Hansard

I associate myself with the cabinet secretary’s comments about Richard Simpson. I hope that he continues to have an active role, and I am sure that he shall. I also praise the extraordinary work that front-line community health and care services professionals do, day in and day out, across Scotland.

The debate is timely. We want to increase the importance of primary health services, which are a valued asset that needs urgent attention. Investment of £40 million under the primary care fund was announced in November 2014, but it took the best part of seven months for words to be put on paper to solidify that action, and it turned out to involve reducing the amount that would be invested in primary care from £40 million in 2015-16 to £16.6 million per year over three years.

However, that aside, it is obvious that the cabinet secretary wants to talk about redesigning primary care for Scotland’s communities. I am sorry that I have to start by being slightly negative, but I will go on to be constructive. Some £26.5 million has been cut from primary medical services since 2009-10, and almost £30 million has been cut from the total spend on GPs in that period. Out-of-hours GP funding was cut from £95.7 million in 2008-09 to less than £80 million in 2013-14. The cabinet secretary provided me with those figures just this month in response to a parliamentary question.

It is clear that a redesign is on the Government’s mind, but I do not want it to be of the wrong kind. One thing that the Government acknowledges is the challenge in recruiting and retaining GPs—a challenge that has been brought on by a lack of investment in primary care—and in establishing the recruitment practices that are needed. The chair of the Royal College of General Practitioners has said:

“There is no question that the consistent underfunding of general practice has contributed to the difficulties the service faces. RCGP has been warning for over two years now of the results of year on year cuts to the percentage share of NHS Scotland funding allocated to the service. General practice, which sees 90% of all patient contact with the NHS, received just 7.6% of the budget. Such imbalance is a plan for failure.”

New figures that are out today show that average GP practice list sizes have increased by 10 per cent since 2007. Perhaps that goes some way towards answering Richard Simpson’s questions on full-time equivalents. I will be interested to see the figures that the cabinet secretary finds. We do not want the Government just to pay lip service.

There continues to be little success in attracting GP trainees in the necessary numbers. I welcome the announcement of 100 more GP training places, but I would like an assurance from the Scottish Government on what plans it has made to fill them. If the current places cannot be filled with GP trainees, as Richard Simpson said, what is the plan for the 100 additional places?

In September, the cabinet secretary told us that only 237 of the 305 GP specialty training posts that were advertised in Scotland in 2015 were filled. Research that was presented in the British Journal of General Practice shows that the majority of GP trainee places were in the least deprived 25 per cent of practices, with the most deprived 25 per cent having just over half that number. In those deprived areas, multimorbidity and premature mortality are real problems, mental health problems are a factor in a third of GP consultations, and funding does not match clinical need.

The general practitioners at the deep end warn that the flat distribution of GP resources in Scotland does not benefit those who most need GP care—that is, the 8 per cent of the Scottish population who live in the most deprived areas. Unless a drastic shift is applied to address inequalities in the resource distribution methods, we will see no change in health inequalities.

I am not saying that we should throw money at the problem and expect solutions to magically appear. A guided and educated approach is needed that takes into account the needs of both practitioners and patients. The call for a fully resourced workforce that works in the right way and in the right place is also backed by the Royal College of Nursing and the out-of-hours primary care review. As the cabinet secretary will be aware, recommendation 8 in that review’s report states:

“A national primary care workforce plan should be developed and implemented without delay”.

The redesign of primary care for Scotland’s communities must be precisely that—a redesign for the communities. Next year, we face a project of an enormous scale—the integration of health and social services, which will jointly manage £8 billion-worth of assets and resources. We need a redesign that takes into account the localisation of services and the ability of integration authorities to plan their workforce needs and be supported while they do so. The Ritchie report pointed out that

“Robust workforce planning ... needs to be urgently replicated at NHS Board”

and integration authority level

“to secure a sustainable and empowered multidisciplinary workforce”.

The Scottish Government has to redesign services to meet the needs of the populations in different communities across Scotland. Unless change happens in a way that enables and empowers practitioners to plan for their patients, we will see little progress on reducing inequalities and putting our NHS on the right footing for progress. We need a strong, future-proofed NHS.

I move amendment S4M-15172.1, to leave out from “supports the current work” to end and insert:

“considers that there is a GP crisis, caused in part by the failure of the Scottish Government to invest in primary care; notes that real-terms spending on GP services has fallen year on year since 2009-10, decreasing from £888 million to £858 million in 2013-14; understands that funding pressures are particularly acute in practices serving the most deprived areas, which receive less funding per patient than average, despite the vital role that they can play in reducing health inequalities; notes that the Royal College of General Practitioners has stated that ‘there is no question that the consistent underfunding of general practice has contributed to the difficulties the service faces’ and that the body has previously warned there will be a shortfall of up to 740 GPs by 2020; understands that, of the 305 GP speciality training posts advertised in Scotland in 2015, only 237 were filled, and therefore calls on the Scottish Government to explain how its increasing the number of posts available to 400 will increase uptake and lead to more GPs in local practices; welcomes Sir Lewis Ritchie’s review of out-of-hours primary care and considers that it is an important contribution to the debate on how best to deliver these vital services, and supports efforts to reduce bureaucracy through the new GP contract for Scotland from 2017 in order to give GPs more time with their patients to provide quality care.”