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Chamber and committees

Meeting date: Wednesday, November 29, 2017

Meeting of the Parliament 29 November 2017

Agenda: Business Motion, Portfolio Question Time, Policing, General Practice, Non-domestic Rates (Arm’s-length External Organisations), Business Motions, Parliamentary Bureau Motion, Decision Time, Small Business Saturday 2017


Contents


General Practice

The Deputy Presiding Officer (Linda Fabiani)

The next item of business is a debate on motion S5M-09218, in the name of Miles Briggs, on general practice.

15:15  

Miles Briggs (Lothian) (Con)

I am pleased to open the debate and bring a focus on general practice to our Parliament.

Members from across the chamber will be acutely aware of the shortage of general practitioners in their communities, the number of practices that are unable to take on new patients and patients who struggle to secure appointments with their family doctors due to ever-increasing demands. The fact is that the number of GPs has remained around the same since 2008 but the number of patients has increased by more than 5 per cent in Scotland and the number of patients who are aged 65 or over has risen by around a fifth. At the same time, the number of general practices in Scotland has fallen by 6 per cent, while average list sizes have increased by 12 per cent. All the time, the demand for consultations continues to grow significantly.

The Royal College of General Practitioners Scotland has correctly identified “the longstanding underfunding” of general practice over the past decade. For everyone who takes part in the debate, it is worth noting that general practice in Scotland receives 7.24 per cent of the health budget, compared to 8.24 per cent in Northern Ireland and 8.79 per cent in England.

Another stark indication of the huge pressures on GP services will be demonstrated in Lothian region tomorrow. The GP partners at the East Craigs practice here in the capital, which serves almost 8,000 patients, will become the latest in a growing number to hand back their practice to the local health board, having previously closed their list to new patients. A notice to current patients from the GP partners states:

“Due to the ongoing nationwide recruitment crisis in General Practice we are unable to provide the level of service we’d like.”

Local people in that part of west Edinburgh are understandably anxious and uncertain about the future of their practice and angry that their valued family doctors feel that things are now so bad that they can no longer manage the practice and provide local healthcare.

The fact that even general practices in dynamic, attractive and growing cities such as Edinburgh find it impossible to recruit new GPs speaks volumes. Two decades ago, many GPs would have jumped at the chance to secure any position in an Edinburgh practice. What frustrates our hard-working GPs, who have to deal with such pressures and demands as our population grows, is that Scottish National Party ministers were consistently and repeatedly warned that a GP shortage was likely and coming, given the demographics of our doctors and the increasing demands on general practice.

Tom Arthur (Renfrewshire South) (SNP)

Will Miles Briggs give way?

Miles Briggs

Briefly.

Tom Arthur

Richard Vautrey, the chair of the British Medical Association general practitioners committee, has said that eight out of 10 of England’s GPs say that their workload is unmanageable, that there was a record number of closures of general practices in England last year and that we are now seeing a—[Interruption.] Miles Briggs has raised issues and he has referred to Northern Ireland, Wales and England. The pressures are felt throughout the United Kingdom, so does he recognise it as a broader, global phenomenon? If he is going to make accusations against SNP ministers, does he not see that Jeremy Hunt has responsibility as well?

The Deputy Presiding Officer

I will give you an extra half minute, Mr Briggs.

Miles Briggs

Thank you. I think that I might need three, actually.

I remind Tom Arthur—as we have to do with all SNP members—that this is the Scottish Parliament and we are talking about Scottish health.

Tom Arthur

Does the member’s party take responsibility for the situation in England?

The Deputy Presiding Officer

Will you stop shouting, please, Mr Arthur?

Miles Briggs

Back in the spring of 2008, the BMA said that a workforce crisis was imminent, as too few GPs were being trained to replace those who were retiring or leaving early. The Cabinet Secretary for Health and Wellbeing at the time, who is now the First Minister, insisted that there no problem and that the SNP had

“robust GP workforce plans in place to retain and recruit doctors”.

However, the reality is that those plans do not appear ever to have existed—except, perhaps, in Nicola Sturgeon’s imagination—and, all these years later, we are still waiting for the Government to publish a national GP workforce plan.

Meanwhile we are nearing a severe crisis that could affect primary care in every community of our country, as a shortfall of 856 GPs by 2021 is predicted. The situation is critical.

The truth is that, when general practice works well, our national health service works well. The new GP contract contains some welcome elements, but many of them have come too late. Rural GPs in particular have serious concerns about aspects of the proposal, as voiced in the past few days by the Rural GP Association of Scotland. Those will need to be addressed as GPs begin to vote on whether to accept the new contract in the next few days. The new contract needs to contain flexibility, as a one-size-fits-all approach will clearly not suit the needs of all GPs in the different parts of our country.

As Margaret Watt, the chair of the Scottish Patients Association, said at the weekend,

“We need fresh blood in our government who have new ideas for a way we can take our GPs and NHS collectively forward in the future”.

As an Opposition, we are working hard to provide some of the new thinking and fresh ideas that are needed to make general practice as attractive a career choice as possible. That means investing in front-line technologies to make long-term savings and a redesign of service to help modernise health systems.

It also means more Scottish medical places for Scottish students from all backgrounds, and it means encouraging them to stay in Scotland, work in Scotland and give back to our NHS in Scotland. It is worth reflecting on the fact that, had the SNP Government retained at 1999 levels the percentage of Scotland-domiciled students studying medicine and not allowed it to plummet, we would be training hundreds more young Scots to become GPs every year. Today, we see a recruitment and retention crisis in general practice in Scotland and an SNP Scottish Government that has almost had as many GP recruitment campaigns as it has managed to recruit GPs. Just as this SNP Government has dragged down Scotland’s once world-class education system, it has presided over a crisis in our GP surgeries. To use the First Minister’s favourite saying in the chamber, SNP members should hang their heads in shame.

It is now conceivable that Scotland could face a shortage of over a thousand GPs by 2021. It is little wonder that we will hear excuses, as we already have, from SNP ministers and back benchers. It is time that SNP ministers take responsibility for the crisis in general practice that they have presided over. Our NHS desperately needs effective and strategic leadership from the Government. Instead, most people I speak to who work in our NHS, and even the Government’s own advisers, are simply waiting for the SNP front bench to be sacked or redistributed.

We make no apology for bringing this debate to Parliament today. We on the Conservative benches care about the NHS. Like GPs and patients across Scotland, we want change.

In closing, I call on the other Opposition parties to support the motion. The Parliament can send a clear and united message that the SNP Scottish Government needs to take urgent action on general practice and to do far more than it is currently doing to prevent a meltdown in GP services. Until the Government fundamentally addresses the crisis that is facing general practice in Scotland, I believe that it will fail to realise the other health and social care opportunities and policy agendas that have cross-party support. Shifting the balance of care from acute to community can truly be achieved only with a well-resourced and funded GP service in Scotland.

