Chamber and committees

You have again said little that I would disagree with. A concern that we have always had is that we must not, in creating multidisciplinary teams, merely take things away from other services in the community. That concern is particularly valid, given the pandemic’s impact on the ability to attract staff from outwith Scotland to this specific programme. I should say that the same concerns surfaced in the early years of reform, but they have levelled off in recent years.

We are confident that there is genuine additional capacity in primary care to complement existing teams. In the recruitment of MDTs, we are seeing much greater emphasis on training and on “growing your own”. A good example of that is pharmacotherapy. The plans for years 1 and 2 were very pharmacist-heavy, if I can put it that way, but recently the skills mix has been moving towards use of pharmacy technicians, with a projected 75 pharmacy technicians in post for every 100 pharmacists in 2023, compared with the current figure of 29 for every 1,000. Just for reference, I point out that training a pharmacy technician takes about two years, which is considerably less than it takes to train a pharmacist. It is important that we have that pipeline for the future to ensure that we do not end up cannibalising the existing workforce.

I am keen to attract much of the workforce from other parts of the United Kingdom and from the common travel area, as well as from overseas. We are putting a lot of emphasis on international recruitment. I was pleased to see some of our international nurse recruits in NHS Fife recently. That was in a hospital, on the acute side in secondary care, but there is also a role for them in primary care.

Potentially, people might think that they are far enough away. That is why the signage will be really important, to continue to reinforce the message that people are still within the no-smoking perimeter.

My hope is that, for the vast majority of people, that walk of 15m away is enough for them not to light up and have a cigarette. However, some people will still wish to smoke. That is why we need a period of time to remove smoking shelters, for example, from within that 15m boundary and make sure that they are outwith that boundary.

If there are areas for smoking outwith the perimeter, I hope that people will be cognisant of footpaths and other areas that people walk in, because if you are not a smoker, having to walk past a crowded smoking shelter and catching that second-hand smoke is an unpleasant experience. We know the dangers of second-hand smoke, which have been well articulated by a number of studies and third sector organisations—in particular, there is the good work that the Roy Castle Lung Cancer Foundation does in that regard.

We keep that under regular review, as you would expect. It would be fair to say that there have been some challenges. There has been a focus on out-of-hours services in a number of health boards, with NHS Lanarkshire and NHS Forth Valley having been looked at most recently. We continue to keep the matter under review. There have been challenges throughout the pandemic and we are still in a very tricky position, but I hope that, as the pressure eases, we will be able to make out-of-hours options more attractive and sustainable.

We know that people need out-of-hours access. The demand on NHS 24 services, which has gone through the roof in recent months, is an example of that. We keep that under regular review, but I also recognise that there have been challenges.

You are spot on, convener. That is why, this month, we have launched a specific campaign to support our receptionists. A couple of weeks ago I was at Taymount surgery, where I had a discussion with Dr David Shackles of the Royal College of General Practitioners. When you walk into the surgery, it is immediately obvious how busy the receptionists are.

Unfortunately, we have heard reports of receptionists facing abuse over the phone and sometimes in person. I am sure that everyone around this table will agree that that is completely unacceptable. It does not matter what pressure the individual is under or their need to see a GP or a member of a GP practice—aiming abuse at our receptionists or any health and social care staff member is unacceptable.

Clearly, there are people who feel that receptionists act almost like a kind of gatekeeper. That is why we launched a campaign this month to explain that when receptionists redirect patients it is being done because that is in the best interests of the person’s clinical care. There may be others who can see the person and that will allow the GP, as an expert general medical practitioner, to focus on complex cases. I hope that will result in a better experience for the GP and, most importantly, a better experience for the people we are looking to serve.

That is certainly part of the feedback that we get. The focus on being an expert medical generalist makes that option more attractive. Easing the workload burdens so that GPs can focus on more complex cases also helps. There are also other issues around retention. I am well aware that there is a practising GP on the committee and I would be very interested to hear his thoughts. The feedback that we get from GPs is that the contract and the work that we are doing around MDTs in particular—if we get it right and embed it—will make general practice a more attractive proposition. Having said that, last year’s fill rate was about 98 per cent so we are doing well. However, retention is an important issue and this approach could be key to retention.

I hope that I can reassure you as much as possible that we are very much aware of that point. We hope to mitigate some of those challenges, in everything that we do. Part of the conversation that we are having will be about whether we need to look at transport solutions, for example.

The question that Emma Harper asked a moment ago is pertinent. Can something be done to ensure that, instead of people in some parts of Scotland having to travel 50, 60 or 70-plus miles to a service, they can access services remotely, through digital means, in a way that is not currently available?

For people who end up having to travel, whether they are in an urban or a remote and rural landscape, it is important that we put solutions in place at inception, as opposed to designing a service and then thinking, “Goodness, there are challenges here that we will have to try to fix.” The issue is a fundamental part of our thinking about services as we move forward.

Good morning to you, convener, and to the committee members. I hope that you are all keeping safe and well.

I am pleased that, as one of your first inquiries, you have chosen an area often referred to as the bedrock of our health and social care services, which is, for most people, the front door to accessing the health service.

