Hansard

I am pleased to close the debate for Labour and to support the stage 1 report and the general principles of the bill. The bill is a short one with a clear intent, and it has our full support. It has been interesting to read and listen to members talk about why St Andrews is in the unique position of not granting degrees in medicine or dentistry.

The cabinet secretary will know that I have raised the difficulties that come from a shortage of GPs. There are shortages in Kirkcaldy in particular, but there are challenges with recruitment across Fife and other parts of Scotland. The difficulties that health boards and integration joint boards face in recruiting and retaining GPs and primary care staff are well known. There has been a steady flow of retirals and resignations in Fife, and it is proving very difficult to replace those people.

In Fife, a number of GP practices operate with closed lists and a number have had to come under the control of NHS Fife. Too many practices rely on locum cover and are described as being high risk. The situation has also led to difficulties in delivering out-of-hours services in local hospitals. Other members have referred to the situation in St Andrews and to the closure of a palliative care ward in Methil when a responsible medical officer could not be identified.

There are a number of solutions and responses to the crisis in GP numbers. In response to the questions that I have raised, the cabinet secretary has often highlighted the ScotGEM programme. As a Mid Scotland and Fife MSP, I am pleased that the course—which is the first graduate entry medical degree that is aimed at graduates who are interested in a career in general practice—has been developed. The focus on rural medicine and healthcare improvement is welcome, and I support the financial incentive that is offered. We are competing in an international market for healthcare staff, and I hope that graduates of the ScotGEM programme decide to commit to the NHS on graduation.

The model that has been created at St Andrews and Dundee universities is innovative, and I welcome the fact that the first students are due to graduate in 2022. It is interesting to see the students’ backgrounds, the different workplaces that they have come from and the variety of experience that they bring to the course. Their expectation is that they will graduate with a joint degree in medicine from St Andrews and Dundee, and the short bill before us will enable that to happen.

As other members have highlighted, the repeal of the legal prohibition on the awarding of medicine and dentistry degrees is broader than the intention and aim of the bill. During the evidence stage, that raised questions about the interest that the University of St Andrews has expressed in awarding medicine degrees, in addition to the joint degree that graduates of the ScotGEM programme will be awarded.

The Aberdeenshire health and social care partnership and the University of Dundee have expressed a preference for a partial removal of the prohibition. The partnership between Dundee and St Andrews universities has led Dundee university to express concerns about training capacity for its students if St Andrews university were to start awarding medicine degrees, and about its ability to place students in local hospitals. In other words, it is concerned about capacity and competition. The AHSCP is concerned about the impact on the retention of school leavers and graduates in the north-east if St Andrews university were to change its offer.

St Andrews university has argued—rightly, I think—that complete removal of the prohibition is needed to address the issue of fairness and to allow it to compete with other institutions. The policy memorandum says that the prohibition

“is unfair, anti-competitive and serves no legitimate purpose in today’s context.”

As the cabinet secretary said, she does not support a partial removal of the prohibition. She argues that it was always intended to be temporary, and that it is unfair. It is unclear whether the ScotGEM programme was the catalyst for that change or whether that argument had already been had and won.

Although the bill will allow St Andrews university to award medicine and dentistry degrees, a number of measures will have to be taken first: the GMC must approve such institutions, and there are financial restrictions. St Andrews university has made its intention clear and has submitted a bid as part of the open competitive commissioning process to develop proposals for a new medical school that was set out in the 2019 programme for government. While that process is currently suspended, the bill will allow St Andrews to pursue its plans.

When any decision is made, it will be important to consider the points that have been made on widening access, NHS recruitment and the potential impact on the north-east. However, such decisions are outwith the immediate concerns of the bill. I fully support what the bill seeks to achieve as regards the ScotGEM programme, and I think that there is a positive case for St Andrews university to expand its offer in the future.