Meeting of the Parliament

Meeting date: Tuesday, September 26, 2017

Official Report 780KB pdf

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General Practice (Recruitment)

The final item of business is a members’ business debate on motion S5M-07505, in the name of Jamie Greene, on general practice recruitment in West Kilbride and across Scotland. The debate will be concluded without any question being put.

Motion debated,

That the Parliament notes with concern the recent issue experienced at West Kilbride’s General Practice (GP) surgery in North Ayrshire where it understands that the practice struggled to find sufficient replacement GPs to meet its demands, which could have led to its indefinite closure; further understands that, although locums were eventually found to keep it open until at least Christmas 2017, this issue is far from resolved; believes that the management of the surgery handed back their GP contract earlier in summer 2017 citing “concerns over the sustainability of continuing to deliver a safe and effective service” as their reason for doing so; highlights what it understands was RCGP Scotland’s recent warning that Scotland could have a shortfall of 828 GPs across the country by 2021 and believes that this is well illustrated in the outcome of the West Kilbride practice; understands that West Kilbride is not the only area in Scotland where GP shortages have been highlighted and that other NHS boards, such as NHS Lothian, have also experienced problems with recruiting sufficient GPs; believes that interim locum solutions in staffing GP surgeries are not long-term solutions to a problem that has been highlighted to the Scottish Government on many occasions in the Parliament since the SNP administration took office, and considers that this identifies a clear lack of long-term strategy and vision over workforce planning of GP services across Scotland.

16:44  

First, I thank MSPs from across the Parliament for supporting my motion and thus enabling us to have this very important debate. From the outset, I make it clear that all front-line national health service staff make a valued contribution to the provision of healthcare in Scotland.

West Kilbride GP surgery in North Ayrshire fell into crisis recently. In March, two of its general practitioners announced that they were leaving the practice and, in August, the three remaining doctors took the sad and very regrettable decision to hand back their practice.

The surgery is now under the control of the local health board and is being manned by locums. Since April, it has been operating with an on-the-day appointments system. Such practices, which are called 2C practices in the NHS, are thought to cost almost twice as much to run. In West Kilbride, adequate locum coverage is available until the end of November, but there are gaps in the December rota and, to date, no detail has been provided as to what will happen next year or, indeed, beyond. That has left many local residents feeling understandably distressed and worried.

In their departing letter to local residents, the West Kilbride GPs noted:

“There has not been sufficient support in the form of further doctors ... Due to our significant concerns over the sustainability of continuing to deliver a safe and effective service we took the serious step of handing back our General Practice contract to the health board.”

The letter closed with the following, quite poignant words:

“General practice can often be more than a job; it is hard for us to be leaving the families we have been involved with over the past years.”

I therefore pay tribute to Doctors Struthers, Maxwell and Barbour on behalf of the local community and thank them for their many years of service.

However, this is a much wider problem across Scotland. No doubt we will hear some stories about that from other members. We know that 52 practices have returned their GP contracts to health boards. Since 2007, the number of patients being treated in 2C practices across Scotland has jumped from 83,000 to 160,000—a spike of more than 90 per cent. Why is that important? The knock-on effect is that our accident and emergency and acute services have seen huge increases in demand as people struggle to get access to a GP. The GMB union has described the ambulance service as being “at breaking point.”

Before any member on the Government benches—I note that they are few and far between—stands up and says to the Parliament that the problem exists in England and Wales, too, I will save them the bother. The provision of cradle-to-grave healthcare in Scotland has been devolved to this Parliament for 20 years, the SNP has been in government for 10 of those years, and the First Minister was in charge of health for five of them. The situation today has been a long time coming.

We should let the statistics speak for themselves. It is a fact that general practice in Scotland receives the lowest share of NHS spend anywhere in the UK. It is a fact that more than a quarter of practices in Scotland have a GP vacancy. It is a fact that three quarters of those positions have been vacant for more than six months. Some 90 per cent of GPs in Scotland think that their heavy workload is having a negative effect on the quality of care that they provide, and just 7 per cent think that 10-minute consultations are adequate.