Above all, when the SNP Government is rejected by the people of Scotland in 2021, I believe that it will be because of its mismanagement of our NHS by Nicola Sturgeon and the Government over the past decade.

I move,

That the Parliament recognises that general practice is a vital frontline service of the NHS; believes that the Scottish Government has underfunded general practice over the last decade and failed to shift the balance of care from acute to primary services; notes with concern Audit Scotland’s report that there is a lack of national data on the primary care workforce; further notes that one-in-four GP practices has a vacancy and one-in-three GPs is approaching retirement, and believes that the Scottish Government must take urgent action to prevent a crisis in general practice.

The Deputy Presiding Officer

I call Shona Robison to speak to and move amendment S5M-09218.4. You have no more than six minutes, please, cabinet secretary.

15:23  

The Cabinet Secretary for Health and Sport (Shona Robison)

Thank you, Presiding Officer. This is a landmark month for general practice, and I welcome the chance to talk about what we in the Scottish Government, working hand in hand with the BMA, integration authorities, health boards and the wider health professions, hope to achieve together for primary care over the next few years. It is ambitious and it is exciting. This is an opportunity to talk up general practice in Scotland, which is something that we have heard very little of in the past few minutes.

Before I get to that, let me stress, as I have on many occasions, that I fully understand the issues that are facing GPs and patients right now and that we are far from complacent. That is why we are taking the action that we are, which I will come on to in a minute.

In particular, I am very aware of the specific challenges of recruitment and retention for GPs in some areas, but those are the same issues that affect GPs elsewhere in these islands. Under this Government, there have been increases in the number of GPs, which is up 6.9 per cent since 2006. On its own, though, that is not enough. We need more GPs and more members of the wider multidisciplinary team, and healthcare has to adapt to meet Scotland’s changing needs.

In March, I announced that funding in direct support of general practice would increase by £250 million by the end of this parliamentary session, as part of our commitment to increase primary and community care funding by £500 million to 11 per cent of the front-line budget. That investment was described by the BMA as

“a positive step in the right direction”.

In September, we announced plans to lift the pay cap in Scotland for NHS staff in our next budget.

We have announced a game-changing new GP contract offer. The offer was prepared jointly by the BMA and the Scottish Government, which had never been done before, and was in marked contrast to the contract that was imposed on GPs in England in 2013. I understand that many of those GPs are considering with great interest our offer in the new GP contract that was published on 13 November, and that Alan McDevitt of the BMA has been invited to many meetings in England as that interest has grown.

GPs told us that they were overworked and spending too much time on matters that would be better led by other professionals such as nurses or pharmacists, so the contract offer will mean that the core role for GPs is one that they have trained to do: caring for people who do not know why they are unwell or who have complex needs and, in their leadership role, improving the quality of care.

At a local level over the next three years, new services that are based in general practices will be developed and staffed to take work off our busy GPs where it is safe and appropriate to do so. They will be run by multidisciplinary teams of pharmacists, nurses, allied health professionals, community link workers and many others.

We cannot mandate a one-size-fits-all approach.

Neil Findlay (Lothian) (Lab)

I am listening very carefully. What would the cabinet secretary say to the practice managers and GPs I met over the summer who told me that they are a resignation away from closure?

Shona Robison

I would say that I hope that they support the new GP contract and vote for it, because it will usher in a new era for general practice and primary care in Scotland.

In Scotland, some of our practices have a lot of older patients, some practices are in rural, remote and island communities, and others are in areas of socioeconomic deprivation, so we have published a draft memorandum of understanding that sets out how we expect services to be developed and delivered locally, led by the health and social care partnerships with national and local oversight involving our GPs.

We are not starting from scratch. Through our primary care transformation fund, we have already funded tests of change in every corner of the country, the learning from which will support development of the new services locally. In some areas, such as in our test of change in Inverclyde, GPs are already seeing the benefit of having embedded pharmacy support. Across the country, 198 pharmacists and 47 pharmacy technicians have already been recruited and are providing support to more than a third of practices in Scotland. Under the contract, every practice will receive pharmacy support by April 2021.

At national level, the third part of the national workforce plan, which focuses on primary care, will be published early next year, following on from the contract negotiations. It will help to identify and address the key issues for every part of the workforce. We are also dealing with the premises problems that GPs face and we have published a new premises code, which is backed by £30 million of new investment.

We are addressing the day-to-day challenges that GPs tell us they face. We have increased funding five-fold to £5 million for GP recruitment and retention this year, which is part of an overall £71.6 million package of investment this year in direct support of general practice. The number of GP specialty training posts in Scotland was increased from 300 to 400 in 2016, and bursaries of £20,000 were available for some of them. More GP training posts have been filled this year in Scotland than at any other time since the beginning of the decade.

The Deputy Presiding Officer

Very quickly, Alison Johnstone.

Alison Johnstone (Lothian) (Green)

The cabinet secretary spoke of the importance of recruitment and retention. Although recruitment lies at the heart of the issue, does she agree that we simply do not train enough doctors and that a significant number of new training places needs to be made available beyond those that have already been created by the new graduate school of medicine?

The Deputy Presiding Officer

That brings a new meaning to “very quickly”. Very quickly, Shona Robison.

Shona Robison

Alison Johnstone will be pleased to know that we have increased the supply of doctors and widened access for medical education, and that we have increased the number of training places. We will look to do more, but we are already investing £23 million in a wider medical education package that includes an increase of 50 undergraduate medical places from 2016-17, two pre-medical entry programmes, which commenced this autumn, and the establishment of Scotland’s first graduate-entry medical programme, which will commence in 2018 and will focus on rural medicine and general practice, in particular. Bursaries are available to students on that ScotGEM course in return for service to the NHS in Scotland. Above and beyond that, we have committed to investing in a further 50 to 100 undergraduate medical places over the course of this session of Parliament.

We are investing in the here and now and are planning ahead for the challenges to come. That means more investment, more staff, more GPs and locally driven change. We want everybody involved to get behind our vision of the future for primary care and help to make it a reality.

I move amendment S5M-09218.4, to leave out from “believes that the Scottish Government” to end and insert

“recognises the challenges, including in recruitment and retention, faced by GPs and the wider primary care sector; notes that the new GP contract, developed in partnership with the BMA, aims to reduce GP workloads; recognises GPs as expert medical specialists leading a wider primary care workforce; welcomes that the contract plans to significantly improve national data on primary care, as well as move to address the inverse care law by giving greater emphasis to the effects of deprivation on both physical and mental health and wellbeing; believes that an increasing share of NHS frontline funding being directed to primary care is necessary in order to help increase the number of GPs and wider primary care workforce, and that steps toward this should be set out in the primary care workforce plan, and is concerned that the potential impact of Brexit on free movement and the mutual recognition of qualifications may become a serious barrier to current and future recruitment efforts.”

