Good morning. We begin with a debate on primary care. I ask members who would like to speak to indicate now that they do. I call Susan Deacon to move the Executive motion.

White coats, hospital beds, high-tech equipment, intensive care units—those are typically the images that flash up on television screens and in people's minds when we talk about the national health service. However, the reality is that more than 90 per cent of patient contacts with the NHS do not take place in our hospitals, but in our communities. Every day, one in 10 of the population visits a community pharmacy; more than 60,000 people visit their family doctor; 8,500 people visit the dentist for a check-up; 2,700 people receive a free eye test; and district nurses make 12,600 visits. That is the scale of the effort every day in the NHS in Scotland. Our motion reflects the Executive's view that front-line, community-based primary care and, crucially, the staff who provide it, deserve more airtime and more recognition in the Parliament and, more widely, in the media.

The Labour-Liberal Democrat Executive has made clear the priority that we give to the NHS and our recognition of the key role that primary care plays in delivering a modern, responsive and patient-centred NHS. In "Our National Health: A plan for action, a plan for change"—the Scottish health plan that was published in December—we set out an ambitious but achievable programme for investment and reform.

That plan was developed in dialogue and in partnership with staff and patients. In drawing it up, we consulted widely. The findings of our MORI-System 3 survey of patient views and experiences were clear. More than 90 per cent of patients were broadly satisfied with general practice and other primary care services. However, certain key issues were identified. First and foremost, people were concerned about access to primary care. Care is not always provided at a time that suits people or in a convenient location. Sometimes they have to wait longer than they think is reasonable and sometimes health professionals are not easily contactable by phone for informal discussion and advice.

Individuals also expressed concerns about the way in which the system as a whole works. People do not want simply a friendly general practitioner who can see them quickly; they want a smooth and responsive journey from GP practice to outpatient clinic, and from hospital to home. As a priority, they want better hospital discharge arrangements and the quick return of test results. Above all, they value services that are provided at, or close to, their homes.

Many of the concerns that were identified by patients during our research and in our dialogue with them have been echoed by NHS staff. The British Medical Association's survey of GPs, which was published last week, shows that doctors want to be able to spend more time with their patients. They, too, want better communication, fewer delays and more co-operation between primary care in the community and secondary care in hospitals. We share those objectives—we have a shared agenda—and we are working together with NHS staff to address them. I shall set out some of the ways in which that is being done.

Investment is part of the solution, although I stress that it is just one part. Almost £500 million more is being spent on health this year than last year, and the health budget is rising from £4.7 billion last year to £6.7 billion in 2003. However, we need not only to spend more, but to spend better to ensure that additional resources reach the front line. That is one reason why we are rationalising the bureaucracy and decision-making processes of the NHS. Next week, we will advertise for chairs of the new, unified NHS boards. Those boards will bring primary and secondary care providers together around the boardroom table to plan and deliver services on a properly integrated basis, to ensure that investment delivers results locally.

Alongside investment we need reform. Many of the concerns that were expressed to us by patients and staff do not have a simple monetary solution; changes to systems, culture and practice are every bit as important. I am pleased that innovations and new ways of working are being developed in the NHS throughout Scotland. Barriers of the past are being replaced with partnership working for the future. The programme of work that the Executive has set out in the Scottish health plan seeks to accelerate that progress. At the heart of that agenda is improved access. Access and availability are not just about opening hours; services must be provided in the right place and at the right time, and easy telephone access is vital. Furthermore, services must neither intimidate nor patronise those who use them.

As "Our National Health" states, we have traditionally viewed GPs as the gatekeepers to the NHS. We need to think about developing and extending gateways to the NHS. For example, we are investing heavily in NHS24, implementation of which will begin during 2001, providing 24-hour access for patients to health advice and a link to the appropriate services. It will be a distinctively Scottish service, building on the excellent work and expansion of GP out-of-hours co-operatives in Scotland in recent years.

We are supporting a range of initiatives that empower professionals to deliver a wider range of services, make better use of their skills and, in so doing, improve services to patients. That will result in a win-win situation for both patients and staff. For example, we are increasing the number of nurses and other professionals who are trained to prescribe, thereby providing a better and more responsive service to patients. That will free up GPs' time so that they can concentrate on other tasks, and it will minimise and reduce frustrations and delays for both staff and patients.

We are piloting new ways of providing nursing care—for example, through the family health nurse. This week, we will publish two major reviews of nursing in Scotland—one on nursing generally and the other on public health nursing in particular. Further details of those will be set out later in the week. There will also be major developments of the school nursing service, which will offer services to people where they are, in the right place and at the right time.

"Our National Health" also stresses the central role of pharmacists and dentists. That is warmly welcomed by those professions as reflecting fully the importance of their roles, perhaps for the first time. Key initiatives include the extension of the model schemes for pharmaceutical care in the community; support for the medication review by pharmacists, in partnership with GPs, of patients with chronic conditions; promotion of the direct supply of over-the-counter medicines by pharmacists to those who are exempt from prescription charges; and the extension of the pharmacists' role in the delivery of repeat prescriptions.

We must ask questions. Are there better ways in which to deliver services? Can we make better use of the skills, time and expertise of all staff? Why should somebody have to wait for a GP appointment or be referred from one professional to another if it is possible for some tasks to be performed by others? There are 1,100 community pharmacists on people's doorsteps in Scotland, who are ready, able and willing to perform that role. Not enough of those fundamental questions have been asked. We are asking them now and we are answering them.

We are following through the actions that are set out in "An Action Plan for Dental Services in Scotland", which was published last year. As in other areas, the key emphasis will be on prevention, especially in the cases of children and the elderly.

What about optometrists? They are also skilled professionals who are right there on most high streets. Why should an optometrist have to refer a patient to a GP if that stage in the journey is not necessary? In some parts of the country, direct referral from optometrists to specialist services in relation to cataract treatment, for example, has been established and is being backed by appropriate protocols. If that can be done in one area, it can be done in others. We are promoting a consistent approach throughout Scotland of co-management schemes that involve optometrists for patients who have diabetes, cataracts and glaucoma. That is not the stuff that grabs the headlines—let us be honest about that—but it is the stuff that makes a real difference to the patient's journey and quality of life.

All the access initiatives that I have mentioned, and more besides, need infrastructure support. We need to invest in better and more flexible premises and we need to promote information sharing while ensuring security and confidentiality. That is why we are investing £33 million over three years in improving health centre premises, mostly in deprived areas, which will enable them to deliver a range of services under one roof. We are also investing heavily in information technology to link GP surgeries and hospitals. The electronic clinical communications implementation initiative—ECCI—will provide the means to deliver more responsive appointments and referrals, faster test results and better discharge information. Those are the things that matter to people—both staff and patients. Community nurses will get access to information technology; the NHS net and integrated GP and nursing records are being developed.

All those measures will enable professionals to access information more quickly and will reduce the need for patients to trudge through the system, chasing information and repeating answers to questions from a range of professionals.

I am particularly pleased to announce that the first pilot scheme for the electronic transmission of prescriptions will be launched in Ayrshire and Arran Health Board this spring. That initiative will provide an improved service to patients by, for example, enabling patients to get repeat prescriptions direct from the pharmacist, rather than having to visit a GP. That is better for patients and better for staff.

All those measures represent an ambitious programme and an enormous package of work and investment. Over the next few years, however, they will start to modernise radically primary care services and transform patients' experiences. They will also enable us to achieve the target that is set out in "Our National Health: A plan for action, a plan for change", that patients in every part of Scotland will be able to get access to an appropriate member of the primary care team in no more than 48 hours. I regard that as a key deliverable for the new unified NHS boards.

We will, of course, continue to work with the professions to consider the implications of changing roles in primary care for work force planning and training. We will continue to invest in the development of skills. We need to ensure that we have the right core capacity for the services that we want primary care to deliver.

Other work force issues must be addressed. Access and flexibility go hand in hand—greater flexibility for professionals and greater flexibility for patients. That is particularly important in general practice, in which significant pressures exist. The needs and expectations of professionals and patients are changing and there are gaps in provision, particularly in rural and deprived areas.

