Hansard

I put on record my appreciation for the hard work and dedication of GPs. We as a society depend on their skills, experience, hard work and sense of duty to others. They are an invaluable profession; they are essential and their dedication should be acknowledged by the whole Parliament.

Before I deal with issues concerning the reform and redesign of services, I draw the Parliament’s attention to the members’ business debate that Patricia Ferguson secured at the end of last month.

In that debate, we heard about the challenges that face so-called deep-end practices, where the consequences of health inequalities are most acute and severe. The life expectancy gap is a stubborn and stark reminder of the extent of health inequality in Scotland. Labour’s amendment allows me to repeat the point that I made in the chamber last month that we need to do much more to understand the financial consequences of health inequalities for our public services and health budgets and we need to properly support practices on the front line in our struggle with health inequality.

There is no doubt that the causes of health inequality are complex. Tackling those root causes is not simply a question of resourcing GP practices; it is also a question of redistribution, regeneration, education and economic opportunity. However, the BMA and researchers from the University of Glasgow and the University of Dundee have shown that practices in the most deprived areas have 38 per cent more patients with multiple morbidity. They have also shown that the average spend per patient in those practices is lower than the spend in more affluent parts of the country and that GPs in deprived areas tend to have a higher workload. That is why many of us have called on the Scottish Government to examine the allocation of funding.

There is no doubt that our health services, including primary care, must overcome significant challenges if we are to make them fit for the future. There is consensus on that point across the chamber, in our healthcare professions and throughout the wider public sector. Demographic change, a rising workload, developments in medicine and medical technology, and pressures on funding all necessitate change in healthcare.

There is also a broad consensus on the principles that should drive the necessary reforms: preventative spend; shifting the balance of care; delivering new models of primary care closer to the community while developing specialisms and expertise in acute settings; and making better use of our pharmacists, nurses and allied health professionals. All that is common sense and none of it is new.

I will quote some recommendations from a report by one of the United Kingdom’s leading health experts. He said:

“In planning the future of the NHS in Scotland we need to;

ensure sustainable and safe local services; redesign where possible to meet local needs and expectations—specialise where required having regard to clinical benefit and to access.

view the NHS as a service delivered predominantly in local communities rather than in hospitals; 90% of health care is delivered in primary care but we still focus the bulk of our attention on the other 10%”.

He recommended

“preventative ... care rather than reactive management”

and developing

“new skills to support local services; generalists as well as specialists, nurses and allied health professionals as well as doctors”.

That could have been an extract from the minister’s speech or from a recent briefing from the BMA, but it is not; it is from a report by Professor David Kerr for the Scottish Executive that was published over a decade ago.

The pace of change that we have seen in the years since that report was published does not match the scale of the challenges before us. If it did, we would not be where we are now. Thirty-two per cent are considering retiring from general practice; 92 per cent say that their workload has negatively impacted on the care that patients have received; primary care’s share of the budget is going down; and in acute care, we also have reports of a crisis in medical recruitment and in A and E.

In NHS Lanarkshire, even out-of-hours primary care services are being centralised under a Government that promised to keep health local. The health board is not driving reform from a position of strength; it is reacting to a shortage of GPs who are willing to work in that service. It is all reactive and it has been reactive for too long.

Many of the challenges that our health services face, whether in primary care or acute care, are related, and they have been foreseeable for some time. Negotiations over the new GP contract are of the utmost importance, as are questions of resources and training. I commend Richard Simpson’s work on those issues. We need to shift the balance of care, but we cannot do that unless we support our GPs with models of care that are fit for the future.