Committee
Health Committee, 02 Dec 2003
02 Dec 2003 · S2 · Health Committee
Item of business
Primary Medical Services (Scotland) Bill: Stage 2
I lodged amendment 49 because I found that many general practitioners, patients and nurses were concerned about what will happen when general practitioners decide either to stay as they are at present or to become salaried and about who will opt out of out-of-hours provision. My practice covered the period from 7:30 pm to 8:30 am, but that might not be the same in every case—I do not know what times will be decided on. I will give members an idea of what general practitioners do at the moment: they provide cover for their patients 24 hours a day. The family doctor service is probably the most effective medical sieve. Practically all patients are seen and diagnosed there, and the family doctor decides which way they should go—whether they should be treated by the GP, whether they should move forward through the system or whether they should go to the emergency service.At present, if general practitioners have to be away from their practices due to ill health, holidays, maternity leave, postgraduate education, another job or bereavement, it is their responsibility to replace themselves with locums if their partners cannot or will not provide cover. I assume that, if doctors decide to become salaried and opt out of providing all the cover during the day as well as in the evening, that is where the health boards will come into play. No doctor can provide cover when they are suddenly incapacitated, for example by illness, and, at present, if the situation in a practice was really bad, the health board would step in. Over the years, locums have become scarce and expensive for practices. They are a cost to practices, as they are usually paid for out of practice income. At present, not all general practitioners do their own out-of-hours cover. In some cases, such as in small practices, the hours between 7 in the morning and 6 at night are covered, which often means that the practice covers the on-call provision from 7 in the morning until 6 at night as well as all its clinics and other work. Such practices therefore often use deputising services, but, despite that, they often work into the evening. They cannot possibly do all their own work, so they need deputising services.In large towns, which have the choice of a deputising service, GPs who wish to do the out-of-hours service make money. There are a few such GPs, and they are able to make a great deal of money. Not every doctor in Glasgow does that. If every GP decided to do out-of-hours work, providing that service would be a small cost to the practice, but because of work loads, it is almost impossible for them to do that work.The bill will mean that the health board will be responsible if the GP is unable to be present in their practice to cover work within the practice. Looking back over the years, I can remember, when I was in a single-handed practice, having to make 20 phone calls to get five people together to cover my work for a week when I was struck down with a flu-type illness. Likewise, when my mother had a heart attack and was dying up north, I could not get a locum, but six practices managed to cobble together cover to allow me to get away.Perhaps members can see where I am coming from. If a practice has a doctor who is still contracted to the health board and another who is salaried, there may be an inequality in covering the hours during the day, never mind the hours in the evening. At present, doctors can work during the day and go on to work all evening. I hope that, for their and the patients' benefit, their ability to work all the hours that come their way will eventually be restricted. At present, they can do 13 hours in a practice and then work all night, and I have known doctors who have driven themselves off the motorway because they were tired or who have come into work in the morning and lain down on their patient couch to recover. That is wrong, and I would like the bill to contain a provision that prevents one doctor in a practice, who might still be contracted, from doing all the work within the practice, or other doctors from being able to continue working all the hours that they can to make extra sums of money, because that leaves patients poorly covered.With serious situations such as the Ibrox disaster, everybody comes together and works extra hours. In the past, good will has cemented the work that has been done. However, under the European Community working time directive, some doctors will be restricted in the hours that they work, which means that, because many doctors might opt out of being salaried, extra hours might not be covered during the day. Further, because many doctors might opt out of out-of-hours work, there might not be enough people to cover those duties. If members listened to BBC radio this morning, they might have heard about the result of a poll of 3,000 doctors, according to which eight out of 10 doctors wish to opt out of work through the night. That is of concern to patients.I may well not quite understand the proposed options. If we want to retain doctors, we have to provide them with choices—that is great. However, if in providing doctors with a choice, they are still restricted to working excessive hours, nothing will have changed from the present situation. Some doctors may work excessive hours because of loyalty to their patients and others will do so because they want to make more money.I am not surprised that the BMA is not exactly on my side. The bill will work only if lots of different professionals work together. I worked closely with nurses and paramedic services—I could not have worked without them—but it looks as if we may well replace doctors with nurses. We must guard against that because the two are not synonymous.I move amendment 49.
In the same item of business
The Convener:
SNP
I reconvene the meeting. I will take members' guidance, but I think that I should share some information, in particular for the benefit of new members of Par...
Section 1—Health Boards' duties: provision of primary medical services
The Convener:
SNP
Moving swiftly on, I call amendment 1, in the name of the minister, which is grouped with amendments 4, 5, 6, 7 and 24.
Mr McCabe:
I will speak to amendments 1, 4 to 7 and 24. This group—
The Convener:
SNP
I ask the minister to move amendment 1.
Mr McCabe:
Okay, I will move amendment 1.
The Convener:
SNP
You can speak to all the other amendments in the group.
Mr McCabe:
I was waiting for your next instruction.
The Convener:
SNP
I am sorry. You are required to move only the first amendment. I presume that you wish to move it.
Mr McCabe:
Yes—I think that that would be a good idea.This group of amendments deals with health boards' general powers and duties over primary medical services. I will...
The Convener:
SNP
I refer members to the letter that we received from the minister and I thank the minister for it. It is not numbered among today's papers because it came in ...
Amendment 1 agreed to.
The Convener:
SNP
Amendment 2, in the name of Carolyn Leckie, is grouped with amendments 3 and 8.
Carolyn Leckie (Central Scotland) (SSP):
SSP
All the amendments in the group seek to ensure that the bill provides no opportunities to contract with private, for-profit medical establishments. As it sta...
Mike Rumbles:
LD
I oppose the amendments in the group on the ground that they challenge current practice. Private health care providers already provide care in the national h...
Mr Davidson:
Con
I also wish to speak against the amendments, although not quite along the same lines as Mike Rumbles did, despite my having some sympathy with his views. I g...
Shona Robison:
SNP
Whereas I would always take the opportunity to restrict private profiteering from the health service and oppose the use of private finance initiatives and so...
Mr Davidson:
Con
Will the member take an intervention?
The Convener:
SNP
I am afraid that interventions are not allowed.
Shona Robison:
SNP
We have to realise that the current set-up of the NHS, with its many elements and the relationships that it has with community pharmacies and so on, is compl...
Helen Eadie:
Lab
I will oppose Carolyn Leckie's amendments, from the perspective that the existing set-up is correct, provided that there is always state funding when contrac...
Dr Turner:
Ind
I did not get a chance to consider further the detail of Carolyn Leckie's reasons for lodging her amendments but I think that we must take care when introduc...
The Convener:
SNP
For the record, could you tell us what GEMS is?
Dr Turner:
Ind
GEMS stands for the Glasgow Emergency Medical Service (General Practice) Ltd. It was run by doctors and set up by the Government and the local health authori...
The Convener:
SNP
David Davidson, would you like the right to reply?
Mr Davidson:
Con
Thank you, convener. I would like to respond to a comment made by Shona Robison, who more or less accused me of giving an ideological response that all thing...
Mr McCabe:
As members have recognised, amendments 2, 3 and 8 seek to prevent health boards from contracting with private health care providers to provide primary medica...
Carolyn Leckie:
SSP
The contributions have merely confirmed my fears about one of the insidious purposes of the bill. I shall start with Mr McCabe's contribution. By asserting t...
The Convener:
SNP
The question is, that amendment 2 be agreed to. Are we agreed?
Members:
No.