Chamber and committees

Absolutely. There is little for me to add, because Emma Harper has articulated the matter well. There is a continued role for the hybrid model, but it might be particularly important in rural areas and for island communities. That goes back to my earlier point about the need to ensure—as the Government is doing—that there is good digital coverage across the entire country. We know that that is particularly important in remote, rural and island communities. Our investment in that respect speaks for itself. I have little to add, other than to agree with Emma Harper’s assessment.

Again, that is a really good question. You said that a third of respondents gave that response. I will need to look at the survey, but I hope that that means that the majority of people, then, found social prescribing quite helpful as a pathway. However, that third is still significant. It is not an insignificant number of people.

A few things need to be done. First of all, we need to be able to extol collectively the virtues of social prescribing. I am a real believer in the ability of social prescribing to have a positive impact on people, because I have seen it at first and second hand. I have seen it in my own personal experience, and I have seen it as a constituency MSP. I have a fantastic community link worker in Pollok, and she has just taken over from an equally fantastic community link worker at the health centre in Pollok. I am, in some sense, an evangelist for social prescribing.

Social messaging, too, is absolutely needed and is key to this. Given what you have said, perhaps the Government needs to think about how we can articulate the virtues of social prescribing. It is not just about signposting people to X, Y or Z service in their local community; it is about the relationship that a link worker builds up with an individual and their being able to say, “This is how I think this or that service could support you”, and taking that journey with them. I think that that is key.

It is fair to say that there is an issue with consistency across the country, and we have commissioned Voluntary Health Scotland to develop a national network of community link workers where they can share best practice and act as peer-to-peer supporters for each other. The question, though, is: how will they share that knowledge across the country? Voluntary Health Scotland is undertaking a review of the support and training needs of link workers, and it will build on those findings, too.

There is a lot to do in this space, but I hope that, for most people who experience an interaction with a community link worker, the experience is a very positive one.

For me, this is about ensuring that we invest in multidisciplinary teams. I have every trust that the clinical advice that a person will receive will mean that they get the best care possible. For example, someone might be signposted towards physio, but the physio might be so interconnected with the rest of the multidisciplinary team that they could say, for example, that the best thing for that patient would be to see the pharmacist, because their mixture of medicines might be having a side effect that was causing their issue. The patient would then be passed on to the pharmacist who might be able to provide a different medicine or a combination of different medicines that will help with the patient’s pain.

We have to trust in that clinical judgment—I certainly do. In those few instances where things go wrong, which we must acknowledge can happen, there are avenues for pursuing complaints, but I would hope that in the vast majority of cases, because clinicians are working as part of a multidisciplinary and multi-agency approach, people will get the right care in the right place at the right time.

There is little for me to add to that, other than to say that that is part of the reason why we have left it as broad as saying that we are committed to an additional 1,000 mental health workers. For some areas, a community link worker with all their different specialties might be important, but it might be more important for a GP practice to have a specialist in a particular area of mental health such as, for example, young people’s mental health. We want to allow local areas to have that flexibility. It is also why the relationship with the integration authority at the local level is really important, as is the relationship with the third sector.

There is little more for me to say other than that I agree with Emma Harper’s assessment of retaining that local flexibility. As I have said previously, that is the tension that we sometimes have to work through, because there are challenges around standardisation and good arguments are made for why it is necessary, but it could have a diminishing effect on local flexibility. That important discussion is under way and we need to continue with it.

We are conscious and aware of that issue. If you have not read the report that was published by the short-life working group on primary care and health inequalities, I would definitely recommend it to you. You may well have done so already, but if you have not—I know how busy we all are—it is certainly worth taking a bit of time to go through it. The points on digital exclusion are well made by the likes of Dr Carey Lunan, who was involved in the working group and is part of the deep-end project, of which I know members are aware. That project involves 100 GP practices in the most deprived areas, and those who are involved in it often talk to us about digital exclusion.

I have a couple of points on that. One is that, with anything that we do in the digital space, we have to ensure not just that we are aware of and acknowledge digital exclusion, but that there is an alternative pathway for people who just do not have access digitally. No matter how hard we try, there will be some people who do not feel comfortable or are not able to use digital routes, so we have to ensure that alternative pathways are available for them.

The other thing that we should do—and we are doing this—is focus on digital inclusion. As you would imagine, I work closely with colleagues across Government on that agenda, which is important to all cabinet secretaries and ministers. The connecting Scotland programme aims to support an additional 300,000 households to get online. We need to connect as much of Scotland as possible, but we must also accept that alternative, non-digital pathways will be important for some people, and that is part of our thinking.

That is a really good and important question. There is no getting away from the fact that in the past two years there have been significant increases in backlogs.

As was stressed to me by a number of orthopaedic consultants whom I met recently, it is important to recognise that being on a waiting list is not benign, but comes with serious and significant impacts on the individual who is waiting. Those impacts can include deterioration in health and an increase in chronic pain. Patients who do not know how long they will have to wait for their procedure or operation often manage their situation by going to primary care or their GP practice. I entirely accept that there will undoubtedly continue to be a level of pressure on primary care as the backlog for treatment continues, so tackling the backlog will be key.

