Chamber and committees

That is such a good question. I have been engaging with the British Medical Association and the RCGP on that issue for quite some time. As Brian Whittle will know, before the pandemic, many GP practices would traditionally close on Friday afternoons and would have an agreement with NHS 24 that it would pick up any calls or inquiries that came in after that. That approach gave practices the flexibility to do CPD and it meant that their patients had the confidence of knowing that their calls would be picked up by someone else.

In the course of the pandemic, practices were not able to do that. I suspect that I do not need to tell Mr Whittle how much pressure NHS 24 is still under, so we have to find another model. We are working on that with the BMA and the RCGP. For me, practitioners having protected learning time for CPD is absolutely pivotal. It is important for all of them, but it is especially important in giving our trainee doctors the confidence to progress in their roles as general practitioners. We are working on that.

At the moment, because of the pressure that NHS 24 is under, practices are approaching matters in a way that suits them, as opposed to using the previous model, which involved NHS 24. For example, in a practice that I visited, which is not far from the Parliament, GPs are having to use half an hour in the morning to go through their educational or CPD material, which is not ideal. I give my commitment to the RCGP and the BMA to see what more we can do to support them in that regard.

That is a fair question to ask. Of course I would look to see where we can provide even more support. I make the point, which I know is well understood by colleagues around the table, that the long Covid fund is on top of the £18 billion in this financial year and £19 billion in the next financial year that we are giving to the NHS and social care, a chunk of which is given to our health boards. It is worth saying that our front-line spend per head is higher in Scotland than it is in other parts of the UK. It is £323 per person higher than it is in England, for example.

I keep going back to the Lanarkshire model because I have seen it first hand, and I have spoken to some people who have benefited from that service. When that rehabilitation service was up and running, people did not wait for the allocation from the £10 million long Covid fund; they used their health board allocation to create that team—to recruit and hire those multidisciplinary team members who are providing that support to long Covid sufferers. I hope that that gives you some reassurance.

Agreed.

We have looked at other long Covid clinic models around the UK, such as the Hertfordshire model, which Dr Sandesh Gulhane has mentioned previously. I go back to the Scottish intercollegiate guidelines network and NICE guidelines on long Covid, which say that one model would not fit all areas. I think that we all accept that.

I agree strongly with the RCGP’s written evidence to the committee on that. I will quote it directly. It says that long Covid

“often requires generalists skills to treat, but most can be fully managed in primary care, and the GP is best placed to provide this holistic approach.”

It goes on to say:

“there is an increased risk that patients presenting with Long Covid symptoms may have instead another cardiac or respiratory condition which may have similar or even identical symptoms. Patients need a GP assessment and investigation”—

this is the important part—

“rather than being funnelled inappropriately into a clinic that is designed for one condition, and then require further investigation and alternative management.”

I have never been opposed in principle to long Covid clinics—I have said that from day 1. That is why I have asked my team to look at the Hertfordshire model, for example. In effect, they try to cut out the middle person. We have GPs and, if they have the appropriate referral pathways through the implementation support note that take people directly to a Covid rehabilitation service in, for example, Lanarkshire—that is the example that I keep using—that is a better model than a GP having to refer someone to a long Covid clinic that would then have to refer them on to another pathway. I am not opposed to long Covid clinics in principle; I am trying to allow local health boards to design services to meet their local need.

It will be reprofiled over the next few years.

I will go to the clinician to give a response to that, because it would not be right for me, without clinical knowledge, to assert what will happen in relation to long Covid and its comparison to ME and chronic fatigue syndrome. There are clearly some similarities in how the conditions present. The disbelief that Murdo Fraser referred to in his question we also sometimes hear from ME and CFS sufferers. However, if you do not mind, I will pass to Dr Harden to give a view on the question.

That could be the case, but in the absence of such clinics I do not think that we should take our foot off the pedal at all on data gathering. I agree with the first point in your question, which is that having such data will be vital for improving the services that we provide. For me, the challenge in having long Covid clinics from what I have read and seen from the various models across the UK—there is not just one model—is that they tend to end up being a bit of a middle man. [Interruption.] I hear a mobile phone ringing. It is like the Oscars: when you have talked for too long the music comes on and they tell you to get off. [Laughter.]

Education is an area where we want to get better. I have met a number of young people who were suffering from long Covid—in fact, we had such a meeting a number of months ago just outside the Parliament. Some families told me that their school was excellent but others told me that that was not so much the case.

That is why it is important that I am having—as you can imagine—conversations with the Cabinet Secretary for Education and Skills. We are bringing in education officials, as well as fair work officials, to go back to Jackie Baillie’s question about employment. We are taking a cross-Government approach to that work, but it is fair to say that it is work in progress.

That is a good point, although we should still say that the Covid vaccination programme has been really successful compared with others. You are right that we can see where the uptake level is but, generally speaking, if we compare uptake with that for other vaccination programmes, we can say that we have done incredibly well. I thank the army of vaccinators that we have up and down the country for what they have done in that regard.

We need to do everything that you mentioned. It is not just about vaccination, although that is the game changer. Vaccination must be front and centre of our response to Covid and to not just reducing the number of people who contract it but lessening its effects as best we can.

There is also continued work to do on ventilation in educational and work settings. The messaging is important, too. I referred to our Covid sense campaign, which reminds people about the measures that they can take.

We need to do all those things. There is no single answer.

We are still involved in work around surveillance—we continue to be vigilant, should there be any other mutations or variants of Covid. We continue to work on a four-nations basis in that regard, and I know that the UK will continue to work internationally with global partners on that.

There is not one answer to the question; there are multiple things that we have to do. We will keep up the regular drumbeat of campaigning, as well, of course, as the next programme of vaccination, on which we continue to take the advice of the Joint Committee on Vaccination and Immunisation.

We are getting the balance on that. We will continue to work on a four-nations basis with the UK Government on the various surveillance measures that we have. Waste water sampling is effective. It gives us real-time data in a way that other approaches do not necessarily do, so we will continue to ensure that we have that.

It is also fair to say that we are getting to the transition phase. We had the height of the pandemic and we are now going from pandemic to endemic. As we do that, we will end up treating Covid in the way that we treat other viral infections. Surveillance will be an important part of that transitional phase, as it is for other viral infections.