The Government might mention the additional investment of £250 million that it has promised in general practice, but it is vital that there is a commitment to recurring and sustained investment in primary care and a measurable plan for how it will address the recruitment problem. If the Government does not want to listen to me, it should listen to the experts. The British Medical Association and the Royal College of General Practitioners have provided many MSPs with detailed and constructive recommendations, and I urge the minister take them into account.

The problem did not arise overnight. Repeated warnings from across the board all pointed to the crisis that we face today: a chronic underfunding of general practice and a training and recruitment pipeline that has not met demand. It is the perfect storm. Given that a third of GPs plan to retire within the next five years, today’s crisis will be tomorrow’s disaster. There is a duty on this Parliament to do more than just talk. There is a duty to act and a duty to listen. It is a shame that the Cabinet Secretary for Health and Sport is not here to listen. We must act, and we must do it now. The clock is ticking. I hope that, by bringing the subject to the Parliament for debate, I will encourage the Government to focus its eyes once again on the crisis.

16:49  

I thank Jamie Greene for securing the debate.

I am concerned about the way in which the Tories have for weeks repeated the same factually incorrect mantra about the future of West Kilbride medical practice. They claim that it is set for closure and are worrying my constituents. To this day, we hear that the practice may stay open only until Christmas. That is simply not true, although undoubtedly the practice has been through a tough year with GP retirements and resignations. However, let me be clear that at no point has NHS Ayrshire and Arran ever indicated that the surgery will close; quite the contrary—I have always been reassured that the health board would not dream of leaving West Kilbride without a surgery and that closure was and is simply not an option. Indeed, all the other practice staff remain in place, and the practice manager has reported that patients have been very understanding of recent changes. The level of pharmacy input into the practice has also been enhanced through the SNP Government’s investment in primary care.

I was reassured by the primary care development support manager Karen Grant that at least two locum GPs are enjoying working at the practice so much that they hope to stay for at least another six months and might become salaried. Locum staffing is not ideal for continuity of care, and work is on-going to establish longer-term commitments to the practice. Ms Grant also welcomes the £250 million incremental investment in primary care from the SNP Government, which enables investment in multidisciplinary teams around practices. With three doctors on most days, sometimes two and, today, four, the West Kilbride surgery is now better staffed than it has been for a long time.

I commend practice staff, our local health and social care partnership and NHS Ayrshire and Arran for their work in West Kilbride and their tireless efforts in utilising SNP Government initiatives such as the Scottish rural medicine collaborative in attracting doctors to the practice. Those professionals must be sick of hearing that what they are doing is not good enough, regardless of what we may have heard earlier this evening.

At one point, the incessant stream of misinformation about the practice was so bad that several constituents asked me which surgery they should go to “now that the one in West Kilbride has closed down.” In late August, I felt compelled to issue letters to inform every West Kilbride household of the real situation.

That brings me to the utter hypocrisy of Tory politicians presenting themselves as knights in shining armour galloping to the rescue of patients in West Kilbride. Their party has cut Scotland’s budget by 9 per cent—with more to come—but they stand up in the chamber demanding that the SNP Government does more with less.

Meanwhile, the Tories’ stewardship in England invites no faith in the Tory approach. In January, the British Red Cross declared that a humanitarian crisis was taking place in England’s NHS, in which junior doctor strikes took place not long ago. The Financial Times revealed that GPs are leaving NHS England at a rate of more than 400 a month, and it has been estimated that there will be a shortage of 12,100 by 2020. Recruitment agencies could be paid over £100 million by the English NHS to find GPs to replace the 5,159 GPs who left last year. Half of those replacements are being sought overseas. I wonder what impact the Tory Government thinks that its isolationist Brexit rhetoric will have on attracting those doctors.

The SNP Government is working with Scottish health boards to train, recruit and retain GPs. With one GP per 1,100 people compared with one for every 1,380 people in Tory England, one for every 1,378 people in Labour Wales and one for every 1,436 people in Northern Ireland, Scotland still has the best GP coverage per head of population in the UK by far. The measures to attract more GPs include a £71.6 million investment in direct support of general practice; activities to attract junior doctors and qualified GPs to work in general practice, including a GP returners programme; the Scottish international medical training fellowship programme; widened access to medical education—and so on.

