborative training programme for clinicians to help them to reduce unwarranted variation. This will support a workforce that can find more effective and valued ways of delivering medicine;

• Incorporating the principles of realistic medicine as a core component of lifelong learning in medical education and mainstream the principles of realistic medicine into medical professionals’ working lives at an early stage.

• Developing a Single National Formulary to further tackle health inequalities by reducing inappropriate variation in medicine use and cost and reduce the overall cost of medicine.

We will report progress towards achieving these actions through regular updates to the Delivery Plan Programme Board.

There is already some evidence of change in practice from individual clinicians, departments and NHS Boards as described in the CMO’s annual report Realising Realistic Medicine and we encourage boards to share and adopt good practice.

The new GP contract which has now been agreed between the Scottish Government and the Scottish General Practitioners' committee (SGPC) is a critical part of our plans to transform primary care services in Scotland. The proposals include reducing GP workload through the expansion of the primary care multidisciplinary team.

There will be significant new investment in expanded teams of health professionals in practices, widening patient choice and ensuring that GPs are able to focus on their expert medical generalist role. Additional health professionals will include pharmacy; nursing; Allied Health Professionals (physiotherapy, and paramedics and other urgent care practitioners); community mental health workers and non- clinical Support Workers (e.g. community Links workers).

The Scottish Government is committed to ensuring that NHSScotland delivers high quality services and improved outcomes for patients. The Modern Outpatient Programme and Scottish Access Collaborative will deliver sustainable improvements. We have adopted a collaborative approach for Unscheduled Care and Scotland’s A&E performance has been the best in the UK for the last 30 months.

As part of the existing approach to planning and identifying savings, NHS Boards focus on delivering recurring savings.

To ensure that public resources are used as effectively as possible and to help meet increasing demand and deliver reform, the Scottish Government has established a Sustainability and Value Programme to maximise the benefit from efficiency and productivity savings.

This Programme supports NHS Boards in identifying recurring savings which are then retained for local reinvestment. Savings plans are continually developed throughout the year, to deliver better services, better care and better value.

The new GP contract which has now been agreed between the Scottish Government and the Scottish General Practitioners' committee (SGPC) is a critical part of our plans to transform primary care services in Scotland. The new contract aims to reinvigorate general practice and turn it into a positive career choice for existing and future GPs. GPs will have the opportunity to vote on the new contract at a special SLMC Conference in December.

The proposals include reducing GP workload through the expansion of the primary care multidisciplinary team and allowing GPs to focus on their role as expert medical generalists. This will give GPs a more fulfilling role, with more time to see and treat the patients that need them most.

There will be new investment in expanded teams of health professionals in practices, which may includes pharmacists, nurses, physiotherapists, paramedics, community mental health workers and non-clinical support workers for example community links workers.

More detail on the primary care workforce will be provided in the National Health and Social Care Workforce Plan: Part 3 Primary Care in 2018.

The new GP contract can be accessed here - http://www.gov.scot/Publications/2017/11/1343

The Scottish Government published Part 1 of the National Health and Social Care Workforce Plan on 28 June 2017. This makes specific recommendations in key areas to strengthen national, regional and local improvements to NHS workforce planning.

Parts 2 and 3 of the Plan, respectively covering workforce planning in Social Care and Primary Care, will bring this together iteratively to enable different systems to make the right links. A further integrated Plan will be published in 2018.

The Health and Social Care Delivery Plan, published 19 December 2016, affirms that there will be a shift in the balance of care from hospital to community care settings, and to individual homes when that is the best thing to do. By 2021-22 more than half of frontline NHS spending will be in community health services.

As part of this shift, in every year of this Parliament there will be an increase in the share of the frontline NHS budget dedicated to mental health and to primary, community, and social care. This will be supported by an increase in health resource funding of £2 billion over the life of this Parliament.