15:30  

Colin Smyth (South Scotland) (Lab)

General practice is at the heart of our NHS. Almost 90 per cent of patient interactions are with primary care. For many, GPs are the first and vital point of contact with our healthcare system, but GPs and their practices also have vital on-going relationships with patients, whether in managing long-term conditions such as diabetes or in throughcare outwith the acute hospital setting.

However, a decade of cuts to the share of NHS spending for GP services and to training places has left that point of contact at breaking point. Like the NHS as a whole is, GPs are facing ever-increasing demand. In the decade up to 2016, the average practice list size increased by 12 per cent, but surgeries simply are not being equipped with the staff and resources that they need to meet demand. In fact, GP practices are closing at an alarming rate, with 70 fewer practices in Scotland than there were in 2006. A record number of practices have had to be taken over by health boards, with 1 in 20 now being operated by boards. Put simply, the number of patients is growing but the number of GPs is not.

In my home region of Dumfries and Galloway, the number of GPs who practise has decreased from 160 in 2008 to 130 in 2016, and over the same period the average practice list size has increased by 228. Crucially, research by the British Medical Association found that almost half of practices in Dumfries and Galloway have a vacancy. Nationally, one in four GP practices has at least one vacancy, and three quarters of those vacancies have been open for more than six months.

The problem is set to get worse. A BMA survey found that a third of GPs in Scotland plan to retire within five years, while only 15 per cent of medical students indicate an interest in entering general practice. An estimate from the Royal College of General Practitioners predicts a shortfall of 856 GPs by 2021. Frankly, that is a ticking time bomb. It is a crisis not just that is happening on the Government’s watch but that has been caused by many decisions that the Government has made.

As Miles Briggs highlighted, it is also a crisis that the Government has been warned about time and again. In 2008, Audit Scotland called on the Scottish Government to collect comprehensive data on GP and GP practice staff numbers in order to support workforce planning and to avoid a crisis. Almost a decade on, that crisis is upon us and the Government’s response so far has been woeful.

A GP recruitment and retention programme that was set up in 2015 with the aim of securing more GPs in rural and deprived areas has, since it was launched, recruited a total of 18 doctors across only five health boards. Those tokenistic attempts to improve recruitment fail to recognise the deep-seated issues that underpin the workforce crisis that our health service faces. Workloads are increasing, but resources simply are not keeping up with demand.

In general practice, we have seen the share of NHS funding fall by more than a fifth, to just 7.3 per cent—even lower than it is in England. As is the case for all staff across the NHS, GPs’ wages are falling in real terms, but the Scottish Government has continued to impose a pay policy that means that someone who enters nursing today is £3,400 worse off in real terms than someone who entered nursing seven years ago. There is a pay cap that every single SNP MSP voted with the Tories to keep when Parliament voted on the issue in May; they failed to recognise the link between the pay cap and the recruitment crisis in the NHS.

Shona Robison

Can Colin Smyth explain why on 1 November Labour voted against an SNP amendment that said that

“Parliament believes that the Scottish Government should work with the unions to lift the pay cap”?

Colin Smyth

Labour members voted for the motion that we lodged. If there is a debate about who will vote to lift the pay cap today, will Shona Robison get to her feet and tell us whether she is going to support Labour’s amendment, which calls for a real-terms increase in staff wages in the NHS?

I did not think so.

Staff shortages in surgeries compound the pressure on GPs, so it is not surprising that patient care is being put at risk. A British Medical Association survey found that nine out of 10 GPs believe that the quality of care that their patients receive has been negatively affected as a result of their growing workload. I repeat: nine out of 10 GPs are saying that patient care has been negatively affected. The reality behind all the figures and reports that will be quoted today is that patient care is being compromised by decisions that the Government has taken.

It is not just in relation to GPs that the Government has failed to listen to warnings about the inadequacy of its workforce planning. There are 3,500 nursing and midwifery vacancies, more than 950 of which have been vacant for three months or more. There are 476 consultant vacancies, 543 vacancies among allied healthcare professionals and 159 pharmacy vacancies. The consequence of those high vacancy rates is an increase in the burden on existing staff, which adds to their already unsustainable workloads.

From GPs to nurses, we have an NHS workforce that is overworked, under pressure, underresourced and underpaid. It is a workforce that the Government has failed.

I move amendment S5M-09218.2, to insert at end:

“; further believes that long-term workforce planning failures, including years of pay restraint, have contributed to rising rates of vacant posts across the health service, often placing general practice under further strain, and calls on the Scottish Government to deliver a real-terms pay rise to NHS staff as part of future support for Scotland’s health workforce.”

15:35  

Jamie Greene (West Scotland) (Con)

I am grateful to Miles Briggs for lodging this motion for debate in Opposition time today.

Some members will recall that, back in 2008, the BMA said that a workforce crisis was imminent, with too few GPs being trained to replace those who were retiring or leaving. They gave that warning to the then health secretary, Nicola Sturgeon, now First Minister. She said at the time that the SNP had

“robust GP workforce plans in place to retain and recruit doctors”.

Nine years later, where are we? One in four surgeries in Scotland has a vacancy and one in 11 is turning away new patients. One surgery closes every month and a record number of surgeries has been taken over by health boards. At the current rate, we are looking at being more than 800 GPs short by 2021. If the First Minister had robust GP workforce plans in place, the simple question that remains to be asked is: what went wrong?

Perhaps I can offer some insight. Promises and policies are one thing, but they must be backed up by sufficient funding. Investment in GP services has fallen from 9.8 per cent of NHS spending in 2005-06 to just 7.2 per cent in 2015-16, and that at a time when demand for health services is increasing due to an increasing and ageing population. In my own region, NHS Ayrshire and Arran is running a £5 million healthcare deficit, which has built up over many years. In Scotland, spending has been stagnant at £800 million a year, despite there being more than 125,000 extra patients since 2012.

Members do not have to take my word for it; what do the experts say? The RCGP Scotland chairman said recently:

“The state of the general practice service in Scotland is the worst it has been for at least a generation.”

Last year, the BMA said that the lack of GPs in Scotland was extremely concerning. This year, the BMA accused the SNP of ignoring a critical shortage of doctors.

Sandra White (Glasgow Kelvin) (SNP)

Jamie Greene has mentioned the BMA three times. Will he join the BMA in encouraging GPs to vote for the new contract?

Jamie Greene

I would like doctors to make that decision for themselves.

As it stands, 52 Scottish GP practices are now classed as 2C, which is to say that they are run by the local health board, mostly because of a lack of GP staff. The number of patients who are being treated by 2C practices in Scotland has almost doubled, from 83,000 in 2007 to 160,000 in 2016. In our eyes, that is wholly unacceptable. Anyone who took part in my recent members’ business debate on GP shortages in West Kilbride learned that that practice was handed back to the health board by its longstanding GPs.