The SNP Government is committed to providing an extra £250 million annually in direct support for general practice by 2021 and increasing overall primary care investment by £500 million. The GP recruitment and retention fund is increasing this year from £1 million to £5 million, which will enable the expansion of and continued support to existing and new initiatives across Scotland. The British Medical Association’s Scottish GP committee chair, Dr Alan McDevitt, welcomed that as

“a very positive step in the right direction towards our shared vision of general practice”.

I am sorry, but you need to close.

I trust that I have clarified what is really going on in West Kilbride medical practice. I have every faith in a healthy future at West Kilbride. The practice was never up for closure, and nor will it be.

16:54  

I congratulate my colleague Jamie Greene on securing the debate and on the good work that he is doing in representing the concerns of residents in West Kilbride about the future of their local surgery. He is entirely right to bring these serious issues to Parliament and to the attention of ministers. The GP recruitment crisis is one of the biggest challenges facing our NHS, and every MSP in the chamber will be acutely aware of the pressures on local GP services in constituencies and regions across our country.

The motion correctly identifies that RCGP Scotland warned in a submission to the Health and Sport Committee this summer that there will be a shortfall of 828 GPs across Scotland by 2021. It updated that figure just this week; the projected shortage now stands at 856. The RCGP was highly critical of the Scottish Government for giving the impression that an extra £500 million would be invested directly in GP services by 2021. The real figure is half that; the rest will be invested in primary care.

The RCGP stated starkly:

“If the longstanding underfunding and confusion that we are currently experiencing is to continue, we will keep witnessing a considerable number of general practices closing and transferring the running of their practices to Health Boards due to insufficient resource through which to remain solvent. Patients will continue to be found queuing outside practices for the uncertain opportunity merely to register with a GP.”

Ministers must heed such warnings and act urgently.

Jamie Greene’s motion refers to the significant problems in my region, Lothian—a part of Scotland where the population is rising fast and, consequently, demand for primary care services is increasing dramatically. More than 40 per cent of GP practices in NHS Lothian are either full and not accepting new patients, or restricting registration. That is the crisis that we face in Scotland, and I hope that members across the chamber will start to recognise that.

Patients regularly contact me to complain about the difficulty, which Jamie Greene identified, of securing non-emergency GP appointments. The situation in the capital is particularly serious. On Friday, the Edinburgh integration joint board considered a report about the GP premises that will need to be provided in the next few years. That report contained serious warnings about the pressure on local services as the capital prepares for an additional 55,000 residents by October 2026. Since 2009, the GP list in Edinburgh has grown by approximately 5,000 per year—the equivalent of a new GP practice annually. The report states that, although primary care has been flexible in absorbing that new population,

“this elasticity is now exhausted in most areas of the city.”

We clearly need significant investment in new and expanded GP practices across Edinburgh and Scotland if we are to avoid a meltdown in GP services, which would lead to additional pressures on emergency and acute health services. The Scottish Government has known for years about the GP recruitment crisis and the demographic challenges facing many GPs. The consequences of its failure to do more on national workforce planning are of concern to us all across Scotland.

I acknowledge that the Scottish Government is taking forward a new graduate entry medical course. I have welcomed elements of that—especially bonding, which I hope will ensure that students who take up bursaries return to service in NHS Scotland—but I still have a huge concern.

Will the member give way?

The member is just closing.

I do not have time to take an intervention, but this might answer the point that the minister would have made. I am hugely concerned that the percentage of Scotland-domiciled students studying clinical medicine in Scotland—those who are most likely to stay and work in our NHS after they graduate—has fallen sharply under this Government, from two thirds in 1999 to just over half this year, because of an effective cap on the number of Scots who can study medicine.

Please close, Mr Briggs.

I again welcome the debate and the opportunity to talk about this critical subject. Scottish Conservatives will continue to press the Government, and we will never be shy of bringing these issues to Parliament as we work to secure investment in our GP sector.

16:58  

I apologise to members in advance that I will have to leave the chamber before the conclusion of the debate. I thank Jamie Greene for bringing this important matter to the chamber.

