Hansard

I had better keep going because time is passing at an alarming speed. Other examples include cancer care, stroke care, services for the elderly and mental health services. NHS Greater Glasgow, in recognising that mild to moderate mental illness is the biggest reason why patients present for primary care, has developed a framework for primary care mental health services. That framework will be provided by a range of agencies and co-ordinated through LHCCs. Such developments will be key to the development of services in primary care, especially in the care of mild to moderate mental health problems.

We intend to build on the excellent work that is taking place throughout Scotland and to share the innovative work and learning that is emerging from the redesign projects by putting in place a national collaborative improvement programme. That programme will help to create the infrastructure and the resources that will support the wider implementation of best practice. The first programme of work, supported by the primary care modernisation group and the Scottish diabetes group, will tackle demand and management of access within primary care and will support the implementation of aspects of the Scottish diabetes framework.

A number of other measures can help to improve access to primary care—I will mention just three. The introduction of NHS 24—which will commence this spring in the north of Scotland—will become an important gateway to the NHS. It will provide quality-assured nurse telephone advice and an authoritative source of health care information. Where appropriate, it will direct referral to primary care professionals, accident and emergency services or the ambulance service.

The development of nurse triage and nurse practitioner services in general practice, as the first point of contact for urgent problems, will ensure that patients get to see the most appropriate member of the primary care team. That will deal effectively with minor illnesses and injuries.

Expansion in the scope of nurse prescribing in order to provide more accessible patient-centred services will also be an important development. Specially trained nurses will be able to prescribe from a range of products. That will support their growing role in treating minor illnesses and injuries, and will enable them further to develop their role as the first point of access for patients.

We also aim to maximise the expertise of pharmacists who, of all health professionals, have the widest knowledge of the science and use of medicines. At present, only doctors can change a patient's dosage. In conjunction with the Department of Health, we plan to introduce pharmacist prescribing to allow pharmacists to adjust doses in repeat prescriptions. That will help to prevent medicine-related hospital admissions, provide greater convenience for patients and their families and reduce GPs' work loads.

So many things are happening in primary care that I will simply mention in passing the joint future agenda—we have discussed it on many occasions. I would also like to highlight the provision of intensive home care and of rapid response teams to prevent admission to hospital and to facilitate discharge from secondary care.

I have made general reference to local health care co-operatives, but I highlight the recent appointment of public health practitioners, who will provide a vital resource for LHCCs. Public health practitioners will act as linchpins for actions to improve the health of local populations, as catalysts for change and as links to other agencies and communities. Everything will be done in collaboration with patients and front-line staff. There is public involvement in primary care, but I apologise for not having the time to go into it in detail. I assure members that public involvement is of fundamental importance to us.

I will move on to discuss the work force. Recruitment and retention is crucial to the development of primary care. We have agreed incentive packages for GPs, such as the £5,000 that is available to a new GP on joining the NHS and the further £5,000 on average to every new GP who joins a practice in a deprived, remote or rural area. We are piloting the World Health Organisation's family health nurse model in some of our remotest communities. The family health nurse will be a generalist community nurse who will focus particularly on the health needs of families and the communities that they live in. I look forward to visiting some of those people in the Highlands in the first half of May.

I am well aware that, in some remote and rural parts of Scotland, there are difficulties in recruiting and retaining dentists to provide NHS services. I am pleased to announce today an initial package of measures to help address this situation—which we have agreed with the profession—worth about £1 million. That package includes: funding to support a vocational training place for every dentistry graduate in Scotland; allowances of £3,000 to each newly qualified dentist who takes up their training year in a remote and rural area; allowances of £5,000 over two years to vocational training dentists who have completed their training and who commit themselves to the NHS; and allowances of £10,000 over two years to those who take up similar positions in remote and rural areas. Mary Mulligan will announce the details of that in a little while.

The new GP contract will also address recruitment and retention. The contract is fundamental to ensuring that general practice is effective, responsive and that it provides high-quality services that are free from the bureaucracy of the current system. The framework for the new contract was agreed last week between the NHS Confederation in Scotland and the UK general practitioners committee. The health ministers for all four countries have agreed to the principles that underlie the framework. I am confident that it will provide the foundations for a better deal for patients, GPs and the NHS in Scotland.

For remote and rural areas, the work of RARARI—the remote and rural access resource initiative—is examining innovative solutions to the problems of recruitment and retention of staff.

An important report on medical work force planning will come soon from Professor John Temple. Professor Gillian Needham has also produced a report—"Planning Together"—on work force planning more generally. On the back of those reports, we will produce an action plan on work force planning and development.

Research is important in order to evaluate what is happening and to establish best practice. We promised in 1998 to double our investment in primary care research over five years. By the end of last year, we had already met that target and investment continues to grow. One of our significant new investments has been in the Scottish School of Primary Care, which considers the full range of clinical and academic primary care disciplines to improve the evidence base for primary care and to support reform. I look forward to addressing its conference tomorrow and to going into some of the issues in more detail.

I apologise for having to omit some issues. Although it is impossible in 20 minutes to go through the whole primary care reform agenda, I hope that I have managed to outline the direction of travel. I also hope, in speeches over the next month or so, to give further indications of where we see the direction of reform going in the next few months and years.

The advantage of the funding that was announced last week is that it will allow us to make steady and sustained progress on our programme, which is practical and concentrates on delivering improvements in communities. Within the next year, I expect tangible progress in at least three key, but not exclusive, areas: the round-the-clock NHS 24 telephone advice line; the work that is being done to develop health improvement champions in every community; and the development of bigger roles for nurses, pharmacists and others in managing chronic disease.

Above all, we must ensure that extra health resources are used as effectively as possible. Resources must be spent where they are needed most and where they can do most good. That will allow us to move closer to achieving right-place, right-time and right-quality care and intervention for all patients, which I am sure we all want.

I move,

That the Parliament applauds the vital contribution to healthcare and health improvement made by primary care teams across Scotland and supports further investment and reform to improve access and redesign services round the needs of patients.