Anyone who was in the chamber for portfolio questions today will have heard the health secretary claim that I am simply complaining about the state of affairs in GP practices in Scotland. Apparently we are talking down GP practices in Scotland; in fact, the local Ayrshire MSP, Kenneth Gibson, said that we are scaremongering in the local community by highlighting the situation.

The SNP faux outrage that the Conservatives dare to come here and raise these issues on behalf of our constituents is as laughable as it is telling. I make no apologies for coming here to be the voice of the many people whose messages fill our inboxes or who attend our surgeries to ask us to raise these issues. The knock-on effect is not surprising. When people cannot access their GP, they turn to acute hospital treatment, which causes massive additional strain on A and E services that are already under intolerable pressure.

The debate is about much more than a GP recruitment crisis; there is a crisis of governance. I urge all members in the chamber to support Miles Briggs and his motion today.

15:40  

Fulton MacGregor (Coatbridge and Chryston) (SNP)

As members know, I am the parliamentary liaison officer to the Cabinet Secretary for Health.

I leave aside the outright brass neck of the Conservatives in criticising spending on health or any public service to say that it is important to recognise that general practice is a highly valued part of our healthcare system in Scotland. I agree that we should take measures to ensure that general practice is an attractive path for doctors to pursue, and that can be achieved through the new GP contract. As has been said, that reform has been reached through discussion between the BMA and the Scottish Government, and I support the view that it best supports Scotland’s health needs at this time.

I was pleased to read in today’s Coatbridge Advertiser, my local newspaper, that the Scottish Government’s proposals are being welcomed, particularly by Dr Chris Mackintosh of the Lanarkshire health and social care partnership. He is a professional in the field, who does not have the doom-and-gloom approach that we have heard from the Conservative benches today. He has stated that the proposals have the potential to ease current pressures on GPs by cutting bureaucracy. Through the new contract, GPs will be able to achieve a much-needed balance, allowing patients to have access to GPs when they really need them.

Many reforms to general practice are needed. The discussion about who we see when we attend our local surgery is an important one. Is it always necessary for us to see a doctor when we need health advice? The answer is almost certainly no. The local Waverley practice in Coatbridge health centre in my constituency has operated with nurse practitioners for some time; theirs is a model that is worth looking at.

Miles Briggs

Will the member take an intervention?

Fulton MacGregor

I am sorry but I do not have time.

The practice operates a system in which GPs answer the triage line. It is often possible for a doctor to give advice over the phone, reducing the number of sick people in the waiting room.

I recently visited another GP practice in my constituency, the Jamieson practice in Chryston, and had a useful and frank discussion with the doctors, nurses and support staff about the challenges that they face as a village practice. It is a sister practice to one in Moodiesburn, which has issues that I am taking up with the health board. It was made clear to me on my visit to the Jamieson practice that a major stumbling block to getting more GPs into the practice is the requirement to take a share of the financial risks associated with the building. I am glad to see that part of the proposed reforms is the creation of a fund to ensure that health boards take on the ownership and associated financial burden of the buildings. That simple step will undoubtedly bring more young doctors into general practice.

Despite all of the good work that is being done by the Scottish Government to drive up standards in our NHS, there can be no doubt that the Brexit shambles, presided over by the Tory Prime Minister in London, is doing more damage to our health service than can ever be mitigated.

Rachael Hamilton (Ettrick, Roxburgh and Berwickshire) (Con)

Will the member take an intervention?

Fulton MacGregor

No. I am running out of time.

It is shameful that the Tory UK Government refuses to guarantee the rights of EU nationals post-Brexit—[Interruption]. The Conservatives do not like hearing this, but it is one of the biggest threats to our current NHS workforce. EU nationals currently account for 3 per cent of the workforce in the health and social care sector, and around 5.8 per cent of doctors are non-UK qualified. Yet again, I make it clear how much we value those workers; we will continue to fight for their rightful place in our diverse workforce.

Our NHS will undoubtedly be damaged if our EU medics and their jobs are not secured after Brexit. Our Tory members need to start providing assurances and answers rather than attacks on this SNP Government.

15:44  

Neil Findlay (Lothian) (Lab)

The searching speeches of a parliamentary liaison officer—every one of them. [Laughter.]

Over the summer, I held a drop-in session for GPs and practice managers, and what they told me was truly shocking. Things are at a critical stage in many practices.

Here are the facts. NHS Lothian is spending nine times as much on locum doctors for staff practices as it did two years ago. NHS Lothian has been forced to take over the running of nine practices in recent years—more than any other area in Scotland. Many practices are reliant on locums to keep their doors open. Several long-standing and well-established practices have told me that they are one resignation away from closure. Locums are commanding a starting fee of anywhere upwards of £450 a day and are able to dictate what they will and will not do for that money. The simple principle of supply and demand is seeing costs soaring at a time of shortages. In short, it is a locums’ market.

In NHS Lothian, 51 of 122 general practices are restricting new registrations, and a number of them are informally closed to new patients entirely. At the then Deans and Eliburn medical practice in Livingston, all five GPs resigned back in March from the practice, which had been taken over by the health authority. It is now run by a company called the Barclay Partnership, which has been invited in to take over failed practices and has a growing portfolio of them. I think that the same company has taken over the East Craigs medical practice.

I hear regularly of practices reporting that they are unable to secure cover. Others say that they have advertised for new GPs or new partners: in the past, they would have had a dozen applicants, but today many are very lucky if they get one. Many receive no applications at all.

All the time, patients wait longer and longer for appointments and existing staff drown under the pressure of trying to keep things afloat. Strathesk medical practice in Bonnyrigg recently had to tell patients that it could offer only emergency appointments because of staff shortages—another example of how the crisis is impacting on patient care.

Of course, the more a patient’s ability to see a doctor is blocked or delayed, the more likely they are to present at accident and emergency, where—according to yesterday’s figures—we have the longest waiting times on record. Is that any wonder, given the GP situation?

Alternatively, people start putting off getting things checked, so bigger health issues emerge down the line. All that causes more delays in the system and, ultimately, increased costs. The overwhelming majority of patients do not have the option to go private: they do not have the option to go anywhere else, and neither should they have to. The NHS is their only option and the SNP Government is failing them.

Joan McAlpine (South Scotland) (SNP)

If he is so concerned about spending, can Neil Findlay explain why he stood on a Labour manifesto last year that committed less to the NHS than the SNP has committed? In fact, Labour committed less to the NHS than any other party in Parliament did.

Neil Findlay

Ms McAlpine likes to mislead Parliament. She has just done it again, as usual.

The Government may have increased funding, but the problem is in recruitment and retention of GPs. With high workloads and lack of support, many junior doctors are not considering general practice as an option.