I and my Lothian colleague Andy Wightman are alarmed by the number of constituents who contact us because they cannot see their GP, whether that is because they cannot register on a list or because they are simply unable to get an appointment. As Miles Briggs pointed out, in Lothian, as in many parts of the country, constituents have been very severely affected by this issue. From Musselburgh in the east to Ratho in the west and in practices in Bangholm and Kirkliston and on Leith Links, challenges have been faced—and not only, as we have heard, when making an appointment to see a GP. I have heard from constituents who have had to queue up at certain times on certain days just for a chance to register with a GP. Of course, that is the very last thing that our GPs want.

Last year, Dr Elaine McNaughton of the RCGP told the Health and Sport Committee that professionals have spent 10 years highlighting “the retirement bulge”. The Government has been too slow to listen, and the effects on patients—and on GPs themselves—are becoming all too clear. Worryingly, as today’s motion notes, the RCGP estimates that there could be a shortfall of 828 GPs across Scotland within the next few years.

I bear in mind the Scottish Government’s recent action to improve access to careers in medicine, particularly the establishment of the new graduate school of medicine, which will help to embed students within a primary care training pathway and facilitate their placements in remote and rural regions. However, I worry that some of those steps have simply come too late, and I was concerned to see that the Scottish Government’s health and social care workforce plans have not yet comprehensively addressed general practice. I welcome the recent action that the Government has taken to improve access to careers in medicine, but there is much more to do, and I am not sure that steps such as the new GP training bursary have yet had a significant effect on recruitment.

I am particularly concerned about the impact of the GP recruitment and retention crisis on patients who live—and GPs who work—in our most deprived areas. Analysis already shows that GPs practising in the most deprived areas of Scotland typically manage larger lists and have more patients with multiple health conditions, including mental health needs. However, it seems that, last year, GP practices in the most deprived 20 per cent of postcodes received £1.34 less per patient than practices in the least deprived.

The shortage of GPs has terrible knock-on effects for the rest of our NHS services with regard to unscheduled hospital admissions and deepening health inequalities. I firmly believe that we still do not place enough real emphasis on preventative health. The fact is that anticipatory care begins in general practice. Just last month, I was able to visit the Edinburgh access practice to learn more about its GPs’ fantastic outreach work on treating hepatitis C. If we do not protect and enhance funding for general practice, the ability to lead outreach work and tackle unmet need will be sorely diminished.

I have called for fairer funding for GPs in deprived areas. I fully agree that GPs across the country are stretched and stressed—the demands of working with elderly populations are very high, and working in remote and rural locations is challenging, too—but our young people in the most deprived areas of Scotland must not lose out as a result, given the long-term consequences that that will have. Ensuring that GP funding reflects the need to tackle health inequalities and ring fencing some of that funding for practice development would go a long way to redressing that historical imbalance, and initiatives such as the Govan SHIP—or social health and integration partnership—project show what can be achieved with a little additional support and funding to give patients with complex needs longer appointment times. I believe that that way of working might well have cross-party support.

We must work smartly to make our GP workload sustainable, and we must do all that we can to attract, retain and recruit GPs. After all, Scotland needs them badly.

17:03  

I thank Jamie Greene for lodging his motion, which has provided an opportunity to debate the GP crisis both in Ayrshire and across Scotland.

GP practices are at the heart of not only our NHS, but our local communities. As many as 90 per cent of patient interactions are with primary care, and for many, GPs are the vital first point of contact with our healthcare system. However, a decade of Scottish Government cuts to the share of NHS spending for GP services and to training places has left that point of contact at breaking point in far too many of our communities.

It is estimated that in Scotland there are 171 GP vacancies, 73 per cent of which have been open for more than six months. Right now, a practice is being forced to close almost every month, with a total of 14 practices closing since 2016. In many communities, the situation is stark. Jamie Greene has rightly highlighted the particular problems facing North Ayrshire and NHS Lothian, but in my home region of Dumfries and Galloway, the number of GPs has fallen from 134 in 2012 to 118 in 2016. Villages such as Wanlockhead have lost their outreach surgery because of a shortage of GPs in the Moffat area who provided that service, and admissions to Thornhill hospital were closed because the local GP practice providing the cover at the hospital could not fill its vacancies.