It is not widely recognised that, since the inception of the NHS in 1948, GPs have not been employees of the NHS, but have worked as independent contractors who are paid by the NHS through a complex system of fees and allowances. While that system has been effective in many areas for many doctors, it has led to gaps in service provision and to recruitment and retention problems in some parts of the country.

During the past three years, we have been piloting new ways of providing GP services, using the powers of the National Health Service (Primary Care) Act 1997. Those pilots have worked and there are many excellent examples throughout Scotland of new contractual options having been explored, with benefits accruing to patients and staff as a result. Many have involved the offer of a salaried option to GPs and that is why we are now enabling the NHS to employ GPs directly and to contract on an individual basis with primary care teams. We are doing that not merely as a pilot scheme, but permanently.

Last week, I announced £18.5 million of investment over three years to target resources through the existing mechanisms to areas of greatest need. Let me be clear: I am talking about net additional investment in primary care to provide more doctors and nurses in our communities. That is not at the expense of other primary care budgets. It is a tangible example of our commitment to giving staff and patients the flexibility that they need.

I note from the recent BMA survey of GPs that 20 per cent of respondents expressed a preference for salaried status. We know from other research that the changing profile of people coming into the medical profession, for example, the increased number of women, is leading to demands for other contractual options and more flexible ways of working. We are now starting to offer that choice. It is a radical shift and one that I am pleased has been welcomed by many GPs.

Last week I presented the Royal College of General Practitioners quality practice award to the Northfield practice in Aberdeen. Converting to salaried status has allowed the GPs there to focus their time and effort on developing services for the local community. As one of the doctors said, it has enabled them to address problems with recruitment and retention. Within two years, the practice changed from being a practice in a deprived area that could attract no applications for a vacancy to one that attracted seven applications—all appointable—for a vacancy.

The minister mentioned that 20 per cent of GPs in a survey said that they would prefer to be salaried, but she did not mention the 60 per cent who said that they would prefer to be independent contractors. Will she comment on that?

I am pleased to comment on that. It is highly significant that one in five of those who have opted to work in the independent contractor system, and whom that system suits, have said that they would prefer to have a salaried option. It is true that 52 per cent of people in the survey expressed a preference for their existing status and we are not trying to remove that option. We want to provide a choice for people who are already in the system who want a choice and for the new people who come into the profession. By offering that choice, we will attract people into the service and we will retain them.

The alternative salaried options have been developed in many places throughout Scotland. I do not have time to go into great detail today, but our evaluations prove that the pilots have delivered demonstrable results. For example, they have enabled GPs to offer longer appointments and consultation times, targeted provision for homeless people and greater integration of GP services and other disciplines. We can and must build on that and I applaud the excellent work of staff throughout the country in making those changes and improvements a reality.

The issue of delivering better services through better use of the team leads me, last but by no means least, to local health care co-operatives. LHCCs are diverse and are still developing—they are not yet two years old. We have monitored their development closely and we share many of the concerns that are expressed in the BMA survey about the patchy development of LHCCs and agree that they are at a key stage of development. During the coming weeks, we will consider several reports that are nearing completion and which have been compiled in conjunction with the service. They include the report of a best practice group, the report on a programme of regional seminars—which has been run with the service—and work that is being carried out by Audit Scotland.

The reports show a picture of tremendous success and improvement in some parts of the country, but of less success and improvement in others. We want to build on success and address weaknesses. That is why, based on that programme of work, we will presently set out the next steps in the development of LHCCs. As stated in "Our National Health: A plan for action, a plan for change", the new unified NHS boards will have a key role to play in developing primary care services and strengthening the role of the LHCCs in their areas.

I do not want the unified boards to get hung up on structures; I want them to deliver better, integrated services. That means listening closely to what primary care practitioners and LHCCs tell them about patient need, about communities and about service development.

I have set out just some of the work that is in progress to support and develop primary care services. I hope that we will hear more in the debate about some of the excellent practice that takes place in primary care in Scotland. I hope also that we will have an informed debate about the challenges that exist, the progress that has been made and the work that still requires to be done.

I hope that we will hear a little less emphasis from the Opposition benches on problems, and a few more suggestions about solutions. Patients and professionals want positive and practical action, investment and improvement. That is what they are getting from the Executive and that is what we—with them—will continue to work to deliver in the months and years to come.

I will finish where I started—by thanking and acknowledging primary care staff, who do some of the least glamorous and most vital tasks in our community, such as bandaging leg ulcers, dealing with the problems of drug abusers and giving caring and consistent support to those who are terminally ill. Thousands of staff in the NHS throughout Scotland carry out those tasks day in, day out. I acknowledge their contribution and thank them for it. In that spirit, I move,

That the Parliament applauds the vital contribution which community-based health professionals make to the health and health care of the people of Scotland and affirms the commitment in the Executive's health plan Our National Health: A plan for action, a plan for change to developing these services.

This is the first opportunity that the Parliament has had to debate at length the issues of primary care. The opportunity is overdue, and I know that Dr Richard Simpson has been waiting for it for some time.

In the spirit of consensus that Susan Deacon appealed for, I start by welcoming much of what she said, particularly her announcement about the pilot scheme for electronic prescriptions, which represents an important step forward.

As we all know, primary care is at the heart of the national health service in Scotland. GPs work in primary care teams, together with other health professionals—including practice nurses, health visitors, pharmacists, and people from all the other professions that are allied to medicine—to provide a range of services. They offer patients a unique variety of competences and experiences, all within patients' own communities. That is a reflection of the range and quality of the services that are provided in the primary care sector, which is so highly valued in Scotland.

As the BMA is rightly always ready to point out, general practice is the most valued public service in Scotland. It is right that we value the strengths of our primary care sector and that we seek to develop it. I associate myself completely with the Executive's motion to the extent that it praises and applauds the hard work and commitment of all those who work in the sector. There is a wealth of evidence to suggest that the more we improve and strengthen primary care, the better our nation's health will be, and the more satisfied patients will feel with the NHS in general. Given the finding of the recent ICM poll, that eight out of 10 people in Scotland—including 70 per cent of Labour's supporters—believe that the NHS has either stayed the same or got worse under Labour, patient satisfaction must surely be a priority.

Although primary care is so important, many of the people who work in the sector feel that, to an extent, it is treated as the Cinderella of the health service. Susan Deacon rightly touched on that in her opening remarks. The media and the politicians—I do not mean only those in Government; we are all guilty—focus more on what goes on in hospitals than on what goes on in communities. The care that patients receive in hospitals is obviously crucial, and deserves the attention that it receives. Care that is provided in hospitals can be a key factor in determining the morale of those who work in the primary care sector.

As Susan Deacon said, we should never forget that, for the vast majority of patients, the main and perhaps only point of contact that they will ever have with the NHS is in the context of primary care. To illustrate the point that they are rarely credited adequately for the work that they do, GPs often use an example that all members have probably had related to them. During last year's winter crisis, the media's focus and, to a great extent, that of the Parliament, was on cancelled admissions and other pressures on hospitals. It was correct that attention was given to those matters, but little was said about the increased pressures that the crisis brought to bear on those who work in primary care. GP consultations, for example, increased by one third over the period.

The debate is welcome and timely, although Susan Deacon's speech contained the usual self-congratulatory rhetoric, which has become the hallmark of the Government in debates such as this. There has been action for which the Government should be praised, including increased investment in health—although I might argue that there has not been enough—many aspects of the health plan, the greater focus on the role and importance of primary care in the NHS than was ever the case under the Tories and the many other initiatives than Susan Deacon outlined.

However, not everything in the garden is rosy. More recognition of the current strains on primary care would have been highly appropriate in a debate of this nature. The recent survey that was carried out among BMA principals, to which Susan Deacon referred fleetingly—I am the first to admit that it does not tell the whole story of primary care in Scotland—paints an alarming picture. It paints a picture of a primary care sector that is, to use the words of the BMA in the published survey, "facing a crisis". That view should not simply be brushed aside, as the Minister for Health and Community Care attempted to do in her rather ill-tempered attack, when she accused GPs of hypocrisy and of doing a disservice to the profession. She has tried to brush that view aside again this morning.

