Meeting of the Parliament

Meeting date: Tuesday, November 4, 2014

Official Report 856KB pdf

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Topical Question Time

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General Practitioners (Funding)

To ask the Scottish Government what its response is to reports that patients are being put at risk by its failure to adequately fund general practitioners. (S4T-00820)

Under the tenure of this Government we have increased the Scottish Government’s contribution to primary medical services by 10 per cent. Working with health boards, we are ensuring that more money than ever is being invested in local GP services. Investment in primary care has led to an increase in the number of GPs in Scotland by 5.7 per cent under this Government and this year we have ensured a GP pay increase and agreed a new three-year GP contract that frees up GPs to spend more time with their patients by reducing bureaucracy.

However, we can go further. Today, I have announced a new £40 million primary care development fund, which will allow our GPs and primary care professionals to evolve our health service to meet the changing needs of the people of Scotland. The new fund aims to empower GPs to develop initiatives that address workload challenges, tackle health inequalities in deprived and rural areas and meet the changing needs of the people of Scotland.

I welcome today’s announcement that—whether or not it is new money—£40 million is to be made available for GPs in rural and deprived areas. Presiding Officer, that sudden announcement highlights your wisdom and foresight in having weekly topical questions, if the result is a rapid policy alteration.

The reality is that the number of whole-time equivalent GPs in post at the end of January 2013 is just 35 higher than the 2009 survey number. Organisations involved in the sector have warned that boosting services will require much more than a one-off £40 million sum. What is the cabinet secretary’s long-term plan to ensure that we have an adequate number of GPs so that the quarter of patients who cannot get appointments within a week can do so?

Flattery will get you everywhere, Mr Hume.

Good.

I will disappoint you, Presiding Officer, because I told the Royal College of General Practitioners last week that I would be making that funding announcement.

This is part of a wider strategy for primary care. We have negotiated a three-year contract with GPs to get stability into the system, and we have substantially reduced the bureaucratic requirements on GPs to free up their time so that they can be with their patients. I have instructed every territorial health board to increase the GP and primary care funding this year and next. I will continue to do that until we have the required level of funding.

There is a national GP shortage, partly because of the feminisation of the workforce, leading to much more part-time working; partly because of the issue of work-life balance, which is making it more difficult to attract people into the GP profession; and partly because of the particular challenges in rural, remote and island communities, where we have extreme recruitment and retention difficulties.

We are working across a wide range of areas on a wide range of initiatives with all the key stakeholders to address all those issues. I recognise the challenges, but we are facing up to them and putting in place the resources to do so successfully.

In addition to the conventional practice nursing role, advanced nurse practitioners can improve access to GP services. Indeed, in many parts of Scotland, nurses with advanced qualifications diagnose patients and prescribe medication for a wide range of long-term conditions. Will the Scottish Government put in place resources and support to develop more such roles, so that the whole team can provide access to healthcare, as part of a long-term approach to workforce planning rather than more stop-gap measures?

Absolutely. I have been impressed by the nuka model in Alaska, where they have completely redesigned GP services. They recognised that only about 30 per cent of the people who saw GPs needed to see them and that the remaining 70 per cent would be better dealt with by a clinical psychologist, a podiatrist, an advanced nurse practitioner or whoever. Therefore, over the past few years, they redesigned their primary care services and, as a result, they have dramatically reduced the number of incidents and the level of hospitalisation and got a much more efficient system than they had before.

We can learn a lot of lessons from the nuka system. We have successfully run a pilot in Fife and a GP practice in Edinburgh will adopt the model. That practice is to be officially opened on Friday; I will see whether I can get Mr Hume an invitation.

I welcome the new £40 million primary care development fund. How much has been transferred from the performance-related pay system, the quality and outcomes framework, to core practice funding in the past two years? Has the transfer had a beneficial impact on how much time GPs have when treating their patients?

Over 2013-14 and 2014-15, the QOF, which is the framework for performance-related pay in the GP contract, was reduced by 341 points to 659 points, which moved £47 million of funding of GP income into core funding and out of performance-related pay. The reduction was negotiated with the Scottish general practitioners committee, which agreed that it would help to reduce the bureaucratic burden on GPs and free up GPs to spend more time with patients.

I compliment the cabinet secretary on the general direction of travel. I think that he would agree with me that the first step is to recognise the challenges that we face. For example, in the north-east of England—as opposed to the United Kingdom as a whole—there are more full-time equivalent GPs than there are in the whole of Scotland. That is reflected in a Nuffield Trust report. In Lothian, 74 practices have closed to new registration, and the same problem is occurring in other health board areas. [Dr Simpson has corrected this contribution. See end of report.] In Millport and in Drymen, to take just two examples, we are unable to recruit GPs, as a consequence of dispensing changes, which I know we are trying to address but which are causing difficulties. Locums are difficult to obtain, which puts pressure on partners in practices.

I accept the cabinet secretary’s long-term vision, and I understand the Alaska concept, but that will not change things overnight. How can the current local development plans, which the cabinet secretary has seen but I have not been able to see, affect general practice this year and next?