That practice is not alone, as 42 per cent of practices in the region have a vacancy—that is 16 posts—largely unfilled for six months. NHS Dumfries and Galloway has had to take over the running of two GP practices, and that number is set to rise. The problem is set to get worse, because 26 GPs in Dumfries and Galloway are aged over 55 and are, therefore, likely to retire within the next five years. In addition, as a result of Brexit, applications from the European Union for health posts in the region have all but dried up. It is, frankly, a ticking time bomb—a crisis that is happening on the watch of this Government, and a crisis that the Government should have seen coming.

In 2008, Audit Scotland called on the Scottish Government to collect comprehensive data on GP and GP practice staff numbers to support proper workforce planning. In 2014, the Royal College of General Practitioners warned that the underfunding of GPs was putting patients at risk; yet, by 2015-16, the proportion of NHS spending that was allocated to GP services was at an all-time low. After 10 years of ineffective action and countless ignored warnings, tackling the GP crisis in the short term will not be easy, not least because the current shortage is adding to the workload of those GPs who remain, impacting further on recruitment.

It is also impacting on patient care. A recent BMA survey revealed that 91 per cent of responding GPs said they felt that the quality of care that their patients receive has been negatively affected as a result of their growing workload. Urgent action is needed. Professional bodies across the primary care sector support a move towards a multidisciplinary approach in GP practices to take pressure off GPs, provided that the crucial role of the GP is protected. Such moves are simply not happening quickly enough, and Audit Scotland has rightly called on the Scottish Government to

“provide strong leadership by providing a clear framework to guide local development”.

There are clear examples of successful models such as the Govan SHIP project, which Alison Johnstone mentioned, which show that, if general practice is properly funded, major benefits can be achieved for patients, for GPs’ workload and for recruitment and retention.

Funding is the key, whether that is for a proper, high-profile recruitment campaign that reaches beyond the EU or an increase in the share of funding for general practice, which fell from 9.27 per cent in 2006-07 to just 7.2 per cent in 2015-16. It would be helpful if the minister could tell members, in summing up, whether the Government intends to ensure that 11 per cent of the total NHS budget will go to general practice to deliver improvements in patient services, reduce the strain on our GPs and help to make the profession an attractive choice of career for medical students again. Without fairer funding, there is no doubt that the crisis that we face in GP practices will continue.

17:07  

Jamie Greene was right to say, in his opening remarks, that the situation exists not just in West Kilbride but across Scotland. “Crisis” is a much-used word in politics, but the figures that Colin Smyth and other members across the chamber have cited illustrate why the situation is exactly that. Learned bodies that represent GPs, organisations that represent carers and anyone who looks at the NHS budget and the consequences of the squeeze that is now taking place know that the crisis is hitting constituents the length and breadth of Scotland.

Colin Smyth was right to point to the 2008 report. I read it at the time, and it made clear recommendations to the Government. There could be some good parliamentary questions about what happened to those recommendations and why they have not been followed—because, discernibly, they have not.

The biggest change has been the move away from independent practice to salaried practices, which has been publicised in the newspapers in the past couple of days. That is now the reality for an awful lot of the delivery of primary care throughout Scotland, and members should not believe that salaried practices always work. In Lerwick, this morning—as on too many mornings at the salaried practice that is now the Lerwick health centre—people queued at 8.30 am to get an appointment. There is nothing good about that. There is nothing that is working about that model, yet that is the reality in too many parts of Scotland. Alison Johnstone indicated that the situation is the same here, in the capital city.

The Government has some big questions to answer, and here is why: the health boards are a creature of the Government. The idea that they are an independent part of the process is complete nonsense. Health board chairs and chief executives are told to jump by the minister of the day. That happened under the Government of which I was a minister, and Alex Neil, the former health secretary, who is in the chamber tonight, knows how the system works. I am not making a political point about the current Government; I am saying that we have had that system since devolution and it is demonstrably not working. If ever a system needed change and reform, it is the health board system.