The Scottish Government has to be called to account for the crisis. It cannot have come as a surprise to it that a large cohort of GPs are approaching retirement age, or that potential recruits to the profession want a better work-life balance, so where was the workforce planning? What did previous health secretaries do to plan for this situation? What did the First Minister do to avoid the crisis when she spent years as health secretary?

A combination of Tory austerity and the SNP’s shambolic incompetence has brought one of the most vital elements of community healthcare to the brink. We have to stop cutting and start investing, and we have to do things better and smarter, but we also have to train more GPs. My fear is that things will get much worse before they get any better.

15:48  

Richard Lochhead (Moray) (SNP)

For many of the reasons that members have mentioned in relation to the situations in their own constituencies, I have had more reason to speak to local GPs and medical staff in Moray over the past year than I had in the previous 12 years. I have to say that what they are telling me does not exactly chime with what we heard from Miles Briggs. I do not hear vitriol from them, or simplistic solutions: what I hear from GPs in Moray is that there is a very complex situation.

It is not just the rest of the UK that also faces such a situation, as we have heard from members. Many western societies do, because of demographic trends that they are experiencing, along with other issues that we are also experiencing in this country, including people wanting a better work-life balance.

Of course, in this country, we have also had budget difficulties over the past few years—in particular, because of the Conservative Party’s austerity agenda. Those are some of the issues that I hear about.

Miles Briggs

In a written answer from the cabinet secretary about the finance that the health service will be receiving, she says that in the budget for 2017-18, there will be £304 million in additional Barnett consequentials. Is that not new money for our health service?

Richard Lochhead

One thing that we have not heard in Scotland is that the NHS is facing a humanitarian crisis, which we have heard about in recent years, where the Conservatives are in charge south of the border. The SNP Government has a good track record of stewarding the NHS in this country and action has been taken.

The GP contract will make a positive difference to GPs. We will pay close attention as the GP contract moves forward, but early feedback to me in Moray is that GPs will not have to own their buildings and that more staff will be employed in their practices, which will help to free up GPs to focus on specialities. A number of other measures, including the minimum income guarantee, are very popular. We hope that they will make general practice a much more attractive career choice for our young people.

I had the pleasure of welcoming the Cabinet Secretary for Health and Sport to Moray on Monday, to visit Dr Gray’s hospital, Keith health centre and the Turner memorial hospital. She met local GPs and consultants at the hospitals and discussed some of the fantastic opportunities that we have to change things to attract more doctors to work in Moray, as well as some of the challenges that they face. Facilities are very important. A modern state-of-the-art health centre will be more attractive in recruiting more GPs to come and work there, especially in rural areas. That is why Keith health centre, along with the local community, is campaigning for new facilities.

Another issue that has been raised with me and which, again, I am thankful that the Government is addressing, is the need to ensure that we give more incentives to medical graduates to stay and work in the Scottish NHS after they graduate. That is why I very much welcome the first graduate-entry medicine programme, which will commence in 2018. It includes a return-of-service bursary of £4,000 per year and an optional grant worth £16,000 over the four-year course that will be payable to students in exchange for a year of service in the NHS in Scotland.

Many doctors now choose to go and work elsewhere for a few years: we have to attract them back to the Scottish NHS and we need to attract them to work in rural locations, as well. Trainee doctors have to undertake some of their training at local hospitals; I spoke to one at Dr Gray’s hospital. Caitlin Collins said that she will praise Dr Gray’s hospital to the sky to other trainee doctors across Scotland to try to encourage them to train there. She said:

“I have just finished Foundation Year 2 (FY2), and have therefore completed my basic training that all UK junior doctors must complete. Usually at this point in our career we apply for ‘specialty training’ or other training jobs. I am sure you are aware, however, that there is an increasing trend for junior doctors at my stage to move out of training, out of the NHS and even out of the country”

to places such as New Zealand and Australia.

“This has become popular for a number of reasons, mainly: better work/life balance; further experience in a specialty they are interested in (before applying for a training post)”,

hopefully back in Scotland;

“experience in a different hospital/area;”

and

“opportunities to improve their CV”.

The demands of trainee doctors in the 21st century are very different from what they were in past times.

The Presiding Officer (Ken Macintosh)

Mr Lochhead, you need to conclude, please.

Richard Lochhead

We have to take that on board and recognise it as we move forward. I welcome all the effort that has been made by the cabinet secretary and the Scottish Government, and I ask the Conservatives to bring some common sense so that we can move forward with a much more rational debate.

15:53  

Alison Johnstone (Lothian) (Green)

General practice is clearly a

"vital frontline service of the NHS".

None of us can do without access to a family doctor, and current vacancy rates are unacceptable. We cannot support early healthcare interventions without well-resourced GPs. In Parliament and beyond I have made the case that investing more in general practice is key to tackling health inequalities. It is unacceptable that GPs in the most deprived areas received very little additional funding per patient when they typically manage longer patient lists, and more patients with complex long-term health conditions.

The Conservative motion calls on the Scottish Government to take

"urgent action to prevent a crisis in General Practice".

I agree that action has been urgently needed. I do not want to prejudge the proposed GP contract; it was published only a few weeks ago and we have not yet heard all the representations that GPs and other health professionals will wish to make. However, whatever one’s opinion of the new contract, it clearly represents a significant intervention by the Government to address GP workload and conditions. For that reason, I will not support the Conservative motion today.

The contract outlines a new way of working. I note that Dr Petra Sambale, a deep-end GP, says that she is “surprised and proud” that the Scottish NHS is trying a “different way” of supporting GPs. It is important that a revised allocation formula for the first phase of the contract will give greater weight to deprivation—a change that I have called for, and which I welcome.

Ultimately, recruitment and retention challenges lie at the heart of pressures on general practice. I agree with the Labour amendment that “years of pay restraint” have affected staff retention across the NHS, and that staff shortages elsewhere create pressures on general practice. The Scottish Green Party has been clear that the NHS pay cap must end and that staff should have the real-terms pay rise that they deserve.

We also have to tackle at its root the shortage of GPs. We simply do not train enough doctors and we must seriously increase the number of medical school training places.

We must also make careers in medicine much more accessible to students from working-class backgrounds. Last year, researchers at the University of Dundee found that the vast majority of students at Scotland’s medical schools come from the most privileged backgrounds: in fact, 86 per cent of Scottish medical students have parents in the very highest-earning professions. Between 2009 and 2012, less than 5 per cent of medical students in Scotland came from the least affluent 20 per cent of postcodes in the country.

We understand that access to other publicly important professions—in the judiciary, in our media and in our Parliament, for example—should reflect the population that we serve. The medical profession is no different. It is a fact that competition for medical school places is less intense than it is generally believed to be. When NHS chief executives presented evidence to the Public Audit and Post-legislative Scrutiny Committee, they noted that last year 830 students leaving school in Scotland applied for a total of 834 available medical school places. We must increase the number of places and take strategic action to contextualise admission to medicine at university and radically change the intake. Such steps are necessary to ensure that, in years to come, we do not struggle to recruit and retain talented and enthusiastic junior doctors who are keen to build their careers in the NHS in Scotland.