When the public are faced with a conflict between Susan Deacon's view from St Andrew's House and the view of those who work at the front line in the health service, they tend rightly to give the benefit of the doubt to the latter, especially because that view is often confirmed by their experiences as patients. The view that primary care in this country is facing a crisis is held by a majority of GPs in Scotland—it is the view of the profession and that view deserves to be listened to and taken seriously.

The fact that Susan Deacon, in an Executive-sponsored debate—

Will Nicola Sturgeon take an intervention?

Just a minute. The fact that Susan Deacon, in an Executive-sponsored debate on primary care, made only very selective reference to that view is a sign of how deeply buried in the sand her head is. With that, I am happy to take an intervention.

Will Nicola Sturgeon answer a simple question? If she is so concerned about the views of GPs and about general practice, why—in the Scottish National Party's recently published health policy document—is there not a single mention of general practice?

If the minister reads that document carefully, she will see mention of primary care. If she listens even more carefully to the remaining 10 minutes of my speech, she will hear much about general practice and about the areas in which the SNP considers that action is needed to improve primary care. Listening is not something that Susan Deacon is very good at, but I ask her to practise it for the remainder of the morning.

Susan Deacon made no reference in her speech to the fact that more than half the GPs who were surveyed said that their morale was low or extremely low; that 71 per cent said that morale had declined over the term of office of the Labour Government; or that 60 per cent said that they were more likely to leave the profession now than they were five years ago. She made no mention of the fact that more than 80 per cent of GPs said that they were under more stress now that they were five years ago. Of course, she made no mention of the fact that 80 per cent think that there has been a decline in the quality of service that patients receive in hospitals in the period during which the Labour Government has been in office.

To put it bluntly, eight out of 10 doctors who work at the front line of our health service believe that the situation is worse now, under Susan Deacon, than it was when that lot over there were in power. What an indictment that is of the Executive's record on health.

The findings of the survey serve to underline the importance of the relationship between primary care and secondary care. That is obviously of importance for patients, but is also important for the morale of the people who work in primary care. Many of the doctors who took part in the survey commented on how often they are forced to apologise to patients for deficiencies in the secondary sector; for example, for the length of time that patients must wait for appointments and treatment. That is yet another fact that was missing from Susan Deacon's opening remarks.

It is no surprise that she decided to body-swerve that aspect of the survey's findings, because the Government squirms at the very mention of waiting lists or waiting times, as anyone who watched "Newsnight Scotland" last night would have seen. No wonder the Government squirms. The Government promised—not, as the minister suggested last night, in some distant age that has no relevance to today, but in the campaign for the election to the Scottish Parliament—to cut waiting lists in Scotland by 10,000 by the next general election. It did not promise to do so by 2002. However, on yesterday's figures, the Government will enter that election having to explain not only why it has failed to deliver the reduction of 10,000 that it promised, but why there are more people languishing on waiting lists today than there were when the Tories left office.

Of course, the Executive wants to be excused from breaking that promise because it now thinks that it was the wrong promise to make in the first place. Susan Deacon says that waiting lists are only one measurement of NHS performance. She is right, but they are the measurement by which the Government asked the people to judge it. A Government source was quoted in newspapers yesterday as saying that

"there was an acceptance that waiting lists had now outlived their usefulness".

For whom—we might ask—is that the case? Waiting lists were only ever politically useful for Labour—they have certainly outlived their usefulness in that respect. Unfortunately for Labour, the rest of Scotland will hold it to account for yet another broken promise. The Government source went on to say that the focus would now shift to waiting times—a swift moving of the goalposts. The only problem is that, according to yesterday's figures, waiting times are also up.

On television last night, Susan Deacon said that it was important to judge the performance of the NHS in the round. Again, in the spirit of consensus, I agree with her. However, whether on the measure by which Labour asked in 1997 and 1999 to be judged or on the measure by which it now asks to be judged, the Government is failing to deliver tangible improvements in the health service. Eighty per cent of doctors know that and 80 per cent of the public believe it to be the case. Labour will have to explain that failure during the general election campaign.

Nicola Sturgeon talked about morale and accused the minister of doing a bodyswerve. That is fine, but what policies would she deliver to lift morale among GPs?

Patience is a virtue. One example of how SNP policies will relieve pressure in the primary care sector is our promise to employ 1,500 more nurses in our health service, including practice nurses. That will address the fact that there are 800 fewer nurses in the health service now than there were when the Government came to power. I am outlining the background against which Susan Deacon is working. If she were honest about that, people would be more inclined to believe what she says about her determination to improve the performance of the NHS.

I will return, as David Davidson requests, to issues specifically related to primary care. I will concentrate on a couple of areas in which action needs to be taken to improve the quality of primary care for patients. First, I will deal with access to primary care, which Susan Deacon talked about. An area of agreement in the chamber is that the quality of service and treatment that is received at all stages of the patient's journey must be improved. That journey starts in primary care.

A key initiative in the Scottish Executive's health plan is that work will be done to ensure that all patients can gain access to an appropriate member of the primary care team in no more than 48 hours. That is an admirable ambition, although no time scale is attached to it. However, it is hard to understand how that ambition can be achieved without a substantial increase in the number of primary care staff, including practice nurses, physiotherapists, occupational therapists and so on. If by "primary care team" the Executive envisages genuinely integrated, multidisciplinary teams—I hope that it does—access within 48 hours is miles away.

Will the member give way?

Not just now.

For example, physiotherapy waiting times in primary care are four weeks in Fife, and up to 12 weeks in Lothian and Perth and Kinross. We need to hear more about how the expansion of staff will take place. If it does not, guaranteed access to the appropriate member of the primary care team will, at worst, never become a reality or it will, at best, lead to increased pressure on already over-stretched primary care staff. That is why the SNP's commitment to employing 1,500 more nurses is so important. A similar commitment from the Executive would not go amiss. We also need such an expansion of staff to provide patients with more time with their GP or other members of the primary care team. All the evidence suggests that that is what patients want.

Secondly, I will talk about the role of local health care co-operatives, which was addressed by the minister. This is another area in which the GP survey had some very alarming comments to make. Sixty-eight per cent of GPs think that LHCCs have made no change to the quality of patient care, and nearly 60 per cent are pessimistic about the future development of LHCCs. Those figures are disappointing. LHCCs could and should be powerful levers for change in the health service. They should drive improvements and ensure a configuration of services that best suits local needs and circumstances. We must ensure that they can do that.

An achievement of the Government that deserves praise is the stripping away of the lunacy of the internal market and GP fundholding that the Tories brought to the system. However, we are some way from securing a structure in the NHS that works to the best advantage of patients. I was glad to hear the minister say that the Executive is still considering how LHCCs should be developed. I hope that, as more changes are made, the Government will consider how LHCCs can be empowered to be levers for change in their communities; that will be crucial.

Those are two areas in which more action is needed. I am sure that, in summing up, the Deputy Minister for Health and Community Care will address them. Action in such areas, coupled with recognition of the problems and strains in primary care, is required to improve morale and the quality of care that patients receive. We have said that primary care is at the heart of our health service. If it is to work properly for patients and for the improvement of health and the health care system, primary care must be the jewel in the crown of the Scottish NHS. I hope that this debate will make a contribution to that.

I move amendment S1M-1699.1, to leave out from "and affirms" to end and insert:

"notes the recent survey conducted by the Scottish General Practitioners Committee which found that primary care in Scotland is facing a crisis, with low morale and increasing levels of stress amongst general practitioners, and concludes that the Scottish Executive has a great deal still to do to develop primary care services in Scotland."

Before addressing my amendment, I would like to make a point about Nicola Sturgeon's speech. Referring to a political party as "that lot over there" is disrespectful, and does a disservice to her party and the chamber. It is time that the party that is against everything and for nothing grew up and entered the world of adult politics.

Today's motion applauds the vital contribution that community-based health professionals make to the health and health care of the people of Scotland, and we fully support that. The second part of the motion affirms the commitment in the health plan to change and develop services. We cannot support vague promises and affirmations from plans, glossy brochures, strategies, focus groups, reviews and consultations until they are translated into action, and genuine efforts are made to enable, empower, support, co-operate with and assist GPs and other professionals so that they can do the job that they are committed to doing.

There is much in the health plan and in what the minister has said this morning that Conservatives totally support.

