Meeting of the Parliament 10 November 2022
As the convener of the Health, Social Care and Sport Committee, I am pleased to open the debate on the committee’s inquiry into alternative pathways to primary care. I thank everyone who engaged with the inquiry, whether that was through the call for views, the public survey or the formal and informal evidence sessions. Being able to engage with so many different people in so many different ways, as the committee always strives to do, has been invaluable in helping us to reach our final recommendations.
Primary care services are the front door of the national health service. When a person seeks healthcare, their first point of contact has traditionally been a general practitioner. However, our inquiry focused on other routes to accessing healthcare in the community, which, for the purposes of our inquiry and report, we termed “alternative pathways”. Those various pathways include seeing a different and, often, specialist health practitioner—for example, a physiotherapist, urgent care practitioner or nurse—who is located in the GP practice or the local community.
A patient’s route to treatment might be through social prescribing, which aims to improve health and wellbeing through activities such as talking therapy groups, social and physical activity groups that are run by the third sector, and volunteering. There is also the option to use helplines or online services to access additional information or therapy. There are pathways on our high streets, where Government-funded specialist healthcare is offered via pharmacists, podiatrists, optometrists and hearing services, for example.
The Government’s vision is that people who need care are informed, empowered and able to access the right professional at the right time. The committee supports the primary care reforms and the Scottish Government’s vision to widen the primary care pathway. However, through our inquiry, we found that there are a number of obstacles to achieving that vision. Those include limited public understanding of primary care reform and what it means for the public; the workforce and capacity issues that non-GP primary care practitioners face; poor signposting to alternative pathways, including inaccurate information about locally available community services; digital exclusion of certain people in our society and variable availability of digital health and care services; and patient record systems that do not align with one another to enable shared data that is easily accessible by multiple healthcare professionals working with shared patients.
Evidence that was submitted to the inquiry suggests that primary care reform and the reasons for it are still not well understood by the public. Many people still expect to be able to see their GP for every health issue, no matter how minor. Limited public awareness of primary care reform seems to be the main cause of that. When they are presented with the idea of alternative pathways, people often say that they feel fobbed off when, in fact, they have been directed to the right type of care. One witness told the committee that there has been a
“failure in getting over to the public that general practice is changing, why it is changing, why it needs to change and what will be put in place to ensure that healthcare needs are fully taken account of.”—[Official Report, Health, Social Care and Sport Committee, 8 March 2022; c 5.]
It is imperative that the public understand the reasons behind primary care reform. Rather than preventing them from seeing their GP, primary care reform is about making sure that they get quick and easy access to the best person to support their needs. Until that is understood, there will continue to be issues with the public making proper use of alternative pathways.
The Cabinet Secretary for Health and Social Care told us that the Scottish Government has undertaken public information work to inform people about primary care reform. Although the committee welcomes that, we believe that more must be done to increase the general public’s understanding of such reform and what it means for them. We recommend that the Scottish Government implement a co-ordinated communications plan to look at where such awareness is lacking and to address it. That should include targeted national and local elements and be accompanied by a robust methodology for monitoring and evaluation of those communication efforts.
The Scottish Government’s intention is that the shift to multidisciplinary working will reduce pressures on services and ensure improved outcomes for patients, while freeing up GPs to spend more time with patients with acute conditions or urgent health concerns who need their expertise. That being the case, a key aim of our inquiry was to establish the extent to which primary healthcare professionals other than GPs have the capacity to take on more patients and accommodate an increase in referrals.
Refocusing GPs to take on an expert medical generalist role is contingent on the recruitment of a range of practitioners into multidisciplinary teams, or MDTs, as I will refer to them from now on. Before the start of the Covid-19 pandemic, Audit Scotland reported that health and social care partnerships were having difficulties in recruiting practitioners to, and retaining them within, GP practice MDTs. The inquiry also highlighted a shortage of available capacity in non-GP primary healthcare professions, including pharmacy, audiology and psychiatry, although some bodies, such as Optometry Scotland, claimed that they had untapped capacity and the ability to take on more referrals. We did not hear from representatives of every discipline, so I wonder how many more bodies out there are in the same position as Optometry Scotland.
The committee has concerns that, in the short term, workforce constraints and recruitment delays will limit the capacity of non-GP professions to take on increased referrals. There is a danger that, if those referrals are not successful, patients might not want to use alternative pathways in the future and will revert back to their GP. The committee firmly believes that better recruitment and retention of professionals is crucial to the success of alternative pathways, notwithstanding the workforce pressures that we all know about.
Accelerated training and recruitment to increase workforce capacity are essential. We must make known the varied career routes that exist to young people who express an interest in healthcare as early as secondary school.
I turn to what the committee has termed, for ease of reference, the single electronic patient record. Such a record has long been seen as having the potential to transform multidisciplinary team working and to give people consistent access to the best care by allowing seamless transition between services. Throughout our alternative pathways to primary care inquiry and other inquiries that we have undertaken, the committee has heard that access to data across different health specialities can be difficult, inconsistent and time consuming, which leads to frustration for practitioners and patients. There was broad agreement among many contributors to the inquiry on the need for better integration.
The cabinet secretary has said that work is already under way to produce a single electronic patient record, but it is incumbent on him and the Government to accelerate that work. Since the report was published, I have appeared at several round tables on the issue. We might need not a single record but a single interface that ties systems together, and we might need to calibrate our language around that. Practitioners should not have to log in to multiple systems that do not talk to one another, and patients should expect that the range of clinicians who treat them will be able to see the right information about the patient in front of them, so that they do not have to recount their story over and over to different people. A single interface could bring records together, and the commitment to that is most welcome.
I welcome the cabinet secretary’s response to our report and what he said about working together to address the challenges. I hope that, by carrying out the inquiry, we have shown that there is a live discussion about access to alternative pathways and the better use of those pathways. We must continue making reforms to make that process seamless for patients. I hope that that will enable us to achieve the better health outcomes that we all want primary care reform to deliver for the Scottish public.
I move,
That the Parliament notes the conclusions and recommendations contained in the Health, Social Care and Sport Committee’s 9th Report, 2022 (Session 6), Alternative pathways to primary care (SP Paper 201).