Hansard

No, but a survey will take place that I think will provide more in-depth analysis of some of the data to which Richard Simpson refers.

I accept that there are significant GP recruitment and retention challenges, and that we need to build and maintain the existing workforce. That is why from 2016 we will increase the number of training places for GPs by 33 per cent and why we are investing in a programme to encourage GPs who have left general practice to return to the workforce, with investment in that this year. Of course, we are investing in GP recruitment and retention more broadly in order to make general practice a more attractive career option.

As we move forward into next year, health and social care integration presents us with a huge opportunity to do things differently. My vision puts primary and community care at the heart of the healthcare system, with highly skilled multidisciplinary teams delivering care both in and out of hours, and a wide range of services that are tailored to each local area. That care will take place in locality clusters, and our primary care professionals will be involved in the strategic planning of our health services. The people who need healthcare will be more empowered and informed than ever, and will take control of their own health. They will be able to directly access the right professional care at the right time, and remain at or near home wherever possible.

We are already heading in the right direction. We know that up to a quarter of the people who see GPs are suffering from soft tissue injuries, and that is why every person in Scotland can now call NHS 24 and get advice or be referred for physiotherapy if that is required. That is an example of the kind of change that we need across the system.

I will now set out my plan for making the vision a reality. I have mentioned Sir Lewis Ritchie’s review of out-of hours care, and again I record my thanks to Sir Lewis for his work. I know that he worked closely with many stakeholders including the BMA, the Royal College of Nursing, pharmacy representatives, national health service chief executives and others.

Sir Lewis told us that we need to do more, and be better at, multidisciplinary working, with more investment in the workforce and in infrastructure, and a drive towards changing the culture, centred on a model of urgent care resource hubs. He said that we need large-scale tests of change, moving quickly to whole-system change, and he is right. My initial investment of £1 million will allow us to begin the process of testing, and we will publish the national implementation plan in spring next year. That will coincide with the integration of health and social care, further enabling just the sort of joint working that we need.

Our detailed budget plans will be published by the Cabinet Secretary for Finance, Constitution and Economy tomorrow, so I will not pre-empt that—I certainly would not dare. However, I can say that I am determined that primary care expenditure will rise. We have already announced the new £60 million primary care fund, and I want to go further than that, with the balance of health spending changing over time so that a greater percentage of funding goes to primary care. That change is not short term but will continue throughout the current process of transformation.

More than £20 million of the £60 million primary care fund will provide a kick start to some of those major tests of change that Sir Lewis said that we needed. Some of the first things that we are going to test are fundamental changes to the GP contract. We are working with our key partners across the Inverclyde health and social care partnership area to develop and test new ways of working. I hope very shortly to be able to announce to Parliament the details of that work, which will draw on the knowledge of those working locally to identify the changes that can be made. That will help us to realise our vision for the future role of GPs and others in primary care and ensure improved outcomes for everyone. That will make a difference not just in Inverclyde but throughout Scotland.

We are investing £100 million in mental health over the next five years in the run-up to 2020, of which £10 million will go towards primary care settings to develop new ways of working such as the distress brief intervention.

I will move on to look at changes that we are making that affect GPs and other parts of our valued workforce. We value family doctors incredibly highly, and we want them to stay in the profession. As I have said before, the time has come to start talking up Scotland’s general practice; to encourage more doctors to stay; and to ensure that medical students choose a career in general practice.

The future for GPs lies in their having high-quality jobs that are focused on undifferentiated presentations, or working out who may need further assessment, investigation or referral; caring for people with multiple conditions; and quality and leadership. Other health or social care professionals will provide the care that they are best placed to provide. That future is a win for patients, who get to see the right person at the right time, and for all our healthcare professionals, who can make the most of their skills and knowledge.

We have been working with the Scottish general practitioners committee to redesign the GP contract, and I thank Alan McDevitt and his colleagues for their work. As I said earlier, we have removed the QOF system as of 2016, and we will take the opportunity that the process presents to focus on tackling inequalities more effectively, which I know is something that members on all sides of the chamber support. We will have the first version of the new Scottish contract in place by April 2017, and by then we will have made significant progress on changing the way in which general practitioners work.

We will remove the annual churn of contractual change and introduce the next version of the GP contract three years later in 2020, when the transformation in the way that GPs work will be nearing completion.

Our model of multidisciplinary working has implications right across the workforce, for community nurses and advanced nurse practitioners, allied health professionals, pharmacists, practice staff and those who work in new emerging roles. Our community nurses can lead and co-ordinate care management and specialist services, and in many instances are already doing so. I want to see more of that, and the chief nursing officer has recently begun work to transform and develop nursing roles so that they meet the current and future needs of Scotland’s people.

Let us not forget the important role that pharmacists play as clinicians in their own right and as a crucial part of multidisciplinary working. Up to March 2018, more than £16 million will be invested from the primary care fund to recruit up to 140 additional whole-time equivalent pharmacist independent prescribers, who will free up GP time to spend with other patients.

We also need to get the basics right. We need information technology systems that are fit for the future and flexible premises. For the period to March 2018, I have allocated £6 million of funding to the primary care digital services development fund, which will initially focus on increasing the availability and uptake of online appointments and repeat prescriptions.

To summarise, the transformational change plan is multifaceted and ambitious and it will take us a long way down the road that we need to travel. However, the changes will not achieve anything without the people who really make our Scottish NHS what it is.

I end where I started, by thanking all those who are involved in the journey so far. I also want to put on record my thanks to Richard Simpson. I had a helpful meeting with him the other day. He has brought a lot of experience in primary care to the chamber and that will be missed after the election. I hope that he might, in some way, continue to share his experience with us as we move forward with such important changes. I look forward to hearing what members have to say in the debate.

I move,

That the Parliament commends the good work of the dedicated health and care professionals who embody the community health services; agrees that effective frontline community healthcare is vital to helping people enjoy life at home, or in a homely setting, for as long as possible; recognises the challenges being faced in the recruitment and retention of GPs; supports the current work to agree a new GP contract for Scotland from 2017, which will see bureaucracy reduced for GPs to give them more time with their patients, presenting the opportunity to go even further to tackle health inequalities in communities; welcomes Sir Lewis Ritchie’s review of out-of-hours primary care and the Scottish Government’s commitment to work with partners to implement his findings; further welcomes the planned increase in GP training places and support for return to practice schemes to aid retention and recruitment in general practice, and endorses the aims of the £60 million Primary Care Fund to test new models of care, support the primary care workforce and enhance patient access.