I was visited by Hugh Campbell, from Tain, of the Association of Optometrists. I am delighted that the minister is now forming partnerships with optometrists and focusing on diabetic care, particularly in relation to eyes. I applaud those partnerships.

I was delighted to learn in a recent written answer that the minister has given a commitment for pharmacists to support and counsel smokers and help them to quit, once prescribing comes forward.

I am also delighted to hear that there will be a greater commitment to ECCI. I visited the pilot study at Raigmore hospital, where I saw how the system operated and how referrals were made instantly to the consultant. Papers were not lost and patients were given more information on discharge. We all commend and welcome that. We look forward to the day when that is spread out across the whole of Scotland, not just to assist GPs and consultants but, at the end of the day, to assist patients.

I will concentrate my comments on GPs, as my pharmacist colleague, David Davidson, will speak on the subject of health professionals. Although I agree that money could undoubtedly be spent better, members should never forget that we already spend over 20 per cent more on the national health service in Scotland than is spent elsewhere in the United Kingdom. If we cannot get it right—by spending wisely, looking at and rolling out best practice and ensuring value for money—then there is something seriously wrong with the management of the NHS in Scotland.

We hear constantly from the minister how proud she is to have abolished the internal market and to have denied GPs the opportunity to be fundholders. Yet it was fundholding that provided the lever and incentives for change; brought forward so many excellent initiatives for care and treatment at the local doctor's surgery; and brought closer collaboration with the primary care and acute sector.

One initiative put forward by the minister, in place of fundholding, was the joint investment fund, but the minister then made it impossible for GPs to access that money. I believe that the joint investment fund, or JIF as it is called, has sunk without trace and that nothing has been put in its place.

Fundholding was in its early days when it was abolished and I say to Nicola Sturgeon that when she insulted fundholding—I think that she called it "lunacy"—she insulted every single GP who operated within that system. I quote from an article "GPs: We're Sick of the NHS", in the Sunday Herald of 18 February 2001. In the article, Dr David Shaw from Dundee, who has been in practice for four years, was reported as saying:

"Changes in recent years, including the scrapping of GP fundholding, which allowed doctors to manage their own budgets, have left doctors with little control over the care of their patients. He said: 'Whatever the rights and wrongs of GP fundholding, it did mean that GPs had an opportunity to deliver care more towards the particular needs of their patients. I think we have thrown the baby out with the bath water. There is no longer a chance to deliver services tailored to local needs.'"

Other GPs quoted in the same article included Dr Helen Jackson, a GP for 22 years, who said:

"Doctors are leaving the profession in droves - they . . . would do anything rather than this."

Dr Gregor Venters, a GP for 10 years, is now leaving the profession because he is sick of the paperwork and of having too little time to treat patients.

Another GP is quoted as saying:

"The care my patients get at hospital level is atrocious . . . I'm ashamed of the NHS and of the care I'm providing."

It is one thing for Opposition members of Parliament to use soundbites and quotes, but this article allows us to hear doctors speaking out as they have never spoken out before.

That is not true.

It certainly is: they cannot all be wrong. Those views were confirmed in a recent BMA study of more than 2,200 Scottish GPs, which has already been mentioned in the debate, and I say to the minister that GPs do not feel that they are in a win-win situation at present.

On that point, what is Mary Scanlon's response to the views expressed to me by a GP who retired at the time when the Tories were still in power. When I asked him how he felt about retiring, he said:

"When I joined the medical profession, I wanted to be a doctor. When I retired I was an accountant".

That was the result of Tory policy.

I cannot comment on an account of a one-way conversation that Fiona Hyslop had with a GP. I can comment not on the situation of four years ago, but on the situation that we face today. It would be far better if we were all a bit more professional and responsible, as we need to identify and address the problems that we face today, not the problems of four years ago.

The BMA study showed that 82 per cent of GPs said that stress has increased in the past five years; 72 per cent said that morale had declined in the same period; 60 per cent said that they were more likely to consider a career change or early retirement; 65 per cent cited increased bureaucracy; and 76 per cent said that they had no sense of involvement in the current NHS changes. I like much of what is set out in the health plan, but how can we vote for a motion that states a commitment to change if the prime movers of that change have not even been involved?

On the changes that have been put in place, 14 per cent of family doctors are optimistic about the future of LHCCs—indeed, I look forward to hearing what the minister has to say about the future plans for LHCCs. She rightly admits that some are evolving, some are moving forward, and many are struggling simply to stand still.

According to 79 per cent of GPs, the quality of service care in hospitals has declined. The debate is not about the acute sector, but when there are problems in that sector, patients go along to their GPs, who deal with 90 per cent of patients' problems, and ask them for help. Problems in the acute sector, therefore, directly impact on the primary sector.

Given the fact that GPs deal with 90 per cent of patient cases, they still receive less than 10 per cent of the budget, and they are far from ecstatic about any of the minister's so-called plans and commitments. According to the recent GP survey, there is no doubt that, after four years of Labour government, things are not getting better in Scotland. Recent cuts in GP funding have meant that many excellent initiatives have been curtailed. The scrapping of fundholding has taken away the incentive to treat patients closer to home just as effectively.

The BMA's "Valuing Scottish General Practice" says:

"Clear benefits in relation to the monitoring of the quality of hospital services which were inherent in the internal market have been lost to the detriment of patient care."

That has led to many problems in the acute sector. Waiting lists are up by 10 per cent on the past year and 1,000 more people are waiting than when Labour came to power. As I said, people constantly go to GPs when they have to wait for a long time to see a consultant and for surgery. GPs are the first line of defence. Anger and frustration with the acute sector are undoubtedly focused back on GPs. That increases their work load and the bureaucracy that they face. It is hardly surprising therefore that emergency admissions to hospitals are rising by between 10 and 20 per cent throughout Scotland.

While people wait to see a consultant or for surgery, many conditions deteriorate as a direct consequence. That is an added pressure on GPs. Examples of such conditions are heart disease, arthritis and particularly mental illness, which is an increasing element of GPs' work load. Patients turn to GPs to ask them to put pressure on the hospital sector. I heard what the minister said about the smooth journey for patients and look forward to hearing the minister's proposals. That matter undoubtedly has to be urgently addressed.

Although the debate is not about the acute sector, we can surely recognise from it that the NHS is a team exercise and that failures in the acute sector impact heavily on the primary care sector. It is reported that Aberdeen royal infirmary has only six out of 16 general surgeon posts filled. An applicant who recently applied for a job at the Beatson Institute reportedly described it as a slum.

In response to the serious crisis in primary care, there is an announcement of 50 salaried GPs. That sounds good, but only £18 million has been allocated and the minister expects that to be recouped by the movement of current GPs from their existing contracts to new contracts. That was in the press release.

The Scottish Conservatives will fully support any motion on and commitment to better patient care and treatment for people in Scotland. However, we need more than mere soundbites: the national health plan may be a plan for action but, to date, it is only a plan.

I move amendment S1M-1699.2, to leave out from "affirms" to end and insert:

"further calls upon the Scottish Executive to address urgently the serious problem of low morale among GPs, the associated issues of workload, bureaucracy and lack of resources, and to look to greater recognition of and partnership with community-based health professionals in order to ensure greater utilisation of local services and to put the patient at the heart of the NHS."

As has been said, this is an important debate. We have waited a long time to have a debate on the specific issue of primary care, yet we cannot help but tip into the acute sector and other parts of the health picture. While primary care is an important strand of health care, it is not the whole picture. We must find a way forward in relation to team building and partnership working among those who work in the primary care sector, the acute sector and preventive medicine.

When people think about health, they think of "ER" and "Casualty". When they think of the NHS, they think of hospitals, when they should be thinking about their doctor's practice or the district nurse who visits their homes. The majority of patient care takes place in the community and involves primary care teams of professionals. I am happy to pay tribute to those professionals and to the great work that they do in our communities. The vast majority of decisions are taken at the primary care level by dedicated GPs, district and community nurses, dentists, community pharmacists, therapists and many more professionals.

It is vital to acknowledge the great importance of primary care services. After a couple of post-internal market years, we are moving into a new era and now is the time to take stock of what was done right and what was done wrong. Not many members will share whole-heartedly Mary Scanlon's enthusiasm for the internal market. However, I suspect that some MSPs have a sneaky suspicion that there was a grain of truth in her comment that we might have thrown the baby out with the bath water.