Jamie Greene rightly mentioned locums. NHS Shetland is spending £1.3 million on locums in the current financial year. Eight out of our 10 practices are now salaried. Eight of those practices are one GP short or more. That is the reality of the problems that now exist in one part of Scotland and no doubt more so in different parts, too.

What strikes me from the debate is the sheer geographic scale of the problem. Far from it being local scaremongering, does Tavish Scott agree that it is a crisis throughout Scotland and is aside from party politics?

That is the case. I hope that, in that sense, the Government will treat it with all the seriousness that it should, given the range of views across the Parliament.

I have a number of questions that I want to ask the minister. I hope that she will deal with them in winding up the debate. Is the Government’s policy still to support single-GP practices? In Shetland, the health board has just issued a letter to patients saying that it is NHS Scotland’s policy not to support single-GP practices. I hope that the minister will set out the position on that very clearly when she winds up.

I would also like the minister to deal with dispensing practices. Many GP practices across Scotland benefited from being dispensing practices. Most health boards have taken away that option. In Shetland, when Whalsay, Yell and Unst ceased to be an independent practice and became salaried, the health board removed the dispensing function. When Alex Neil was health secretary, I raised that issue, as many members across the chamber did, including members from his own party. The health boards appear to be removing the dispensing abilities. That has a significant financial impact on the practice.

I have two final questions. First, I hope that Maureen Watt, who represents the north-east, will tell us what is going on with GP referrals in NHS Grampian. People in my constituency are now being referred to Newcastle for cardiology, when that service used to be available at the Aberdeen royal infirmary.

Lastly, the BMA ran a sensible programme this summer to encourage all MSPs to visit GP practices in their areas. I did that at home. The staff are incredibly valued, not just the GPs themselves but the practice nurses, and others who work in the practices. It is time that the Government recognised the pressure that those people are under, put in the money to support them and answered some fundamental questions about what model of primary care it wants for the future.

17:12  

I thank Jamie Greene for bringing the debate to the chamber. Members across the chamber have highlighted the scale of the crisis throughout Scotland. I will focus on locum GPs, which Tavish Scott mentioned. When we have a GP crisis, the cost of locums goes up, and that is certainly what has been happening throughout the country.

I have been passed letters that have been written by two GP practices in my area of Lanarkshire. I will read passages from those letters. One calls itself a cry for help from GP practices. It says:

“We are rapidly reaching a crisis point with trying to provide adequate GP locum cover. Trying to find locum GP cover for existing GPs already in place in general practice is becoming a major issue.”

According to that letter, locums have discovered their rarity to be a valid reason to try to hold GP practices to ransom.

The letter goes on to say that

“Most of us would usually pay between £230 to £260 per three-hour session for a GP locum cover and up to £500 for a full day. That has recently increased to up to £800 a day.”

That is quite a rise. It goes on:

“Along with this is the demand that locums will not do extra duties i.e. home visits, signing prescriptions, etc.”

Members really would not believe it. It says:

“It is incredibly time-consuming and frustrating”

and it relates a couple of instances of what locums have asked for, such as

“£650 per day to see no more than 30 patients, with no additional duties.”

Another one charged

“£764 per day to see no more than 24 patients with the cost of return flight from their home in the Isle of Man to be paid and to be picked up and returned from the airport.”

That is quite unbelievable.

A different practice says that the crisis in locum recruitment is a source of stress and frustration and talks about the spiralling financial demands of locums and their refusing to undertake duties other than seeing the requisite number of patients in the clinic, so they do no house calls, no routine script signing, no emergencies, no results commenting and no handling of any correspondence. If that is not a crisis, I do not know what is. That practice calls the situation unjust and morally unfair and it goes on to say:

“The situation is now intolerable and unsustainable, with many practices having to reduce their patient-facing time to avoid prejudicing the quality of the consultation.”

That situation is completely unacceptable. If the minister cannot respond to that and say what she and her Government will do about it, that is a disgrace.

17:16  

Having been the Cabinet Secretary for Health and Wellbeing, I could speak for hours on the subject. I welcome the debate, as it is good to discuss the issue openly. Rather than try to cover every single point, I will emphasise two or three issues that have not been highlighted so far.