Of course, key to tackling the backlog is controlling transmission of Covid. Between the delta wave and the omicron wave—between last October and November—we had a bit of a breather; that, alone, allowed scheduled operations to increase by around 23 per cent within the space of a month. We know that the NHS has the ability to recover if we can somehow insulate it from the worst impacts of Covid-19.

Staffing is also key, but I will not rehearse in too much detail our good record in that respect. I am not saying that there are no vacancies—we know that there are—but the more than 28,000 additional whole-time equivalent posts that have gone into our NHS under this Government is an impressive record.

My third point is that the issue is why we are investing heavily in the multidisciplinary team model. For people who are waiting for an operation that has, unfortunately, had to be postponed due to the pandemic, visiting the physiotherapist in their GP practice might have real importance and value and could, at the same time, free up GPs to be expert medical generalists and to deal with more complex cases. Stephanie Callaghan’s point is well made and important, and highlights why the NHS’s recovery is so vital.

We will provide signage and we will work on providing information on the ban. Enforcement information will be available to patients in different languages as well, which is quite important, although the “No smoking” symbol is internationally recognised and that is why it is used. That being said, the information on the ban is really important, so we will work closely with health boards on that.

If the regulations are passed—and I have every confidence that they will be—the period between now and the regulations coming into force will be really important for us. We will make sure that the information about the ban is communicated well, that there is a lot of attention on the ban’s coming into force, and that the consequences of ignoring it are in place. That is all being discussed with local partners in advance of the regulations being passed.

That is a fair comment, and that message came out loud and clear from the various evidence sessions that the committee held. I have a couple of points to make on it. First, I hope that for the vast majority of people who have accessed and had treatment from the various members of a multidisciplinary team at a GP practice—whether that is the physiotherapist, the advanced nurse practitioner or the pharmacist—the service that they received will have been expert and extraordinarily helpful. I have no doubt that, as more and more people get access to such individuals, they will absolutely understand the value of the multidisciplinary team model.

Secondly, the issue of communications has been raised with me by not just patient groups but clinical representative organisations such as the British Medical Association and the Royal College of General Practitioners, the latter of which I met just a couple of weeks ago. There are a couple of things that we can do on that. First, the work that we are doing with the Health and Social Care Alliance Scotland is really important, and it will be well known to you, convener, and to other committee members. We recently commissioned the alliance to conduct a qualitative survey of patients’ experience of accessing general practice, which forms part of a wider 10-year monitoring and evaluation strategy for primary care.

The pandemic has been challenging for us. One thing that we can all recognise is that so much of our marketing and communication has gone into how to behave during Covid: the latest Covid regulations and rules, rules around testing and self-isolation and so on. As we recover, there will still be Covid communication—we are running a Covid sense marketing campaign at the moment—but I hope that we can begin to rebalance some of that communication to the public. That is about the redesign of the urgent care programme and the message that, even if you are not seeing your GP, it might be better for you to see another member of the team at the GP practice within the community.

As part of that, at the end of last year, we delivered a leaflet to every single household with an accompanying letter from the chief medical officer and the national clinical director. That well-produced leaflet showed the various pathways for someone to access treatment and what services people could expect from GPs and the other pathways, including pharmacy first and NHS 24.

I take the point and do not disagree that there will be something of a cultural shift. We are very focused on that.

That is a great question. You are absolutely right that, although we can be ambitious on the recruitment side, if we do not retain those staff, the value of that recruitment is questionable.

I hear a number of things from our general practitioners and people who work as part of GP teams. It goes back to some of what the convener was saying. If we ensure that the burden of the workload is eased and spread out across multidisciplinary teams, that absolutely helps. Again, I do not think that it is giving away any secrets to say that, when I speak to GPs, they tell me that they are exhausted.

The second thing that we need to ensure is that we remove potential disincentives. For example, the BMA asked me to look at whether there is anything that we can do on pensions. I have written to the UK Government on that, but I am also looking to see what the Scottish Government might be able to do with regard to pension schemes. I have not come to a firm conclusion yet, but I am looking at the matter with an open mind.

We also need to continue to make progress with the current contract. I hope that the next phase of the contract will not only make becoming a GP an attractive proposition but will make staying in the profession attractive. There is a lot that we can do, which we are already working on, and there is more that we can do, which I am giving active consideration to. Sue Webber’s point is absolutely right—we have to focus on retention as much as we do on recruitment.

Yes. We have well-established plans, as you know, with an equality impact assessment, and we would test any policy of significance within that assessment. To give you some level of assurance when it comes to our health policies and the initiatives that we pursue, I can say that, in the 10-odd months I have been Cabinet Secretary for Health and Social Care, I have not had a discussion about the initiatives that we are pursuing that has not included some sort of discussion about inequality at the root of it.

The figures are stark, and they speak for themselves. Therefore, a concerted effort in all areas of health policy, not just screening, absolutely must be focused on driving down those inequalities. I can reference the work that the excellent primary care health inequalities working group has done, which we just published earlier this month.