Meeting of the Parliament 21 February 2024
Before I begin my remarks, I welcome the Cabinet Secretary for Health and Social Care, Neil Gray, to his place. I also recognise and welcome to his place the new member for the Highlands and Islands, Tim Eagle. I met Tim very briefly yesterday, and he strikes me as having the makings of a fine parliamentarian. I pay tribute to his immediate predecessor, Donald Cameron. Donald was a rare voice of calm, clarity and consensus in the chamber, and he will be missed, as will his friendship across the chamber.
I am pleased to open the debate on behalf of the Scottish Liberal Democrats. Our health service is in crisis. We all know it, and we regularly debate it in the chamber. The slow and steady erosion of our health service under successive years of nationalist ministerial disinterest is being suffered by those who work in it and those who rely on it.
Nowhere is that pressure felt more acutely than in primary care. For our hardworking general practitioners, the Government has done little more than add insult to injury with a litany of broken promises, skewed numbers, missed targets and cut budgets. It was not that long ago that, if someone needed to see their GP, they could book an appointment and be seen within perhaps even a few hours rather than days. Across the profession, the alarm is being raised.
Dr Andrew Buist, who is the chair of the British Medical Association’s Scottish GP committee, said of the recent fall in the workforce:
“We are often told GPs are the bedrock of the NHS—but on this evidence the bedrock is crumbling, and it is patients seeking access to their GP who will suffer as that becomes more and more difficult.”
The national health service must aspire to health promotion, the prevention of acute illness, the early detection of serious issues and getting the right intervention to patients fast. If that does not happen, it piles more pressure on other parts of the health system through people being forced to attend already swamped accident and emergency departments or presenting later with cancer and other diseases because of the acuteness of their condition.
That is not happening by a long shot. In fact, people are waiting weeks just to be seen by their GP and they might even struggle to get an appointment over the phone. I have lost count of the number of people who have told me stories of being forced to wait weeks for an appointment with their GP. I know of parents who tried to get their sick baby an appointment only to be told that it would have to be really urgent, because there was no routine appointment for the next two weeks. I am sorry, but new parents often do not know what is severe and what is not, and things can go downhill very fast.
If we are not getting it right for babies, we are not getting right for anyone. People are being left to wait on their own in a state of crippling anxiety, pain or both, with no way of knowing whether their symptoms are innocuous or clinical signs of something that could be far more sinister and even life threatening. It is no wonder, then, that one in five Scots says that their mental health has been impacted by delays in getting a GP appointment and 13 per cent say that long waits have also adversely affected their physical health. We know that conditions become more acute.
Lurking behind many of the issues that we will discuss today is the growing workforce crisis that is impacting on primary care, which has been exacerbated by the brutal cuts of this Administration. The figures on recruitment and retention are really worrying. For example, 42 per cent of practices report at least one GP vacancy. If we look at whole-time equivalent figures, we see that the NHS is down 200 GPs on the number it had 10 years ago. I refer again to Dr Andrew Buist, who said:
“All this shows that it is no longer feasible or plausible to think we can simply go on as we are, believing we are on course to grow the GP workforce as required to care for the people of Scotland.”
In an attempt to pull the wool over people’s eyes, the Government would have us believe that the number of GPs is more than 5,000, but that is the case only when we include trainees. A head count, rather than the whole-time equivalent figure, is used as a measurement. How are we going to improve the situation in primary care if this Government is not even going to be straight with the public about the fact that it deploys such smoke-and-mirrors politics?
None of this is the fault of GPs or NHS staff—let us be absolutely clear about that. We will always owe them a huge debt of gratitude. We are asking far too much of those who work in primary care, many of whom are experiencing burnout as a result. The stress and demands mean that more and more GPs are choosing to work part time or to leave the profession entirely, so the failure to have supported them properly is adding yet more pressure on those who remain.
The Government has promised to recruit 800 more GPs by 2027, but bodies such as the Royal College of General Practitioners and Audit Scotland agree that the Government is not on track to meet that target. Part of the answer, of course, is to train, recruit and draw on the wider skills that exist in other disciplines such as mental health, physiotherapy, pharmacy and more.
GPs are the first point of contact for many people as they enter the NHS, particularly at times of mental ill health. That is why my party works so hard to persuade the Government of the importance of putting mental healthcare practitioners—talking therapists—in every practice in every corner of Scotland. However, progress has been far too slow. One recent Government-run survey found that 86 per cent of GPs said that they had either insufficient access or no access whatsoever to a mental health practitioner over a three-year period. GPs were promised new colleagues to lessen the workload and improve the mental healthcare that is available, but, as we know, with Humza Yousaf as health secretary, the Government actually hit pause on its pledge to train and hire more staff.