We all recognise the inevitable challenges that there are in the worldwide shortage not just of GPs but of doctors in general. One of the consequences of Obamacare is that the United States of America has had to recruit nearly 20,000 additional doctors to cater for the extra demand that the policy has created. Sometimes, that has a knock-on impact on the destinations of medical graduates from the UK. A range of issues have influenced the matter. However, I will raise two particular strategic issues in looking forward to try to find a solution to the problem, rather than continually reiterating its nature. Those two issues have not been given enough attention in the debate or more generally.

The first issue is that we are not admitting enough young people to medical school in Scotland. In fact—as Miles Briggs referred to briefly—in some of our universities, less than half the medical students are from Scotland. That is not a nationalist point; it is a medical policy one.

There is clear evidence that, when medical students who come from a country such as Scotland graduate, most of them decide to practise in that country. Indeed, that goes further. There is clear evidence that, if we take in more students from rural and island areas, they will return to such an area, although they might not return to their own area. When Mike Russell was the Cabinet Secretary for Education and Lifelong Learning, he and I deliberately increased the number of students from rural and island areas who gained entry to medicine. Such a policy does not pay off for five to 10 years—until those students complete their education—but, as well as dealing with some of the immediate issues, we need to look at the strategic ones.

One of the strategic challenges is to substantially increase the intake of medical students. The BMA has resisted that in the past, on the ground that it does not want any doctor to be unemployed. Given the exponential increase in the number of doctors who are needed—not just GPs but all doctors—the chances of any good doctor being unemployed are practically zilch, so that is not a good enough reason to resist a substantial increase in the intake of medical students.

I do not think that people realise the impact that the other strategic issue that I want to raise has had. Until 2010, medics—like many other people in the economy—were entitled to build up a tax-free private pension pot of £1.8 million. George Osborne reduced that—the figure went first to £1.5 million, then to £1.25 million and more recently to £1 million.

Most people would think that a tax-free pension pot of £1 million was a very substantial amount of money but, if senior doctors and GPs pay the maximum allowed contribution, they will build that up within 25 years of their working life. When the limit was £1.8 million, people had to work for 38 years at the maximum contribution to do that.

If we speak to doctors, they will tell us two things. First, they will say that the reason why many of them are retiring in their 50s—that is a major factor in the situation that we find ourselves in—is that the pension policy acts as a disincentive to continuing to work full time until anything near the normal pension age.

There is another specific effect. I remember that, when the measure was introduced, there was in Glasgow alone almost immediately a 40 per cent reduction in the number of GPs who were prepared to do out-of-hours work, because the more out-of-hours work they did, the earlier they would have to retire to gain the maximum benefit from their pension.

You must conclude there, fascinating and invaluable though this is.

We must address that issue, which is part of the problem.

17:21  

I welcome the opportunity to respond to the debate on this important subject, which Jamie Greene has raised. I thank members for participating and for the issues that they have raised. The public and members of every party recognise the great work that our health professionals across NHS Scotland do. I welcome that recognition, which we share.

As Colin Smyth said, GP practices are at the heart of our communities, and they are also at the heart of our NHS, which is why the Cabinet Secretary for Health and Sport announced in March that funding in direct support of general practice will increase by £250 million by the end of this session of Parliament, as part of our commitment to increase primary and community care funding by £500 million. That game-changing investment in primary care will deliver multidisciplinary teams that offer patients access to the right professional at the right time, and it will support GPs to do their job.

However, we are far from complacent. Even with the increases in the number of GPs under this Government—the number is up by 6.9 per cent, or 315 GPs, since 2006—we recognise that healthcare must adapt to meet the changing needs of people in Scotland. We are fully aware of the challenges of recruitment and retention of GPs in some areas, and we are taking action on multiple fronts to address them. Our long-term national workforce plan is helping to identify and address the key issues for every part of the workforce. Alison Johnstone wanted to know about primary care in that regard. It is covered in part 3 of the plan, which will be published following the conclusion of the GP contract negotiations.

