Hansard

I draw members’ attention to my declaration of interests as a member of the BMA and a fellow of the Royal College of General Practitioners.

The debate is welcome and I thank the cabinet secretary for her kind remarks. I am slightly regretting the fact that the first third of my speech will be quite negative, but the remainder will be quite positive, so she could dwell on that.

The Government motion does not recognise the extent of the urgency that the cabinet secretary conveyed in her speech. The Government remains slightly complacent. The current national conversation is similar to what Labour proposed in 2011 as a Beveridge commission for the 21st century, although such a commission would have been more independent of politicians. The Scottish National Party rejected our proposal out of hand on the ground that it would take too long, and yet here we are.

My first call for a new GP contract was made in 2010, when the Government and the BMA rejected it. There were two reasons for making that call at that time. One was that the Tory plans in England were creating a totally different approach to general practice with commissioning groups. In Scotland, I was hearing anecdotally that the number of applicants for partnerships in general practice had reduced to a level that had not been seen since the early 1970s.

The Labour Government in Wales set up the Bevan commission, which was similar to what we proposed. The result has been that Wales now has 64 funded clusters. I have no doubt that the Scottish Government will have studied the Welsh Government’s document “A Planned Primary Care Workforce for Wales” on the further development of those clusters.

In the meantime, Scotland has experienced an increasing population; an increase in the birth rate; an increase in the number of over-75s who have multiple and complex conditions; increasing demand, as evidenced by the year-on-year growth in the number of GP consultations; and a largely unresourced transfer of work from secondary hospital-based care to GPs. There is also an increasingly bureaucratic quality and outcomes framework, which I am delighted to hear that the cabinet secretary has agreed to remove early, before the new contract. That is a welcome move.

In the past few years, the SNP’s response to preparing for this transformational change, which I think we all agree will be worth while, has been to cut the nursing student intake. However, nurses will be vital to the transformational change. The midwifery student intake has also been cut.

I recognise that this is not an easy area. The establishment of the out-of-hours review by Sir Lewis Ritchie was a welcome first step and, as is usual for Professor Ritchie, it has resulted in a thorough piece of work with achievable objectives. I welcome the pilot that will be undertaken, although I am slightly concerned about the level of funding, which I have queried before.

The Government’s announcement of £60 million to fund the testing of new models of general practice is welcome. The 140 pharmacists are also welcome, although I would like to know how GPs will apply for them. GPs are phoning me and saying, “We would like one of those. How do we get one?” and I am finding it difficult to respond, so some detail as to exactly how the pharmacists will be put in place would be welcome. I know that they are going into the 2C practices—those that have been taken over—and that tests the model, which is excellent.

The delay over the past five years in recognising and acting on the deterioration in general practice recruitment and retention means that we need further action urgently. Increasing the number of GP training places sounds good, but I would like to know how the cabinet secretary will get people into posts when 20 per cent of them are currently unfilled.

Action on the deep-end practices is urgently needed. The cabinet secretary alluded to that, but we need a lot more detail. The discrepancy in funding for those practices was made evident in the paper that was published last week, and it needs to be addressed urgently. I am told that, although those practices have not yet collapsed as some others have, they are extremely fragile and their sustainability is quite questionable.

In her answer to my written question about a risk register for general practice, the cabinet secretary said that she believes—I do not doubt her belief—that there is a risk register in every health board. I have to say that I have subsequently repeated my freedom of information request. The response to my first request was that seven or eight boards do not have such a risk register, and I have to tell her that three still do not have one. NHS Greater Glasgow and Clyde has said that it will start on one, but that is another recognition of the fact that the problem has really not been followed through on.

I have some suggestions, many of which are in a paper that I produced. The cabinet secretary was kind enough to discuss that paper with me and I think that we are to discuss it more. It is a Labour paper that is based on our survey and review and on consultation with GPs.

The health boards should start to contract banks of retained GP locums and other primary care staff. Where are they to come from? There are a lot of sessional doctors out there and doctors who have almost retired or who have taken a break to have a family; they could be recruited into a bank of locums to provide cover at least for short-term sickness absences.

Evidence of that approach is already materialising. With the Bannockburn practice closing, the practices in Stirling have rallied round; the sessional doctors there are providing some locum cover already. Colleagues are willing to support other local practices that are in difficulty, and that needs to be built on.

We need a national performers list today, tomorrow or certainly this week—we cannot wait. That is in Lewis Ritchie’s report, and it should be acted on now. Local performers lists, to which doctors have to apply through individual boards, are outdated and outmoded and must be done away with.

We should have a reversal of the cuts in medical undergraduate places. We should establish a graduate-entry medical course—that will take a little longer.

Nurses are critical. We have 1,900 vacancies. The family nurse partnership originally needed another 350 nurses, not all of whom have been recruited yet. The Royal College of Nursing reckons that we need another 500 for the named-person requirement. That comes to about 2,500, yet 640 fewer nursing students have enrolled in universities since the start of this parliamentary session.

That is one area in which the cabinet secretary cannot stand up and say, “We are doing better than Labour did.” The recruitment numbers this year are 476 down on the year when Labour left office. We cannot have the transformational change without having an adequate number of students. The increase in the number of nurses who are returning to work is welcome, and I hope that it will be built on.

We need to have negotiations now, if they are not already taking place, on how to incentivise senior GPs not to retire. We need moderation of the bureaucratic revalidation scheme, which is work intensive and is a particular problem for senior and experienced GPs, who do not need that level of revalidation. I strongly suggest that we have discussions with the General Medical Council immediately about moderating that bureaucratic process.

We need an immediate revitalisation of the GP retainer scheme. Given the gender shift that we have had, one would expect there to be more GPs in the scheme—originally, when we were less politically correct and more gender specific, it was called the women’s retainer scheme—but there has been a 40 per cent drop. That is despite the fact that women as a proportion of those who qualify in medicine are up from 10 per cent in my time to more than 50 per cent today.

There should be post-registration work placements for every allied health professional. I know that the Government does not control the intake, but putting those people into work placements now would help with some of the elements that the cabinet secretary mentioned.

The essential workforce, training and contract measures must be underpinned by a national infrastructure programme that uses a combination of non-profit-distributing programme and GP-backed finance. An example of that is the innovative scheme in Tayside to close the Aberfeldy community hospital but to open beds in a care home that is going to be built. That sort of combination might work in Portree, where there are problems. Stirling’s care village is another example of a joint venture between the NHS and a local authority, which is welcome.

The cabinet secretary mentioned information technology. Improving the IT links to pharmacies should be an immediate priority, along with the links to optometrists who are prescribing.

The system of clusters that the royal colleges advocated nine years ago and which the King’s Fund has endorsed is essential. The Commonwealth Fund’s survey of 10 countries reported that the system is essential to achieving greater satisfaction with and improved delivery in general practice. The clusters need to be established quickly. I know that we have 10 pilots, but we have to look at and adapt what has happened in Wales.

I have only about 30 seconds left, but I still have a way to go, Presiding Officer.