Making general practice an even more attractive profession is vital, too. I have seen the difference that a little bit of protected time makes to GPs and patients in the Govan SHIP—social and health integration partnership—project by encouraging young GPs to commit to working with patients who have complex health needs. That involves providing additional funding so that GPs can lead extended consultations with patients and so make a difference to the most vulnerable families and reduce demand on acute services.

All practices should also have access to expert money-advice workers, because embedding financial support in general practice is a really effective way of boosting low family incomes and protecting health. A focus on the family is vital. We often talk about person-centred care, but GPs get to know families across generations. We cannot allow that unique perspective to be lost.

15:57  

Michelle Ballantyne (South Scotland) (Con)

Over the SNP’s 10 years in government, it has systematically driven general practice to the brink. One Scottish surgery closes or is handed back to the local authority every month, one quarter of GP training places go unfilled and thousands of GPs who have been trained right here in Scotland are leaving the country to live and work abroad. We have a crisis of recruitment, a crisis of resources and a crisis of confidence in the SNP Government.

The situation did not emerge overnight. The cabinet secretary was warned last year by the BMA that the lack of GPs in Scotland was “extremely concerning”. As Miles Briggs and others have said, the First Minister was warned in 2008, when she was health secretary—again, by the BMA—that a workforce crisis was imminent, with too few GPs being trained to replace those who leave or retire. The First Minister did not listen. Instead, she declared that the SNP’s GP workforce plans were “robust”. I wonder whether she would now like to reconsider that declaration. We must not look at the issue in a vacuum. As the SNP has systematically weakened general practice over the past decade, A and E services, out-of-hours services and acute hospital admissions have been put under extreme pressure.

To give credit where it is due, I say that I believe that the new contract for GPs is a step in the right direction. As well as a new funding formula better to reflect workload demands and demographics in practice’s local areas, there will be service redesign to permit longer consultations for patients with complex health needs. There are proposals to refocus and refine the role of the GP and to expand multidisciplinary teams, and to factor in and expand the skills of other health professionals, including nurses and pharmacists. Those are laudable and necessary actions that should go some way towards relieving the unsustainable workload that is facing general practice, and towards allowing our incredible GPs to do what they do best, which is to provide expert and patient-centric generalist medical care.

However, for many who have lived and loved the profession, the damage has been done. This is particularly stark in my region—South Scotland. I have spoken with constituents on the doorsteps and I have heard their concerns at my surgeries. Their opinions do not diverge from one another—GPs are brilliant and their expertise and compassion are unquestionable, but getting an appointment feels like an insurmountable task. Seven out of 13 GP surgeries in Midlothian now operate restricted lists. One of them—the fantastic Newbyres medical group in Gorebridge—wrote to me in September to explain the decision to restrict its list. It said:

"We did not take the decision to restrict our list lightly. We came to the decision in order to provide safe, quality and accessible care to our existing patients. Over the last 18 months, our list size has grown by over 12%, with no increase in central funding, whilst we have had to increase the number of GPs, along with an increase in nursing and phlebotomy hours."

Midlothian is the fastest-growing local authority area in Scotland. The increase in new housing and the influx of new families, all of whom will need a GP, will exert further pressure on surgeries such as Newbyres. I submitted written questions to the cabinet secretary in the hope of clarifying for my constituents exactly what the Government is doing to support the surgeries. One question was on action to improve GP recruitment in Midlothian, while the other was on what discussions the Government has had with Midlothian GPs on the impact of increased house building. It will come as no surprise to many members that the answers that I received were almost identical. They were cut-and-paste responses that did nothing to address the concerns of GPs and patients. That is simply not good enough.

That is not an isolated example. GPs on the front line have been crying out for help from Gorebridge to Garthdee, and from West Linton to West Kilbride, but they are consistently let down and underfunded. A cut-and-paste solution will not work. I hope the new contract will be a catalyst for fundamental change, but after years of empty rhetoric from the SNP, it is no surprise that many GPs are not holding their breath. I hope that members will support the motion.

16:02  

Alex Cole-Hamilton (Edinburgh Western) (LD)

I am grateful to the Conservatives for securing time for the debate, and although I believe their motion to be incomplete, I am happy to assure them of our support for it.

Just days after I was first elected, something strange began to happen in my constituency. A small but steady stream of people walked into my office with letters stapled to their prescriptions from the doctors at East Craigs medical practice. The letters were short, but amounted to something akin to a distress call. “Help us”, they said, “Contact your MSP—we cannot go on like this.” Members should find that story familiar because I have told it in almost every debate about the GP crisis since I took my oath, and I have backed it up with representations to the cabinet secretary and NHS Lothian.

Nevertheless, irrespective of the work that I have undertaken and the work of the partners at the East Craigs practice, it emerged last week that the partners have to hand back their contract to NHS Lothian, and the surgery will be taken over by Barclay medical practice. There will now be disruption, a loss of local knowledge and relationships and possibly even a reduction in out-of-surgery services. I put on record my thanks to the partners, doctors and staff at East Craigs for soldiering on so valiantly in the teeth of the worst crisis facing our surgeries since the formation of the NHS. The pressures on that practice represent, in microcosm, a story that is being played out in every constituency in the country. Increased demand on lists are compounded by the needs of an ageing population and worsened still by an inability to fill partner vacancies caused by widespread retirement.

Therefore I welcome the motion lodged by the Conservatives and stand with them in their condemnation of a Government that seems wholly unequal to the task of dealing with the crisis, given its reluctance to put local medical services at the heart of planning reform; its workforce planning cycles of five years, which fail to recognise that it takes seven years to train a GP; and its failure to address mental health problems, which still account for one quarter of all GP appointments.

The motion is timely, but it is incomplete. It conveniently fails to address the 600 lb gorilla in the wings that is the headlong rush of the Conservative Party into a hard Brexit. Put simply, Brexit has the potential to turbocharge our GP staffing crisis. Indeed, the Royal College of General Practitioners in Scotland said that if the 226 GPs from other EU countries who are working here were forced to leave there would be grave consequences for patient safety.

The uncertainty is already having a material impact on staffing levels: EU doctors who might have come here are put off and those who work here are returning to other EU countries. Frustratingly, that uncertainty is far from necessary. The UK Government could—and should—immediately guarantee the rights of all EU citizens who are working here, in recognition of how important free movement is to our NHS. I am quite certain that nobody who voted leave in June last year did so on the basis that their local GP could be deported.