As I have said, under LDP guidance for this year and next I have instructed boards to put additional resources into GP practices. I think that GPs will buy in particular services that they require. For example, as I said to the Health and Sport Committee at this morning’s meeting, the addition of link workers in deep-end practices is making a substantial difference. In practices that are not deep-end practices but have an above-average percentage of patients who are elderly or very elderly, the money will be used differently.

I am happy to let GPs make the decision about how they need to spend the resources, as long as, in return for putting the resources in, we get an improvement in the ability to service patients, offer appointments more quickly and do all the other things that we all want to see. I do not want to write a blank cheque without getting something in return; I want to ensure that there is improved performance and quality in return for the money that we put in.

Recruitment and retention is a recurring problem in general practice. The main reason why I was happy to support the 2004 contract was that young GPs were not coming into general practice because of night work.

We still face problems recruiting and retaining in general practice. Has the cabinet secretary thought about giving incentives to young medical graduates to enter general practice? Today he told the Health and Sport Committee about the need for more medical graduates. Such graduates need to be guided when they have qualified. Does the cabinet secretary have plans to attract them into general practice?

From the work that we have done, we think that the issue is not a financial incentive but the work-life balance, as I am sure Mrs Milne agrees. There is a cart-and-horse situation. If more GPs worked in each practice, each GP would need to work fewer hours, and if GPs worked fewer hours it would be easier to attract more people into the profession.

It is about putting resources in. Jim Hume was right when he said that, given the shortage of GPs and given that a lot of the people whom GPs see could more appropriately be treated by an allied health professional or advanced nurse practitioner, we need a system in each GP practice—which we should be able to bring in sooner rather than later—whereby patients are triaged, to ensure that they go to the right person, who is not necessarily always a GP. If we did that much more extensively, we would take a lot of pressure off GPs. If we managed to do that, GPs’ work-life balance would improve, and the image of the profession and therefore the ability to recruit and retain GPs would improve.

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Justice (European Arrest Warrant)

To ask the Scottish Government how the decision to hold a vote on the future of the European arrest warrant before 20 November could impact on justice in Scotland. (S4T-00818)

As I have already told the chamber, I very much regret that the United Kingdom Government saw fit, with no pretence of consultation, to put our participation in the European arrest warrant system at risk. We hope that the UK Government will win the vote and succeed in opting back in. If not, I note the uniform concern across the Crown Office, defence lawyers and Police Scotland at the loss of an instrument that has seen hundreds of individuals, many of whom have been suspected of serious crimes, returned to Scotland from other member states or to other member states from Scotland to face justice.

I absolutely agree with the cabinet secretary that it will be very detrimental and dangerous if the UK Government does not opt into the European arrest warrant system, and I wonder whether he can explain exactly what limbo Scotland will be in if the option is thrown out in the vote before 20 November. Does the cabinet secretary agree that holding such a vote on such an important issue just before the Rochester and Strood by-election has more to do with political manoeuvring than it has with what is best for the people of Scotland and, indeed, the rest of the UK?

Yes, and that is the position of not just the Scottish Government but prosecutors, defence lawyers, rights campaigners and the police in Scotland and throughout the UK. The European arrest warrant has served us well and has brought people to justice in this country, some of whom have been charged with the most heinous crimes. I am very grateful to authorities in Slovakia and Poland that have assisted us; as I made clear in my previous response, we have also supported returning to justice people who have been wanted elsewhere. This is political manoeuvring by the coalition Government down south, and it is threatening what has worked well in serving justice not only in Scotland but elsewhere in the European Union.

The cabinet secretary has just highlighted one of the points that I wanted to raise in my supplementary question. We know that the rest of Europe supports the European arrest warrant system and, indeed, has been lobbying Westminster to support it. The worry in this Parliament is that, if a decision is not made in November and is left until later, we will be left in limbo. Like the cabinet secretary, I think that this is political posturing coming up to the Rochester and Strood by-election, in which the Conservatives are contending with the UK Independence Party.

I think that there was a question there, cabinet secretary.

I think that this is a case of legislating in haste and repenting at leisure. This is one of the matters that the Conservative Administration had initially not given any consideration to; having spoken to numerous ministers over the time, I know that they are going to considerable difficulty to try to resolve matters of their own volition. I hope not only that we have managed to sort things out but that the UK Government will win the vote but, if that were not to occur, the interests of justice in Scotland as well as the interests of justice throughout the European Union would be the worse for it. As I have said, this is simply political posturing, and it is damaging not only to those who work in the justice system but to all of us in our society who wish to ensure that justice is done.

I was fortunate to attend the human trafficking summit on 17 October, which was attended by representatives of prosecuting authorities from not only Scotland, England, Wales and Northern Ireland but the Republic of Ireland. At that summit, there was unanimity among the UK prosecutors on the importance of the European arrest warrant with regard to human trafficking. Does the cabinet secretary accept that point?

Absolutely. The member makes a very valid point. Human trafficking is a crime that by its very definition does not know or accept boundaries or jurisdictions. Given that, in Scotland, many people who are being trafficked come from European Union countries—we have been briefed on that very matter by Police Scotland—I fully understand the point that Mr Campbell has made and which was made at the meeting to which he referred, which is that the European arrest warrant has served us well in tackling what is a dreadful crime and a threat. It ensures that justice can be done wherever possible.