Hansard

Tommy has had enough of a chance.

The drugs companies would come back at us for doing as Tommy suggests, and the cost of existing drugs would go through the roof. The current 10 per cent inflation in the drugs budget would pale into insignificance next to what we would have to deal with.

I welcome the debate, which is intended to allow us to reiterate our support for primary care services, and in particular for the primary care teams, who deliver 90 per cent of Scotland's health care against the background of a continuing shift in work load from the secondary care sector to the primary and community care systems. Those teams are making connections with patients and with other professions in the health and social care sectors every day. It is essential that we support the primary care sector, not least because patients, as they remind us time and again, want to access services close to their homes and within their own communities.

I reiterate the point that was made in the report of the primary care modernisation group, "Making the Connections: Developing Best Practice into Common Practice", which states:

"If it can be done in primary care then it should be done in primary care."

The modern primary care team is at the heart of the delivery of quality patient care and of the Executive's drive to modernise the service for the benefit of patients. That is acknowledged in the primary care modernisation group's report and is recognised in the on-going investment that we are putting into the sector.

I welcome the minister's announcement of the extra money to recruit dentists in rural areas and for chronic disease management. In the past three days, I and many other MSPs have been involved with the Parkinson's Disease Society, Epilepsy Action Scotland and the Multiple Sclerosis Society. I am sure that any further investment in chronic disease and condition management will be welcomed by those groups.

I welcome the commitment to take forward a national collaborative programme, which will ensure that best practice is spread throughout the system, and the expansion of the use of nurses and community pharmacists in relation to prescribing. Community pharmacists play an important role in health care because they, more than anybody, have an open door and allow people to access good-quality professional judgment and experience. The Wanless report suggested that using pharmacists properly could free up between 1 per cent and 2 per cent of GPs' time. We should examine all of the ways in which we can do that and make the best use of redesigning the service to deliver a better service for the patient. The main areas that we must think about are best practice, best value and the best interests of the patient.

Tommy Sheridan talked about the private sector, but what we have is a hybrid system, even though that might not be the system that we would choose if we were starting with a blank sheet of paper. Just as many of us complain about issues relating to what consultants do with their time or are concerned about the fact that GPs are independent contractors and we do not have total control of them in the NHS, the point that Hugh Henry made is continually worth making: those GPs are responsible for the funding of an awful lot of the capital investment and infrastructure in the primary care system in the country. When I spent some time in Argyll, I found out a lot about the problems with GP recruitment and retention and with accessing funds to improve the infrastructure. Within our hybrid system, we work quite constructively with elements of the private sector. We owe it to the patients of Scotland to try to ensure that we use the capacity and services of the private sector to deliver best practice and the best possible quality services.

Over the past few years, there has been a lot of innovation at the primary care level. In the past few days, many of us have learned a lot about the role of nurses, their increasing specialisation and the greater use of nurse-led clinics. With regard to the joint future agenda, a real shake-up is coming in primary care's relationship to the social care agenda and work force. As I have said, we can also improve the way in which we use community pharmacists.

The Executive has supported the sector with £30 million investment over three years, with the money being spent in agreement with and through the local health care co-operatives. The minister has made clear the fact that we are trying to empower the primary care sector, LHCCs and so on, to increase choice, while reducing bureaucracy and not reopening the internal market. I believe that Nicola Sturgeon quoted the BMA, but I point out that the BMA's briefing paper said that the last thing that the organisation wanted was another shake-up of the health system in Scotland. In the past two or three years, LHCCs have developed from a system that started without total prescriptive direction and have blossomed in certain parts of Scotland. However, the situation is still patchy and we must invest further in them while empowering them. LHCCs must also be accountable. It is right that we use LHCCs as an important lever in the process of redesigning services, but we should not do that in a vacuum; it is critical that we take forward the accountability agenda in relation to them.

We must examine the premises in the sector. The minister mentioned that, last year, £48 million had been invested in projects in 100 premises. It is important not only that patients are treated in decent premises but that our primary care teams work in decent premises.

The fact that the GPs contract has been agreed is to be welcomed. We hear that there will be more flexibility. We have to accept that, as well as the changes across the NHS work force, there are changes in the GP work force, particularly in relation to the rising number of women who are becoming GPs. Therefore, it is important that contracts are flexible and that various types of contracts, such as PMS contracts, can be used.

The role of primary care professionals in the areas of social inclusion and the prevention of ill health has been mentioned. I was pleased to see that the primary care modernisation report said that that would be the next part of the agenda to be addressed. The recent appointment of public health practitioners is a welcome move in that direction. We must ask whom the average member of the population is most likely to listen to for general health advice. Probably, it will be their GP, practice nurse or a public health practitioner who works at a local level, rather than a consultant whom they see for perhaps five minutes once a year.

"Our National Health" set a target that stated that patients should be able to access a member of the primary care team in no more than 48 hours. I welcome the minister's announcement that that will have been achieved by October.

I welcome the progress that has been made in relation to NHS 24. Not only does that show flexibility in the reorganisation of services, to ensure that patients can access them easily; it shows that staff are responding with flexibility to the suggestion that they might be able to work part time to provide a service. The unanswered question relates to the impact that that might have on other front-line services, which some of those same people might provide. We have to watch that.

Last week, we heard the welcome announcement of extra investment in the health service, which will allow good progress to be made. However, no matter what we want to do with the money, we will come up against the issue of work force planning. The minister stated that two reports are currently being undertaken on that issue and we must take them seriously. In the next 10 years, we will lose about 25 per cent of the nursing work force. We have problems with vacancies in community nursing, with the recruitment of community pharmacists and dentists and with rural GPs. I tend to agree with what Mary Scanlon said about the issue being to do not only with money. The golden hello and the on-going work of the remote and rural areas resource initiative are welcome, as they show that the Executive intends to take the issue seriously. However, we must address the other problems that rural GPs and other primary care professionals have to deal with, such as long hours, professional isolation and the lack of out-of-hours cover.

There are human problems as well. It was brought home to me on a visit to Islay that someone who has gone to the island to work in the community hospital or with the primary care team may have no trouble getting a house to live in in the winter, but faces difficulties in the tourist season. We have to consider the possibility of being a little bit more flexible about that.

Another important issue is the information technology agenda, but I do not have time to cover that today—it might be worthy of an entire debate on its own.

I close by saying that I welcome the primary care modernisation report.