What makes the situation all the more pressing is that, irrespective of Brexit, by 2021, Scotland will need an additional 856 GPs. The Scottish Government has been staring the crisis in the face for years and is still found wanting. The UK Government is threatening to compound the situation with uncertainty for our European workforce. My party will not back down from calling out either Government in that regard. We owe our primary care staff at all levels in our NHS a great deal. They are there when we need them; the least that they can expect is to have our support when they need us.

16:06  

Colin Smyth

Today, we have a chance to show Scotland’s healthcare workforce our support, not just with warm words, but with meaningful action. Speaker after speaker from the SNP and the Conservative Party highlighted that our GPs are the bedrock on which our NHS is built, as are our nurses and allied healthcare staff, who deliver care and compassion every day. It is just a pity that none of those speakers said that staff should be properly rewarded for the job that they do. Praise and goodwill go only so far. They will not end the record number of nursing vacancies in Scotland’s NHS, with 3,500 nursing and midwifery staff missing from our hospitals, and they will not magic up the 856 GPs that we will need by 2021 just to return to the levels of 2009.

Today’s debate has exposed the Scottish Government’s failure to listen to warnings given 10 years ago by Audit Scotland, the Royal College of General Practitioners and the British Medical Association on workforce planning. That failure has left us with a workforce crisis—a workforce that is under pressure, underresourced and underpaid. The Government’s amendment fails to recognise that its decisions, such as Nicola Sturgeon’s decision to cut nursing and midwifery training places by almost 300 in 2012, have helped to create the workforce crisis that we face today.

In responding to the crisis, the cabinet secretary talked a lot about the new GP contract. [Interruption.] Does Mr Mackay want to make an intervention? No.

There is a great deal in the contract that I support, including the reductions in bureaucracy, which Fulton MacGregor mentioned, and the removal of the burden of premises from GPs’ shoulders.

The Cabinet Secretary for Finance and the Constitution (Derek Mackay)

Will Mr Smyth take an intervention?

Colin Smyth

Yes.

Derek Mackay

Does Mr Smyth support the position of the Labour Party in Wales that, no matter what, it will not lift the pay cap and properly remunerate NHS staff—or anyone else for that matter?

Colin Smyth

Let me tell Mr Mackay a wee bit about Wales. Wales, unlike the Scottish Parliament, does not have tax-varying powers. However, Mr Mackay will not use those powers to stop the cuts in social care and the cuts to our local councils. I hope that, when it comes to the budget, we will force him to wake up to the crisis that faces our health service, our local councils and social care across Scotland.

As I said, there is much in the GP contract that I support—[Interruption.] I do not know whether Mr Mackay has another intervention—he keeps shouting out.

Derek Mackay

I will make another intervention if I can get one. I have never had so much time in the chamber—I am quite enjoying it, Presiding Officer.

Why did eight Labour authorities not raise the council tax to invest in local services?

Colin Smyth

Let me tell Mr Mackay a wee bit about the hated council tax, as he used to call it. The council tax increased in every single local authority because this Parliament voted to increase it. I would have thought that he would have remembered that, because it was his proposal. If he wants a solution to the council tax, here is one: scrap it and replace it with progressive taxation that does not impact most on the poorest.

If Mr Mackay has finished making his speech, I will return to the GP contract. As I said, there is much in it that I support, but there are issues that need to be resolved. The Rural GP Association of Scotland has raised significant concerns about the impact that it will have on practices in rural areas. It has stated that

“certain key features in the proposal intended to address the challenges faced by the profession will instead destabilise rural practices”.

It is therefore vital that the Scottish Government engages constructively on those concerns to ensure that the new contract works for rural areas, where the impact of the SNP’s workforce planning failures are particularly acute.

Shona Robison and Alex Cole-Hamilton also talked about the possible impact of Brexit, and I share many of their concerns. Scotland’s health and social care sector employs around 12,000 EU nationals, and we know that parts of the sector would simply not function without their contribution. Therefore, I support Alex Cole-Hamilton’s call for the UK Government to guarantee the rights of those EU workers to remain in the UK.

The Government’s amendment fails to recognise that, while 3 per cent of Scotland’s NHS workforce is made up of EU nationals, 12 per cent of it is made up of workers from other parts of the UK. The staffing crisis that our NHS faces is with us here and now, even before the hard Brexiteers have their way.

The Deputy Presiding Officer

You must close, please.

Colin Smyth

In the debate, SNP members have failed to address the issue at the heart of the workforce crisis—the forcing down of the value of wages year on year. If anyone believes that a pay rise is not affordable, they should listen to what Neil Findlay said about NHS Lothian, which now has to spend nine times more on locums than it did two years ago.

The Deputy Presiding Officer

You must close now, Mr Smyth.

Colin Smyth

I urge members to support our amendment, so that we can tackle the workforce crisis.

16:11  

Shona Robison

I will try to respond to as many of the points that have been made in the debate as possible.

I thank the Rural GP Association of Scotland for its positive and thoughtful response on the approach to and intention behind the GP contract. We will listen to what the association has said, and I will offer to meet it at the earliest opportunity.

I turn to the issues that Miles Briggs raised. He said that the solution to the problems in general practice was to improve the IT and to increase the number of medical places. We have just put out a contract for a new GP system, and we will expand the number of undergraduate medical places by 50 to 100 over the course of the parliamentary session. Therefore, those things are already happening. If that is it from the Tories, I am afraid that it does not amount to much.

Miles Briggs

Will the cabinet secretary give way?

Shona Robison

In a minute.

Miles Briggs could have shown leadership by backing the BMA and backing the new contract. It is interesting how prevaricating and equivocating Miles Briggs and the other Tory members—with one exception—were about the new contract. That tells us all we need to know.

Miles Briggs

When it comes to retention and recruitment, the Scottish Government has put a cap on the number of Scottish students who can study medicine in this country. If the cabinet secretary wants to show some leadership, she could today announce the lifting of that cap, so that we can train more Scots to study medicine.

Shona Robison

I have set out clearly how we are expanding the number of medical places—we are expanding not just the number of undergraduate places but the number of graduate places. We are providing a brand-new medical school, where bursaries will be offered in response to a commitment to the NHS. Those are solid proposals that will make a difference. We have had no ideas from Miles Briggs and the Tories, other than suggestions about things that the Scottish Government is already doing, so I will take no lessons from them.

Neil Findlay

Will the cabinet secretary take an intervention?

Shona Robison

I let Neil Findlay in during my opening speech, and I need to make progress.

On pay policy, I have already said that we will negotiate a pay deal in partnership with the unions, as they expect us to do. On 1 November, we put forward a clear proposition, whereby we said that we believed that

“the Scottish Government should work with unions to lift the pay cap”.

Fulton MacGregor rightly highlighted the £30 million that will be provided over three years to support the premises fund. It is a significant problem, with GPs concerned about being the last people standing with negative equity in their premises, so it is right for us to seek to make progress on that.

