Meeting of the Parliament 10 November 2022
I thank primary care staff and everyone who provided evidence to our committee, including patients who told us their personal stories. I also thank the other members of the committee, especially our convener, Gillian Martin.
As other members have said, primary care is the backbone of our health service. One of the points that came up was the question: what is primary care? When asked, most people will say that it is about their GP but, as we have heard, it is about much more than that. It includes community nurses, physiotherapists, occupational therapists, dentists, those who provide end-of-life care, health visitors and many others. That is not to forget the invisible support staff who back them all up.
Primary care is the first point of contact with healthcare for most people, and strong primary care is central to an effective and sustainable health service. In general practice, our GPs are busier than they have ever been. GPs and their teams are striving to meet spiralling patient demand and to establish key primary care networks. In Lanarkshire, there has been an increase of between 40 per cent and 50 per cent in demand for patient appointments.
The challenges of Brexit, the pandemic and 12 years of austerity have all hit really hard, and the current level of inflation is yet another threat that we face.
The need to reform general practice and deliver alternative pathways has never been as pressing as it is today. However, it is a challenging area for reform, both in Scotland and internationally. Our access to primary care is deeply affected by many factors, including resources, staffing and planning. A lot goes on in primary care: as we heard repeatedly in the committee, services are working really hard to adapt at a time when resources are already stretched to the limit, which is compounding the barriers to sustainable and effective change. However, that does not mean that we need to slow down; rather, it means that we need to work even harder to ensure that we meet those challenges head on.
We also need to be mindful that the public are being asked to adapt, too, at a time when they have never been more anxious or confused about access to care. The public might think that the process has started just because of Covid, so we need to get the recognition out there that it started before then. It is not just a response to Covid; it is the right thing to do.
Transformation is needed, and the success of our NHS will depend, to some extent, on our ability to increase access to, and awareness of, alternative pathways to primary care. Those pathways include receiving advice or treatment from allied health professionals, using social prescribing initiatives and accessing websites or using telephone services. People can do those things instead of going directly to their GP every time.
The term “alternative pathways” might be slightly confusing, because we really mean effective pathways to receiving better care. We might need to communicate that a bit more coherently.
During the inquiry, the majority of people did not quite understand why we were reforming general practice. Again, we really need to talk about that message. A general practice is a community asset that should act as the glue that connects all other healthcare services and professionals, rather than being the single focal point with patients dependant on a particular GP.
There is so much more in the report, and we have heard so much about it already today, but I want to touch on three bits of it: community social prescribing, digital opportunities and recruitment challenges. In some cases, there was an increase in uptake of social prescribing during the pandemic. The comments that we got from patients were really positive. They noted
“quicker and better health outcomes”.
However, the evidence suggests that some people were
“reverting back to their GP”,
so we need to take on board that it will take time for behaviours to change.
In my constituency in Lanarkshire, the community link workers programme offers full coverage across all practices. This year, more than half of Lanarkshire’s GP services referred into the GP community link workers programme, with just under 300 referrals. The most common reasons related to mental health issues, but we know that social prescribing can be effective for physical health and fitness, too—it can have a huge impact in that regard. I would welcome an update on any plans that the Scottish Government has to develop social prescribing further in order to build on that success, particularly around a national lead to improve delivery.
On digital opportunities, our report highlights that digital progress will be key to transforming healthcare for patients and health professionals. I read the recent Scottish Government report, “Care in the Digital Age”, which sets out the delivery plan as we move through the rest of this year to 2023.
We want to see easy-to-use patient apps that provide easy access to appointments and test results. That is a huge thing. A single electronic patient record is another huge thing. If health and care professionals across the NHS and social care could access such a record, that would make a huge difference not just to them but to their patients.
The reality on the ground is that a lot of time and money is being invested, but, just now, a lot of that is going into information technology systems on strengthening cybersecurity and training up staff. Although I recognise the complexities and level of background work in that area, I hope that the cabinet secretary will offer a bit of reassurance that developing digital apps and records will be a priority for the future. I know that it is challenging, but it is vitally important.
I will briefly mention recruitment, which is a really challenging area, as other members have said. However, to touch on some positives, I welcome the Scottish Government’s winter plan, which commits to recruiting 1,000 additional staff, including 750 nurses and 250 support staff, over the winter season.