Mary Scanlon also said that we must reconsider how to put incentives back into the system. While I do not think that we should give practitioners financial incentives, there is a need for incentives to empower people in the decision-making process, as Nicola Sturgeon said. We should empower primary care professionals to lever the needs of their patients into the acute sector. Therefore, I give some support to Mary Scanlon's comments, and I will come back to incentives later in my speech.

The internal market created a two-tier system. As Fiona Hyslop said, it created extra bureaucracy, taking doctors away from the fundamental job of caring for people and turning them into accountants and managers. The internal market changed completely their way of working and, for the most part, it was detrimental. In Scotland, we are trying to rebuild the national health service and to create a service that is as free from division and demarcation as we can make it, but we are likely to be successful only to a degree.

"Designed to Care" introduced primary care and acute trusts and we are on the cusp of another change with the introduction of unified health boards. As the minister said, we hope that people will sit around the same table with one common purpose in mind: how to make their area as healthy as it can be. The unified health boards will also produce local health plans and examine the range of services and the different strands of service delivery in order to provide better health services for the people of Lothian, Grampian and other areas of the country.

We must examine the key issue of ensuring that the primary care sector receives the investment that it needs. At present, 90 per cent of decisions are made in the primary care sector, yet it accounts for only about 10 per cent of investment. I agree with the minister: it is not just about investment or the amount of money that is put in but about ensuring that that money is used to best effect to provide the best patient care. That is the challenge that faces the new unified health boards.

The concept of the LHCC is one of the children of "Designed to Care", but it appears to be almost stillborn in some parts of the country. The minister used the word "patchy" to describe the development of LHCCs, and it is indeed patchy. No member who has had the great pleasure of sitting on the Health and Community Care Committee for the past two years would be surprised at the BMA's comments on LHCCs. We discussed LHCCs as a possible route into greater integration for community care services, but we dismissed that option, not because we did not think that good work was being done in certain areas of the country but because we knew that the service was patchy and was still developing, with a long way to go. I welcome the minister's comment that best practice will be evaluated over the next few weeks and that changes will be made. I return to the point I made earlier about incentives: we should find ways to give primary care professionals incentives and the tools to deliver better patient care.

Fifty-seven per cent of GPs are pessimistic or very pessimistic about the future development of LHCCs. When I speak in the chamber, I do not refer often to my constituency because I tend to speak about health on a strategic level, but the north-west Edinburgh LHCC in Edinburgh West has had a successful and enthusiastic start to life. It has worked well with the local social work team and, for example, has been innovative in the field of mental health. As the Deputy Minister for Health and Community Care can testify, by providing financial support to local health projects the LHCC played an active part in the continuing work of the local social inclusion project in Muirhouse, Pilton and Drylaw on the challenge of tackling health inequalities. Both Malcolm Chisholm and I know that funding for those projects has been threatened year in, year out. The LHCC's dynamism comes from the local clinical directors and the local practices, which are working towards accreditation from the Royal College of General Practitioners.

The LHCC's first annual report makes interesting reading. It says that its first year

"has been about developing structures of the LHCC and building relationships between different groups of professionals. Although we are all technically part of the 'NHS family' we have tended to work in isolation. The introduction of the LHCC with its objective of enabling enhanced multidisciplinary and multiagency working has seen . . . the small fruits of such a partnership approach."

It is clear that, without an incentive—financial or otherwise—to get involved, some practices have refused, failed or been unable to embrace that new approach to the same extent as other practices. It is good news for my constituency that professionals got involved and it is a shame—it is unfortunate—that other professionals have not done so. I hope that the Executive will consider seriously trying to kick-start the LHCC process.

I also want to flag up the need for improvements in the fabric of primary care services. I am not talking about big capital projects in our major hospitals alone, as it is important to give both patients and staff good surroundings so that the best possible care can be delivered. In my constituency of Edinburgh West, a large number of capital projects are in progress, with the modernisation of the Muirhouse medical centre, new premises for the Pilton health hut—which is on the border with Malcolm Chisholm's constituency—an extension for my local surgery in East Craigs and new health centres for South Queensferry and Kirkliston. It is clear that money is being put in, but it is important that that money facilitates the best possible care.

The Scottish health plan acknowledged and supported the primary care sector. It recognised and supported the development of multidisciplinary teams of primary care professionals. Making better use of the considerable skills and talents of nurses and others by extending prescribing powers and the use of clinics will allow GPs to spend more time with those patients who require greater clinical input. An all-round educational job needs to be done with the public, so that they realise that they are not getting a second-class service if they cannot see their GP, and with some GPs, who must let go a bit and trust their colleagues. An educational job also has to be done to ensure that our nurses—practice nurses, community nurses, district nurses, school nurses and occupational nurses—have the investment, tools and training that they need to do their extended jobs. We await information on the Executive's strategies for nurses.

The minister highlighted the considerable role of nurses and community pharmacists. All of us in the chamber have been impressed—and Mary Scanlon touched on this—by some of the work that has been done by community pharmacists large and small, from Boots in Glasgow through to local community pharmacists. By meeting people daily, community pharmacists have a great opportunity to engage with them in a way that improves their health.

The minister is right to say that that we can use a number of gateways to improve health. People have talked about waiting times, but I will not dwell on that topic too much, as I am into my last minute and a half. However, we must do all that we can to meet the waiting times challenge that we have set ourselves. We have to ensure that people can have an appointment with an appropriate primary care team member within 48 hours. We can do that in a number of ways. We can utilise new technology, and I welcome the minister's statement on that. I am concerned about some of the reports to do with the Common Services Agency and the overpayments that have been made to community pharmacists.

The NHS has not done so in the past, but it must embrace new technology in an effective and integrated way. An example is NHS24, which allows parents peace of mind at the end of a telephone, so that they may not have to turn up at a GP's surgery and wait for 30 or 40 minutes with a screaming child. The line will give people access to advice from health care professionals.

We all want the same thing, whether we are the BMA, the Executive, the Parliament or patients, GPs and primary care professionals. We all want a good, thriving primary care sector that is supported by Government, has proper investment, has decent facilities and has restructured services that put the patient at the heart of things. We must do everything in our power to improve the range of primary care facilities—whether that means telemedicine or extra prescribing by nurses—in order to improve the health of Scotland. That is the challenge for all of us. We are all on the same track, although we may have a slightly different way of articulating it.

On a point of order, Presiding Officer. Before we get into the debate proper, would it be possible to do something about the heating? It is very cold in here.

I take that point. I have asked that the matter be investigated urgently and I will report back to members when I can.

We now move to the open debate.

I shall begin by declaring that I am still a member of the British Medical Association and of the Royal College of General Practitioners. However, that declaration is incorrect in that I no longer do any locum work—I am not a practising GP.

I have tried to write this speech about half a dozen times since I learnt that we were having this debate. As Nicola Sturgeon rightly said, I have been waiting for this opportunity for two years. The extension from four to five minutes in the time that we are allowed for speeches is very welcome, but even that will not give me much opportunity to say what I really feel about primary care.

I think that everyone in the chamber agrees that British primary care is unique. It is evidently trusted by patients, although the minister has rightly referred to access problems. The system saves an enormous amount of money by providing a gateway. I think that "gatekeeper" is the wrong term—again, the minister is quite right. It should be a rapid transit system that allows people to get the care that they want, either at secondary or, equally important, at intermediate care level, which has not so far been mentioned.

The strategies that are in place are correct. I welcome the minister's speech, which showed the way forward and all the initiatives that are either being undertaken or in the process of being undertaken. However, at present, they are insufficient. The minister recognises that we still have an awful lot to do.

We need to change the role of the general practitioner, for two reasons. First, the general physician has now gone in the secondary care sector, being replaced by the general practitioner. Secondly, the general practitioner's overriding wish is to have more time to discuss with patients the extremely complex care that they now receive at secondary care level. That desire is matched by the patients themselves, who also wish their general practitioner to have more time. However, that will be totally impossible unless the role of general practitioners is changed substantially and they are freed to undertake that additional work.