Richard Lochhead was right to mention the issues in his constituency. I had the pleasure of visiting Keith health centre on Monday. What I saw there was a group of very dedicated health professionals—not just GPs—running a very high-quality service. It is important that, as part of our modernisation, we have a primary care estate that is able to meet the needs of patients not just in the here and now but in the future.

I welcome Alison Johnstone’s comment about the GP contract being a significant intervention, which it is. She has had a commitment to the issue for some time, having wanted the Scottish allocation formula to better reflect deprivation. I am pleased that she recognises that the new contract does that. She also asked about more training places—

John Scott (Ayr) (Con)

Will the cabinet secretary take an intervention?

The Deputy Presiding Officer

The cabinet secretary is in her last minute, Mr Scott.

Shona Robison

Of course, we have more training places and, through our medical education access programmes, we are opening up medical training to those from more deprived backgrounds. I believe that we will see more doctors from our more deprived communities coming through those access programmes. I will be happy to write to Alison Johnstone with more detail on that.

I thank Michelle Ballantyne for welcoming the GP contract—I say well done to her for that, as she was the only member on the Tory benches who did so. There are other points on which I might not agree with her so much. Just so that she is aware, local authorities do not take over GP practices; health boards do. Our salaried GPs do a fantastic job—just as those who are GP partners do. We should remember that when we talk about 2C practices.

The Deputy Presiding Officer

Please come to a close, cabinet secretary.

Shona Robison

Finally, Alex Cole-Hamilton made an important point about Brexit. It will compound some of the challenges that we already have. [Interruption.] The Tories do not like to hear it—of course, they do not.

The Deputy Presiding Officer

You must close, please.

Shona Robison

I thank all those who contributed to the debate. I will write to those I have not managed to mention.

The Deputy Presiding Officer

I call Brian Whittle to close the debate. We have already eaten into time for the next debate, so a speech of less than six minutes would benefit us all.

16:16  

Brian Whittle (South Scotland) (Con)

Health debates tend to be rather feisty, and today has been no exception. I was interested to hear the cabinet secretary suggest that the NHS has to adapt to the changes in healthcare, without mentioning the fact that the Scottish Government has failed to do exactly that.

The Scottish Government may very well argue that there are record numbers of healthcare professionals working in our health service, but it conveniently ignores the record number of vacancies. However, the Royal College of Nursing said to me recently that it is fed up hearing the SNP boasting about the numbers working on the front line when there is a serious shortage of staff across all disciplines required to enable nurses to do the job for which they are trained. That is just another example of the poor workforce planning that is becoming a hallmark of the Government.

There are worrying signs that being a GP is no longer seen as the career path that it once was. In 2010, 99.7 per cent of GP training places were filled. By 2016, that had fallen to just 68 per cent. The cabinet secretary and her predecessor must shoulder some of the blame for that. As has been mentioned, the situation is compounded by a steady decline in the number of home-grown students studying clinical medicine at Scottish universities, which has dropped from 63 per cent in 1999-2000 to 51 per cent in 2016. The strain on our GPs and GP practices that we see today has been a long time in the making.

As numerous members have mentioned today, surgeries across Scotland are closing. I am aware of at least two cases of surgeries closing or being taken over by the health board in Kilmarnock alone. Those might be the first, but I fear that they might not be the last. I recently visited a surgery and heard from practice partners who are faced with three GPs nearing retirement and are unable to find anyone to come in as a replacement. Increasingly, locums are being used, at serious financial cost to the health board. However, there is also a real social cost in losing the continuity of care that long-serving community GPs can give—knowing and understanding their patients’ needs, and knowing the things that are not in the notes.

As Miles Briggs highlighted, GP numbers have stagnated since 2008, while the number of patients has risen by 5 per cent, and the BMA has accused the SNP of ignoring a critical shortage of doctors. In 2015-16, around 7 per cent of the health budget was invested in general practice, against over 9 per cent in England. Here is the crux of the matter: in government, there are choices to make, but the SNP Government has consistently chosen not to invest enough in our GPs and GP practices. By failing to invest, the Government has failed to shift the balance of care from acute to primary care, despite pledges made to the contrary. It is not too late to act. We have made it clear that, if that is the direction of travel in which the Scottish Government is going and how it chooses to act, we will support it. However, we will not support it if its only action is to promise action and not to deliver.

This is not Oz and the Cabinet Secretary for Health and Sport is not Dorothy. Clicking her heels together three times and saying that there is no staffing crisis will not get the job done. lnaction, indecision and denial have left general practitioners without the resources that are required to deliver the service that they are trained to deliver and the service that we ask them for. If the status quo remains, the mental health strategy, the diet and obesity consultation and the shifting of care to more community-led initiatives, especially around palliative care, will end up gathering dust on a shelf because the very people we need to take the lead on delivering those strategies—our GPs—will not be there or will be under so much pressure firefighting that they will be unable to commit time or resource to the preventative agenda. Primary care is called that for a reason: it is the first port of call and the first step into care. We need to get it right.

Other members have been less vociferous in their interjections. It seems to me that the SNP is content to descend into blaming anyone else. The Scottish Government’s health team needs to spend more time thinking about how to address those problems and less time finding a comparison from elsewhere in an attempt to make Scotland’s situation look much better. It is time for less spin and more doctors.

For nearly two decades—in the second of which the SNP has been in charge—health has been a devolved matter. It is time that fingers stopped pointing elsewhere and people stopped hiding behind Brexit, as they have done recently—Fulton MacGregor tried to do that earlier—to cover up an increasingly difficult problem.

Fulton MacGregor

Will the member take an intervention?

Brian Whittle

I do not have time.

I recognise the difficulty in delivering solutions and that health is a major issue way beyond the Scottish Borders, but we cannot use that as an excuse for not making tough decisions, as Richard Lochhead tried to do. Tough decisions have to be made because making no decision at all for fear of making a tough decision, which happens currently, is not an option any more.

There is no getting away from it: our GPs and GP practices are suffering from a chronic lack of investment and support. If the Government is serious about shifting the balance of care into the community to relieve pressure on acute services, it is time to stop talking about it and to get on with the job.

The place to start has to be with our GPs. They lead our healthcare front line, they are the trusted professionals in our communities, and they are the first point of contact in the health service. We need to listen to what is being said on the ground and let the GPs help us to develop a profession that offers a desirable long-term career path once again.

GPs tell me that, most of all, they require time. They require time for proper consultations and continuing professional development, which is a luxury item these days, and in order to do the job that they are trained to do. Dismay at not being able to give the service that they want to give because of a lack of time is a significant reason that is given for leaving the profession.

It is time to support general practice, to give our GPs the tools to do the job that they trained for, to give general practice back the status that it deserves and to give GPs the chance to lead the drive towards a primary care, preventative health-led service and relieve the pressures on our hospitals.