I am impressed that the committee has gathered quite a diverse range of views from both primary care providers and, importantly, the wider public who use those services. It has been extremely interesting to read the feedback and the comments of contributors to the evidence sessions over the past months.

As in most areas of health and social care, we have engaged in significant redesign of primary care both before and during the pandemic. It goes without saying that the contribution that primary care services make each day to the health and wellbeing of Scotland through continuity of care and meaningful relationships with patients is foundational to our public services. I thank every single member of the primary care family for their incredible efforts during the pandemic.

Prior to the pandemic, we were already engaged in significant reform of pathways through the 2018 general practitioner contract. That has been a real step change in primary care pathways in the community, with people able to access a wider range of healthcare professionals through their practice while freeing up GP time to focus on more complex care.

By March 2021, 2,463 staff had been recruited to the multidisciplinary teams—over two and a half whole-time equivalent staff per practice—and that number will have risen significantly over this year. For our part, we have allocated every penny of the £360 million investment committed to recruit those teams over four years, and we are delivering a further £170 million investment as part of the 2022-23 budget to continue the expansion of those important MDTs.

Injecting that additional capacity into practices has been a real boon in allowing our wider primary care system to respond flexibly to the pandemic, staffing Covid hubs and assessment centres and supporting the Covid vaccination roll-out while keeping core GP services going to address the wide array of patient issues.

On those core services, it is worth pointing out that, even before the pandemic, video and telephone consultations were part of how care was delivered in general practice. Over time, as restrictions ease, the balance will shift towards more face-to-face appointments—as it should—but a mixture of appointment types will remain a core part of general practice, as we know that it suits many patients to have consultations with their GP over the telephone or over video.

It is not just general practice that has made significant adaptations throughout the pandemic and changed to meet the needs of its patients while keeping them safe. For example, we launched NHS Pharmacy First Scotland in the summer of 2020, which has increased the range of common clinical conditions that the community pharmacist can treat.

NHS 24 has also seen a significant increase in demand over the past year as a consequence of Covid, the expansion of mental health hubs, and access through 111 to the national redesign of urgent care, all delivered 24/7, where previously NHS 24 operated largely out of hours.

As we look to the horizon and to recovering from the worst of the pandemic, it is important that we continue to shape our pathways to address the demand that has arisen, and that we learn from the experience of the pandemic.

As I said, GPs are usually the first port of call for people who are seeking professional help for mental health issues, and the vast majority of mental health consultations occur in primary care, covering a diverse range of needs. That is why, by the end of this session of Parliament, we will have invested in 1,000 additional mental health workers in primary care.

Primary care services often deal with far more than clinical issues. That is why we are investing in providing non-clinical and social support and advice, including support for individuals who are experiencing social and financial disadvantage and exclusion. Staff such as community link workers, welfare advisers and mental health workers can help with those concerns.

We are committed to a range of recommendations on tackling inequalities, following the publication of an expert group report last month. I see the focus on mental health and health inequalities as complementing and further developing the primary care reforms that we have already instigated.

We will continue to commit our efforts towards having more multidisciplinary and multi-agency working, and to shifting our focus to the community to ensure that we get the right care to people at the right time.

I am of course happy to take questions from the committee.

Yes. That goes back to what I said. I am happy to state on the record that, in the conversations that health boards have had with me and my officials this week, they have said to us that this feels as though it could be the worst week of the pandemic—or, if not the worst, certainly among the worst weeks. There is an accumulation of factors that I have already spoken about.

Yesterday, I met Pauline Howie and Tom Steele, the chief executive and chair of the Scottish Ambulance Service, and they said again that they are under severe pressure. We know the knock-on effects—I will not go into detail on them. In fact, from my reading of previous evidence sessions, I know that Murdo Fraser has previously raised the issue of ambulance waiting times and turnaround times at hospitals.

We are seeing those pressures play out this week. My hope—it is not just a hope; we are working to do this—is that we will alleviate as much of that pressure as we possibly can while realising that, as Professor Leitch says, we will get through the peak that we are currently at. The question is how we will insulate our health services, including emergency medicine, when we have a future peak. We are working as hard as we possibly can on that. However, it is a challenging time at the moment.

There have been some positives on the redesign of urgent care. If any programme has been needed during the pandemic and is needed into recovery, it is the redesign of urgent care. It is not unusual for the Government to take feedback on what areas of any programme can be improved and to take advice on whether it needs to be readjusted.

We are implementing the redesign of urgent care programme, which is supported by significant investment. For example, a hub has been established in every health board to directly receive referrals from NHS 24, offering rapid access to senior clinicians and using telephone or video consultation, where possible, which minimises the need for people to attend A and E.

There has been good innovation, but we are never against seeing how we can improve programmes, including the redesign of urgent care.

We have certainly seen a positive impact, although it is difficult to judge that during the pandemic. The redesign of urgent care programme will be vital to our recovery, as we will have to reduce the demand on acute care. The redesign of urgent care will help with that, as will the hospital at home work that we are doing. Addressing the issues on social care that Alex Rowley raised will also help with it.

We will have to reduce the demand. The redesign of urgent care programme has helped to an extent, but I have no doubt that we should consider what additional improvements could be made to it.