Over the years, many systems have been employed to try to change practice, but I will touch only on the ones that have been employed over the past decade. Mary Scanlon referred to fundholding, but Margaret Smith had a much more balanced approach to that. Fundholding was bureaucratic, market-based, competitive and divisive—and I say that as someone who was a fundholder. On the other side of the coin, it brought out new leaders in general practice; it created innovation of a sort that I had not seen in my professional life; and it changed secondary care practice, in a way and at a speed that had never occurred before and that has not occurred since.

When fundholding was stopped—and I am absolutely convinced that we were right to stop it, because I have no desire to return to that bureaucratic market system—we threw the baby out with the bath water, as Margaret Smith said. In effect, we decapitated many of the new leaders, by taking away from them the opportunity to change secondary care. Part of the waiting list problem that we now have has come as a result of that. There is now no pressure on secondary care to meet its targets. I will come back to the waiting list initiative at the end, because it is not so important.

What have we had instead of fundholding? In 1997, when trusts' structures changed and primary care trusts emerged, the JIF was introduced. If any members have not heard of the JIF, it was the joint investment fund—referred to as a lemon by most people in primary care. The JIF was the opportunity to replace fundholding, but it died the death in 1997 because there was no funding available to make it work. Its obituary is one of the shortest in history: three lines in the NHS plan saying that JIF is no longer with us. That is regrettable, because JIF was about service redesign and about creating vertically integrated networks—which we are all agreed should happen. We were on the point of getting the money that could have allowed the JIF system, which was created by Sam Galbraith, to function.

We now have local health care co-operatives. Those are collaborative and have been welcomed by GPs, but their honeymoon period is almost over. It is over for two reasons. First, in the first year, generic drug cost rises—which we did not ameliorate to any great extent—meant that the LHCCs had no flexibility and little opportunity for innovation. Secondly, there are no funds, no mechanisms and no levers for change for LHCCs in relation to the secondary care sector. In the primary care sector and across community care they are making big changes, but in the secondary care sector they are not.

I have some suggestions for the minister. First, give a small amount of money—£100,000 to £400,000—to each LHCC. Sow those talents, and hold the LHCCs accountable. Insist that patients are involved in the spending of that money so that it is spent wisely. Secondly, for goodness' sake push the public health nurse initiative and the school health nurse initiative as hard as possible. I know that the minister is very keen on those initiatives. Thirdly, give the LHCCs some commissioning powers so that they can develop vertically integrated networks, choose a few topics such as diabetes, and make things work. Fourthly, merge practice nurses and community nurses so that the discrepancy between the two is removed, provide 100 per cent funding for practice nurses, and ensure that teams are self-managed.

Fifthly, introduce intermediate care and ensure that all minor surgery is done in primary care rather than secondary care. That will help the waiting lists. We should ensure that endoscopy, which is done in Liverpool and for which there are no waiting lists, is increasingly done in primary care resource centres. We should ensure that cystoscopy, which is done in Bradford, is done in primary care in Scotland and that sigmoidoscopy, which is fundamental to the colorectal initiative, is done in primary care—that will also reduce waiting lists.

I have one last comment on the waiting lists. There have been 100,000 additional procedures carried out on the NHS since 1997. If that had been 90,000, the waiting lists would have gone down; if it had been 120,000, the waiting lists would have risen by double the amount. The NHS is more productive and its performance greater than ever before and it is insulting to suggest otherwise.

Will the member give way?

I am sorry but I am already running over time.

The waiting list issue is about an increase in performance and not simply an increase in waiting times and lists.

I thank Trish Godman for raising a point of order about the heating. My woolly scarf is not a fashion accessory; it is all that is standing between me and a great chill factor. At this rate, I may need primary care.

I will focus on democracy and the balance of power in the various organs that deliver and administer primary care. Haylodge hospital, a successful hospital in Peebles in my constituency, is served by six GPs. It also houses the community centre. There are 50 beds—34 that are notionally for the elderly frail, although they are no longer used for that purpose. Unfortunately, a breach has developed between the Borders Health Board on one side and the GPs and the community on the other about the health board's plans for the hospital. At a recent meeting, 200 people turned up to oppose the plans.

The health board wants to provide secluded long-term stay beds. As I understand it, that would involve the closure of the community hospital for some eight months at a cost of £1 million and with the loss of 14 beds. However, that is based on a three-year-old plan that criticised the long-term stay conditions at the hospital at the time. There was no consultation with GPs at that time and things have moved on. Bed use has changed; at the time of my recent visit, only three of the long-term stay beds were in use. All the other beds were being used for intermediate treatment and for convalescents from the Borders general hospital—they were being used as GP beds. Indeed, they were all full and there was no room for anyone else to be admitted. That reflects the national trend in the treatment of the elderly, which rightly endeavours to maintain the older person in their home for as long as possible, rather than consigning them to a hospital bed unnecessarily. Nowadays, older people are more likely, if it is appropriate, to be moved to a nursing home. I will come to problems with that in a moment.

The health board refuses to give ground and, when it does concede a little, it does so with bad grace. I wrote to the chief executive supporting the GPs' call for a moratorium. I mentioned updating the local care provision—remember that the report was three years old—bed use and what was required locally, given the democratic changes in Peebles. Behind the polite façade of the chief executive's reply, I detected a resistance to listening to local voices—she has rejected a moratorium out of hand. That shows little sign of the empowerment of professionals or partnership working to which the minister referred. I am concerned that the chief executive of the Borders Primary Care NHS Trust appears to have no profile in those decisions. The policy is driven by the health board rather than by primary care management or, better still, by locally informed requirements.

I would like the minister to address the question that I have illustrated with the problems at Haylodge. Why should unelected administrators do something other than administer? Why are they interfering in policy matters? The minister and I have to listen to the general public, because our jobs depend on it. However, the jobs of the people at the Borders Health Board do not. Those people could drive through unwanted reforms. In my view and in the unanimous view of local GPs, the board's plans are out of date and out of touch. There is a huge fault line in the structure of health care at a local level when policy is driven by the board and the primary care trust is left with the role of delivery.

The minister referred to cultural changes in the system. We have heard much today about the proposed changes to the administrative structure of health provision at a local level—the merging of boards and trusts. There have also been many references to LHCCs. However, as my colleagues have said, provision is patchy. The changes must be radical enough to meet the needs and aspirations of the local professionals and users, rather than simply demand compliance with some one-size-fits-all template. We must strengthen democracy and accountability in primary care services.

The other issue that I want to raise is what happens when a patient is transferred from hospital to a nursing home because it is not suitable for them to return home. The Borders Health Board will not pay for an additional GP to visit the people who have been transferred to a nursing home. That is not necessarily what happens elsewhere in Scotland. In the Lothians and in Grampian, services continue, whereas in the Borders only crisis treatment is provided—there is no physical therapy or occupational therapy. One day patients receive such treatment and the next day they do not, simply because they are in a different venue. We are back to postcode care, which is unacceptable. Does the minister intend to do anything about that problem? She has talked about additional GP funding. Will she iron out the unfairness in the delivery of GP services to elderly people who have been transferred from a community hospital to a nursing home?

Before I call the next speaker, I want to reply to the point of order raised by Trish Godman. It is unusually cold outside, but I am informed that the boiler is going at full belt. If members wish to drape themselves in their coats, I am prepared to make an exception and disregard the restriction on so doing.

I should declare an interest as a member of Unison, which has a significant number of members working in primary care and the NHS in Scotland.

For the vast majority of the people of Scotland, primary care is the face of the national health service. Patients have significant needs and those needs must be addressed in new ways. It is no longer acceptable for services to be provided without patient involvement. Much has been said this morning about the involvement of the professionals but, in designing services, we must also take on board the views and aspirations of patients.

We have the opportunity to design new services and to redesign current services so that they are patient centred. That is firmly on the NHS agenda, particularly with the advent of personal medical services. The benefits of PMS for primary care are vast. It challenges professionals to work in a team that crosses professional boundaries, even extending beyond the national health service. Many health service professionals have faced structural and professional barriers that have worked against the interests of patients. Partnership is a big opportunity and it is there for everyone to take. That is the way forward for primary care, because it involves not only those who work in the service, but those in other organisations that contribute to the provision of that service.

