Hansard

I am pleased that we are being given the opportunity today to discuss the way forward for primary care in Scotland. Throughout my time in Parliament, we have heard of an impending crisis within the NHS as more people are living longer, with many people in their senior years coping with complex health problems.

The Scottish Government’s 2020 vision is what we all wish for—being able to live at home or in a homely setting for as long as possible, avoiding hospital admission unless we really require specialist in-patient care and then returning to the community as soon as possible with the support services that we need in place. However, the system is currently creaking at the seams due to doctors retiring early, an ageing nursing workforce, young medical graduates being unwilling to face the stresses of general practice and difficulty in recruiting the good home carers that are essential if the frail elderly are to sustain a reasonable quality of life within the community.

I supported the 2004 GP contract because of the difficulty at that time in recruiting young doctors who were prepared to undertake the 24/7 on-call responsibilities of their predecessors. That contract has now run its course and recruitment has fallen again—this time because the demands on the service are leaving GPs with too little time for face-to-face contact with the patients who really need their expertise, and a workload that is stressful and which is leading to a less than satisfactory work-life balance.

Because of the undoubted challenges that are facing the system, it has been all too easy for opposition political parties to attack the Government on health issues which I frankly think—as Jackson Carlaw does—is not good either for patients or for the NHS staff who, in the vast majority of cases, provide a tremendous service for patients, most of whom are very grateful for the care that they receive. I am therefore glad that there now seems to be some consensus developing on the way forward.

The excellent report that was published recently by Sir Lewis Ritchie on out-of-hours care gives an in-depth analysis of the current situation and a comprehensive assessment of what is needed for a sustainable and—to quote Sir Lewis’s report—“seamless service” that not only meets the needs of patients but offers

“a valued working and learning environment for all those delivering health and care Services—whether that be NHS, local authority social services”

or the third sector.

The thrust of the recommendations is that there is a need to develop multidisciplinary teams that include GPs, nurses, AHPs, community pharmacists, social care and other specialists all working together to secure the best out-of-hours care for patients in urgent-care resource hubs across Scotland.

Sir Lewis Ritchie’s recommendations for out-of-hours care would sit well with the daytime integrated health and social care service that is envisaged by most experts who have considered the issue, and with the Scottish Government’s plans to transform primary care services in the light of the demands of an ageing population, and as health and social care services are integrated. I look forward to the Government’s detailed response to the out-of-hours report early next year, and to how it proposes to implement it nationally. I also look forward to hearing the detail of the new general medical services contract that is currently being negotiated with the profession. I am pleased that the Government has now announced the end of the QOF, which has undoubtedly outlived its usefulness.

The future of primary care is clearly at a crossroads at the present time, and the BMA and others point the way forward by stating that the role of GPs and other primary care professionals must be to make best use of the unique skills of each, with proposals that GPs become more involved in complex care and system-wide activities, and that the more routine tasks become more reliant on other health professionals in the wider community team. As senior decision makers, GPs would be seen as the expert generalists in their communities, able to support their local teams where their specific expertise is required.

As has been emphasised by the BMA, the core of general practice that is expected by patients and is the basis for learning the necessary skills has to be personal contact with patients who are, or who see themselves as being, unwell. However, because of limited capacity, there will have to be a balance struck between access to GP appointments, access to other health professionals including nurses and community pharmacists where that is more appropriate, and encouraging supported self-care where appropriate, aided by the use of modern communications technology.

For that to be acceptable to the public, effort will be needed to explain why the changes are required and how they will work. Practices would become the patients’ gateway to appropriate services, and would be overseen and managed by GPs to ensure that patients get the care that is best suited to their needs. For that to be effective, GPs must be at the core of health and social integration at locality level. Indeed, if they are not significantly involved and engaged with integration joint boards, I cannot see integration being successful. As I understand it, that involvement is currently patchy across the country.

It is never easy to change the way we work, and health and social care professionals come from different cultural backgrounds. They will need support to learn different ways of working together with mutual respect for each other, as they seek the best outcomes for the patients in their care. That is already beginning to happen, and there are many good examples of professional co-operation, not least in my region.

For example, the NHS Grampian out-of-hours model employs a significant number of advanced nurse practitioners—all of whom are, or are training to be, independent prescribers—in the main centre in Aberdeen alongside GPs, team members from the Scottish Ambulance Service, community psychiatric and district nurses, Marie Curie nurses and on-site pharmacy provision, and are collocated with NHS 24. Different arrangements apply in the rural centres, where help is available from the main centre via video and telephone links.

If primary care is once again to attract and retain young medical graduates, every indication is that we have to develop team working involving all health professionals, including nurses, AHPs and pharmacists working together with social care and the third and independent sectors. If we can achieve that—at the moment, there is the will, but there is a long journey ahead—we can build a sustainable system of good care in our communities. I think that we are on the cusp of some exciting developments in primary care. I am just sorry that I will not be in Parliament when they come to fruition.