We have heard about the situation in the West Kilbride practice. During this period of uncertainty, NHS Ayrshire and Arran has enhanced the level of pharmacy input into the practice, which is thanks to Scottish Government investment in the multidisciplinary team. Kenny Gibson was right to write to all his residents in West Kilbride to reassure them of the commitment on that, not only from NHS Ayrshire and Arran but from the Government.

NHS Lothian has indicated that its list restrictions are only a temporary measure, and I am confident that patient safety is always the top priority. We will continue to work with all boards to ensure that our investment delivers better care, better services and better value.

Kenny Gibson and Alex Neil were right to highlight all the factors that have led to the current situation, many of which are outwith our control, such as the pension issue.

Oh, come on.

The pension issue is a real problem, which Alex Neil was right to highlight. He first encountered it when he was working as health secretary.

It is absolutely disgraceful for Tory members to dismiss Brexit, because we know that it will have a direct effect on the Scottish workforce. People from the European Union who choose to live here, including doctors, nurses and others who provide healthcare, are welcome in Scotland, as the First Minister has made clear. However, the uncertainty is already leading to people deciding not to come here to live and work or to them deciding to leave. That is a problem.

We are addressing the day-to-day challenges that GPs tell us that they face. Two years ago, Scotland was the first country in the UK to remove the bureaucratic, tick-box quality and outcomes framework; instead, our GPs are working together to make services better. We are working hard with the BMA to deliver a new GP contract that will see our GPs focus more on the challenging work that they have trained to do, supported by a bigger multidisciplinary team.

I specifically asked whether the Government is committed to delivering 11 per cent of the NHS budget to GPs. On 24 May 2017, Dr Philippa Whitford told Pulse magazine:

“The GP contract is currently under negotiation but the Scottish government has committed to reversing the decline in the share of the health budget that general practice has had and bring it up to 11% by the end of parliament.”

Is that the case?

We are committed to bringing the proportion of the NHS budget up to 11 per cent. The GP contract is under negotiation, so it would be wrong to go into any detail on that. We have increased funding fivefold for GP recruitment and retention this year, to £5 million, and that is part of the overall £71.6 million package of investment this year in direct support for general practice.

The minister has spoken about multidisciplinary medical teams a number of times. How do they fit into single-GP practices in rural areas?

The member mentioned health boards; he knows that it is up to them to deliver Government policy according to the needs of their local populations. Across the country, GP practices and multidisciplinary teams are working together to give patients access to the right person at the right time. I will make sure that the member’s particular question about single-GP practices is replied to.

As for Tavish Scott’s query about dispensing practices, he will know that that trend was taking place long before this Government took office.

We are not only working with the BMA on the new contract but increasing the numbers of young GPs who are coming through the pipeline, as Alex Neil mentioned. To increase supply and widen access, we are investing £23 million in a medical education package, which includes an increase of 50 medical undergraduate places from 2016-17, a pre-medical entry programme to commence in the academic year 2017-18 and the establishment of Scotland’s first graduate-entry medical programme—ScotGEM—which will commence in 2018-19. Those programmes—particularly the pre-medical entry programme—specifically address the point that Alex Neil made about getting into medicine people from more disadvantaged backgrounds and from our rural areas. They are precisely the people who are more likely to return to, and stay in, those rural areas.

We have heard concerns about board-run practices. As of 1 July 2017, of the 959 practices in Scotland, only 57 were run directly by NHS boards rather than as independent businesses. Sometimes that is the best solution for a local area; sometimes such practices will return to independent contracting. The point is that patients will always be able to see a GP, whether from an independent business or from a 2C practice. The safety of patients is always the highest priority.

We are committed to primary care and to GPs, who do a difficult job and do it well. As the needs of our population change, so too will our primary care services, as we shift the balance of care towards the community.

We are investing a huge £71.6 million in direct support of general practice this year, and the figure will be £250 million by the end of this session of Parliament. However, we know that we have more to do. Our work on the GP contract and our investment in GP recruitment and retention are on-going and are supported by our primary care fund investment.

We want everybody who is involved in primary care to get behind our vision for the future of primary care in order to help to make it a reality. I trust that all MSPs from all parties want that to happen, too.

Meeting closed at 17:30.