Recently, I had the opportunity to work with a community group, the New Farm Loch initiative, in Kilmarnock. New Farm Loch is a large housing estate that was built just over 30 years ago. In those days, large schemes were built without any facilities—they had a school and, if they were lucky, a shop. Adam Ingram, another native of Kilmarnock, will know exactly the type of scheme that I am talking about. New Farm Loch was built without any health provision. Thirty years ago, the population of that estate was young—there were many young families. The individuals who have stayed on the estate need more and more health care, yet there is none. In Kilmarnock, there are five GP surgeries within spitting distance of each other, all in the town centre—patients have to travel to them. The New Farm Loch initiative obtained money to undertake a survey of the community, which was carried out by the University of Paisley. High on the agenda was the desire for some health provision within the community.

That area is no different from many others throughout Scotland—everybody has an example that they can refer to. We looked at what was available—for example, the buildings—and we looked to our partners on East Ayrshire Council, who were talking about opening a local office in the area. The primary care trust decided to manage the office in partnership with the council. We tried to include our colleagues in the local health care co-operative, but unfortunately there are still barriers—whether technological or professional—that prevent them from having a branch surgery for people in the area. We have to overcome that barrier.

It is heartening to hear the minister talk about the extended role of nurses, because that is one area in which we will be able to provide my constituents with a service that has been denied them for so long. It is not always necessary to have a GP. There are many other highly skilled and highly competent professionals in the health service who are not being used appropriately to take the weight off GPs. If we are serious about doing that, we need to address the issue. I welcome the fact that the nursing strategy will be published tomorrow, but that strategy will fail if it is not backed up with sufficient funds to allow additional skills to be developed in nursing.

The pilot scheme for the electronic transmission of prescriptions will significantly decrease the number of scripts that GPs have to look at. Irvine in Irene Oldfather's constituency will be the pilot area for the Ayrshire and Arran Health Board. We have piloted a great deal in Ayrshire and Arran that is now being used throughout Scotland. I hope that that pilot will also be a success.

On a point of order, Presiding Officer. You have been considerate enough to allow us to put our coats on, but in the corridors—those marble halls—the security staff are shivering. Many of them are not permitted to come into the chamber or the members' coffee room except by special dispensation from the Presiding Officer. Would you be kind enough to grant that, so that they can at least go in and out of the coffee room for a bit of a heat? They are in a worse situation than we are.

Yes, I shall see what can be done.

I declare that I am a member of the Royal Pharmaceutical Society of Great Britain.

Today's debate is important, so I am disappointed that so few members are present. I do not think that we in the Parliament appreciate how vital the debate is. I welcome some of the Minister for Health and Community Care's comments, but I have one or two questions for her. I am concerned about her attitude and her perception of what is in fact a crisis in morale in the NHS. That is being talked about not only by GP associations and bodies, but by individuals. There is a perceived difference in attitude between the minister and people who work in health delivery, which I hope she will attempt to address. Laying out the stall is all very well, but the minister has to be more persuasive in getting across what she is all about, in order to get the partnership that I believe she is seeking.

Richard Simpson said that the minister once again focused on controls rather than outcomes. If that is the case, is that why there were great underspends in last year's health budget, despite the crying need for the resources that have already been voted through? I recently talked with medics in Grampian, who are extremely concerned about the shift of resources under Arbuthnott. They claim that there is no recognition of the demand on primary care, especially the demand on GPs. They say that they cannot expand the range of services that they want to provide, which will put pressure on the hospital sector. Worse, some GPs are talking about curtailing current services, which will also place a strain on hospital trusts.

I am fed up with the obsession with waiting lists and with trying to pick out one or two sexy disease areas. Everything should be based on the clinical need of individuals. If we are to have a patient-centred NHS, we have to ensure that decisions on the services that patients need and their design and delivery—I accept Margaret Jamieson's point about the voice of the patient—are made close to the patient.

As I have said before in such debates, there is a brain drain of qualified health professionals from Scotland. There is now no incentive to become a GP, as the BMA research that has been cited today clearly shows. If GPs are to have more time with patients, there must be more GPs or, as Richard Simpson eloquently said, some of the roles that they perform must be transferred. Why are no new GPs coming on stream? It is not just because of salaries. The key is the conditions and professional environment within which they have to operate. There are problems with retention. Incentive is not just about salaries; it is about giving GPs the professional environment that they want and the tools to do the job that they want to do.

We mentioned the ins and outs of fundholding. Fiona Hyslop and Margaret Smith had a pop at it, and Richard Simpson was honest about his experiences. Last week, The Press and Journal carried an article on a medical practice in Buckie. It is a state-of-the-art practice, which runs all sorts of clinics, performs minor surgery, uses all sorts of health professionals to deliver clinics and services and has an integral pharmacy—the list goes on. The GPs say that that is a result of fundholding and their ability to design their service. They are concerned about whether they will be able to keep that service running. It is an integrated service, which is the gold standard, particularly in smaller communities in Scotland.

I will now deal with salaried service. Has the minister considered salaried service for dentists, given that we do not have many dentists in Grampian and the Highlands? She should also consider salaried service for GPs, but only as an interim solution, because the people who go into salaried service do so as a career move; they do not do so with a long-term commitment to stay in general practice, which is worrying. Recently, I tried to get help for a practice in Gardenstown. It has been operating with locums, which is a disaster for co-ordinated health care. Once again, why are pilots taking money away from existing services?

Other people play their part in primary care. We must recognise that many of them, such as pharmacists and optometrists, are in the private sector. We have to accept that there is a need for those contractors in the system and that there is no two-class system with the public and private sectors. We have to co-ordinate and use existing resources. Although there might be shortages of pharmacists, chiropodists and physiotherapists, the main point is to get access to all those services and treat people as near to home as possible. If all those professionals were involved in screening, a lot of GPs' work would be removed and care would be focused on what has to be done.

We have said often enough—I said it two years ago in the health debate at our party conference—that we need to co-ordinate social care and health budgets because, on the ground, health and social care people work together. At the moment, there is an artificial divide. It is pointless having two sets of masters when much can be delivered more centrally.

Community hospitals have the ability, particularly in the north of Scotland and rural areas, to deliver a range of services from all parts of the health service, but they are funded by hospital trusts. All those who practise in community hospitals are concerned that there are not enough resources to run community hospitals. I would like Malcolm Chisholm to address that issue when he winds up the debate. How will he ensure the continuing existence of community hospitals?

The member has 30 seconds left.

I have one final comment to make. The chamber has today recognised the potential role that everybody out there can play in the care of our people; we must now focus on looking for the best delivery system.

As the convener of the recently formed cross-party group on mental health, I welcome the opportunity that this morning's debate affords to raise some concerns regarding the delivery of mental health services in Scotland.

The debate has been brought into sharp relief by the publication of the report "The Reality Behind the Rhetoric", which revealed the appallingly low morale and increased stress among Scottish GPs. It is clear that, in a situation where practitioners are stressed, the propensity to misdiagnose or to be less sympathetic to patients who are suffering from mental health problems is likely to increase.

The Millan report, which was commissioned to review mental health legislation in Scotland, received evidence from professionals and from NHS users and their families that mental health services are often overstretched and inadequate. The report also states that the proper operation of mental health legislation is

"clearly predicated on the provision of effective and responsive mental health services."

There is plenty of evidence that there are problems with access to urgent help through primary care services for mentally ill people. Carers in particular may not have the credibility with GPs to get over how urgent that need is. In a recent survey by the National Schizophrenia Fellowship, one carer related:

"I phoned the GP to say that my son was suicidal and was told that this was only attention-seeking behaviour. He tried to commit suicide that same evening."

Another stated:

"The GP refused to come. We had no car. Over the phone, the doctor told my husband that my son did not need to take medication."

On Tuesday, The Herald reported a case in Glasgow in which a GP was found by the General Medical Council to be guilty of serious professional misconduct by refusing to see a psychotic woman in her home. Unfortunately, such experiences are far from uncommon for families, particularly those who have to deal with disturbed adult patients who do not believe that there is anything wrong with them.

The answer to such problems must lie with the development of primary care teams so that, as has been suggested this morning, they include many more skilled nurses. Community psychiatric nurses are worth their weight in gold.

