Hansard

The Scottish National Party is committed to developing and improving primary care. We support and endorse the report of the primary care modernisation group. I agree strongly with the central premise on which the report is based, which the minister cited this morning. It is that:

"If it can be done in primary care, it should be done in primary care."

Primary care is rooted in local communities. When people are sick, they want to be treated in their own communities, close to their homes and as quickly and conveniently as possible. Primary care also has a huge role to play in the promotion of public health. With the exception of those who face medical emergencies, it is the first—perhaps the only—and certainly the most regular contact that people have with the NHS. No one is better placed than are those in primary care to disseminate messages and advice about how to stay healthy.

Professionals who work in primary care already cater for the overwhelming majority of patient needs, with 90 per cent of all patient contact with the NHS beginning and ending in primary care. It is vital that those people are recognised properly and valued for the enormous contribution that they make to the national health service. However, they could do much more if they were empowered to do so.

The drive to improve and modernise primary care must have two express objectives. First, it must enable those who work in primary care to maximise and improve what they are able to do for patients in the primary care sector. To that end, the intention to put extra money into the management of chronic disease in primary care, which was a particular focus of the primary care modernisation group report, is welcome. However, there must be a second crucial objective, which is to make primary care the engine room of change for the whole NHS. That would allow primary care to influence, on behalf of patients, the range and quality of services that are provided in the hospital sector. In that respect, Government thinking has a lot of catching up to do.

I want to look briefly at some of the challenges that we must face if we are to meet those objectives. First, if we are to maximise what can be done in primary care, we must address the undercapacity that exists in that sector, as in the hospital sector. As the minister said, recruitment and retention of staff is a major problem.

Since 1997, the number of GP consultations has almost doubled as the shift from acute to primary care has accelerated. However, the number of GPs has risen by only 3 per cent and the number of practice nurses has risen by a similar—extremely small—amount. There is an increasing number of GP vacancies, particularly in rural areas. In places such as Helmsdale, it has proved to be impossible to attract a GP. Newspapers at the weekend carried the story of a Highland GP who resigned from the NHS because of pressure of work and lack of support. It is unfortunate that he is not alone.

The story is the same in nursing. The highest nursing vacancy rates are among health visitors, community and mental health nurses and nurses who work with older people. There are also problems in the recruitment of pharmacists and pharmacy staff.

There is no single answer to those problems, but a range of things can and should be done to aid the recruitment process. Work loads—particularly GPs' work loads—must be addressed not only for doctors' sakes, but because there is a recurring plea from patients for more time with their general practitioners. I hope that the solution will be provided, at least in part, by the proposed new GP contract. It is crucial that we also make full use of the skills of all members of primary care teams in delivering health care. I will return to that point.

Professionals believe that better training opportunities and support for continuing professional development are essential if the NHS is to attract staff. That issue is important also for patients. The National Asthma Campaign prepared a briefing for today's debate, which says that one in five nurses who run asthma clinics do not have an appropriate qualification. That fact, together with other training issues, must be addressed.

On pay, I hope that members will not disagree that there is a need to increase general pay levels in the NHS. We should also be willing to use pay as an incentive to attract staff to parts of the country or to specialties in which there are shortages. The golden hello scheme to attract GPs to rural and remote areas, which was announced toward the end of last year, might help, but an initial payment of £5,000 might not be enough to overcome the considerable disincentives to working in those areas. Those disincentives include professional and social isolation, long hours and no out-of-hours cover. We should be prepared to consider additional financial incentives to attract and retain staff in areas in which there are shortages.

I mentioned the need to involve fully all members of primary care teams in delivery of patient care. Although GPs are important, there is increasing acknowledgement among MSPs and the general public that primary care does not begin and end with them. A range of professionals can be found in primary care teams and all their skills must be utilised at the right times and in the right ways. That will ensure the best patient care.

Good work is under way to foster genuine multi-professional working in primary care. Examples of positive moves in the right direction include the pharmacy strategy and the piloting of nurse and pharmacist prescribing. However, many primary care professionals continue to feel undervalued and underutilised. The primary care modernisation group report highlighted the fact that community pharmacists—who dispense 125,000 prescriptions every week—represent "significant untapped potential".

The primary care modernisation group's report also states that direct access to physiotherapists can lead to a reduction in tertiary referrals and the number and cost of prescriptions and X-rays. It can also lead to a reduction in waiting times. However, patients can still often access physiotherapy only through a GP and waiting times are still measured in weeks rather than days.

The report talks a great deal about reducing the role of the GP as the gatekeeper of the NHS and about ensuring direct access to the relevant member of the primary care team. However, more needs to be done to make that a reality. One way in which to do so might be to make more use of nurse triage services in general practice and another might be to put nurses more into the primary care front line.

There might also be a case for more radical change. One of the debates that will take place this week at the Royal College of Nursing congress in Harrogate is entitled "Do patients need to register with a GP?" That question raises the possibility of a move away from the GP list system to one in which patients can register with the primary care provider of their choice. If there is a genuine desire to put patients at the heart of primary care, that idea and others are worthy of consideration. That is also the case if the Government's pledge that there will be

"access to a member of the primary care team within 48 hours"

is to become a reality. Better access for patients dictates that more investment than has previously been made available must be made if we are to improve primary care premises.

I turn to the second objective in the modernisation of primary care, which is to empower those in primary care to be the levers of change in the NHS. It is welcome and right that we will give more money to LHCCs so that they can provide more primary care services, but LHCCs need more than money. They need the power to spend money, not only to improve primary care, but to influence the range and quality of hospital services that are available to patients in their areas. LHCCs are closest to patients—they have the best understanding of local communities and they should be able to ensure that local needs are catered for.

Malcolm Chisholm says that he wants to devolve resources and decision making to LHCCs, but he is not clear about what he means by that. In my view, that measure will necessitate giving LHCCs the power directly to commission services from the secondary sector.