That brings me to the subject of resources. An article in this week's The Health Service Journal points out:

"90% of patients' problems are dealt with entirely within primary care and this is increasing, yet it receives less than 10% of the NHS budget. We are at a political crossroads. There is a pressing need for real change and improvement in the Scottish Executive's support for primary care."

I emphasise that that is particularly true for mental health services. Although mental health is one of the three clinical priorities, mental health services funding has traditionally suffered leakage to other less stigmatised health areas. There is a fear that, with frameworks for cancer and cardiac care coming on stream, history will repeat itself. I appeal to the minister not to allow that to happen.

Those who provide mental health services within the NHS are committed to change. Service users and carers, having been asked on numerous occasions for their views on what is needed to improve services, are now suffering consultation fatigue. It is up to the Executive to match those needs and expectations with resources. It will be judged on how it rises to that challenge.

We have time in hand this morning, so members may extend their remarks if they so wish.

I start by declaring an interest: I am a member of Unison, the health service union.

I am delighted to be able to speak in the debate, especially as I worked in the health service for 20 years—mainly in the acute sector. I therefore appreciate just how beneficial an efficient primary care service can be.

Unfortunately, Mary Scanlon is not in the chamber. I would like to say to her that, having experienced 20 years in the health service—18 of them under her party's rule—I found Nicola Sturgeon's comment about "that lot over there" more polite than some versions that I have heard. Mary Scanlon should accept that it was not offensive.

The term "primary care" would not have been used a few years ago. Everybody knew about GPs, dentists and district nurses, but the concept of many such disciplines working together as a team was not widely considered. Susan Deacon is right that new developments in that field have given us an excellent facility, which provides local health care and eases the burden on the acute sector.

As most MSPs will have found, constituents often complain about local provision of health care services. Local health care co-operatives, which we have heard about this morning, are one way of improving locally delivered services. It is beneficial for all the disciplines that are involved to talk and work together as a team, but one of the most important elements is the involvement of the community in the planning of the services that are to be delivered. I do not agree with Adam Ingram about consultation overload. Although people get fed up with consultation, we have to make sure that we consult everybody—all members of the team and the people who are on the receiving end of the services of that team.

An LHCC in my constituency held a public meeting to involve local people in workshop groups to discuss their concerns. The afternoon was a success, but it was poorly attended by members of the public. When I mentioned that to local people who are interested in health care, I was met with incredulity at the fact that they could participate in such a discussion and that their views would not only be welcomed but seriously considered in the future planning of the co-operative's work.

I think that we all agree that LHCCs must be developed and fine-tuned so that they can be an effective force in NHS planning. Giving them commissioning powers, as Richard Simpson mentioned, is one way of doing that.

Excellent-quality primary care is vital to our local communities. We must ensure that everyone in those communities has an equal right to access the facilities. The services must be designed around the patient, not the other way round.

As we are all aware, health care provision goes much further than doctors, dentists and opticians. I welcome initiatives such as those in Govanhill in Glasgow, which is close to my constituency, in which the emphasis will be on a joined-up approach to the integration of health and social work services. Other initiatives will involve mental health services and, importantly, health promotion facilities. The old adage that prevention is better than cure is sound advice. We can now offer advice and practical support to people who want to avoid having to use health facilities in the first place.

One of the key principles in such a joined-up approach is the ethos of team working. Staff from a wide range of disciplines are needed to work as part of a team. That in itself provides new career opportunities for health and social work staff. However, we must not overlook the fact that, given the value of those staff, proper provision must be made for training to ensure a high level of skills at the outset and to ensure that skill levels are maintained and updated. If we expect an excellent service from our staff, we must ensure that their terms and conditions are commensurate with that. We must also ensure that they are given the most modern and efficient equipment to allow them to work effectively.

Conditions also include their working environment. We are now in the 21^st century and, quite rightly, people expect health facilities that reflect that. That is why I am delighted that the £27 million over the next three years will improve GP surgeries and health centres. I am sure that all members remember the days of visiting GPs in cold, draughty rooms where even the most minor treatments could not be carried out and needed a visit to hospital. Now, we can provide modern, efficient health care locally and drastically reduce the need to travel to acute hospital sites. That is efficient primary care and represents 21^st century health care at its best.

I do not particularly congratulate the minister, although she has provided fine glossy documents that are thick, heavy and compact.

We must be honest with one another, as a member said, and we must be honest not only with ourselves, but with the public. That means facing the fact that everything is not well—if members will excuse the pun—in the health service. We must take many further steps to develop the services that the Scottish people need.

I would like to refer to many sections in "Our National Health", but I do not have the time. I am sure that someone will pick up on section 3, which refers to funding of services that are provided to more than one NHS area. I look forward to scrutinising that issue further when other proposals are made after March.

I am especially interested in the plight of the homeless in accessing medical care. I do not think that any member discussed that in detail, although the minister touched on it. That is an important aspect of the NHS in Scotland. Every day—especially during such weather as we are experiencing—people out there suffer and cannot access information or care from the medical profession. We must address that.

I noted the minister's comments about the voluntary and professional agencies—particularly the initiative in Edinburgh and various agencies in Glasgow—that deal with homeless people, sometimes in difficult circumstances. That is an onerous task, and I congratulate those agencies. The lack of up-to-date data on the health of homeless people does not make the task easier. I acknowledge the work of the Joseph Rowntree Foundation, which has done a marvellous job in tracking aspects of homeless people's experience of health care in the 1990s. Those data are a wee bit out of date, so we should update them.

Section 2 of "Our National Health" contains patter that mentions a health and homeless co-ordinator. I welcome that idea, but there is just a mention of it. The first part of the document refers to NHS hospitals; I look forward to scrutinising those proposals and getting back to the minister on them. The proposals and relevant action that I hope will accompany the plan should give people—whether a family or a single person—who have no permanent home access to medical services.

I stress the plight of the single homeless. In my opinion and in the opinion of professionals, they are the most vulnerable people. They cannot access help. They are folk without any support. I ask the minister to consider that carefully. Those people are slipping through the net. I do not want to give any figures. I am sure that some exist, but the data are pretty out of date. Even in the current weather, the single homeless have no access to information, and access is important. They need to be able to access medical care, whether they have a serious medical problem or something that we might not consider serious, such as a need for dental care. Toothache may not be serious but, on a cold day, it may seem just as serious as other medical problems.

I received a letter from councillors in Renfrewshire who say that they are establishing a one-stop shop. I congratulate them on that and I will study the initiative closely. Perhaps the minister could contact Renfrewshire Council and see the good work that it proposes to do.

We must be honest with one another, look deeply into the issues and admit that all is not well with the health service for everyone and particularly for homeless people. We do not have current figures. The figures that are available on the number of homeless households, rough sleepers and hostel and night service users are all estimates. A chief aspect of the health plan must be to obtain up-to-date figures on which to base work.

There is ample evidence that single homeless people have poorer physical health than the rest of the population in Scotland. Some researchers, including some from the Joseph Rowntree Foundation, have argued that the key threat to single homeless people is inadequate access to health care services. We must rectify that situation. I have a couple of suggestions. It would help if we advertised the agencies and provided information in areas that rough sleepers and the single homeless frequent. It would also help if we collected up-to-date data. I look forward to the minister's reply on how that can be co-ordinated. We must act sooner rather than later. I ask the minister to please take that on board.

In the past, primary care has not been given its rightful place at the front line of our universally accessible national health service. The Administration and the Parliament can change that, and what I have heard this morning makes me believe that there is a will to change. The primary care sector is the gateway to secondary services, specialist services and the acute sector. It is supposed to be the starting point of the patient's journey that will attempt to ensure equality of care. Recognising that primary care is the critical link between the patient and the community will improve morale among the health professionals involved in the process—and among patients.

Creating a more joined-up health service means breaking down barriers in both directions, which involves co-operation locally and between the primary and secondary care sectors. There must be a better exchange of information between GP practices and hospitals. That is a job for us. We should aim for patients to be able to leave their GPs' surgery knowing the date of their hospital appointment, who it is with and how to access information about it. We should address the issues, not just with the professions, but with patient power. Sometimes, patients want to ask questions about their care after they have left the GP's surgery, but they do not feel empowered to do that. We must set up systems to allow patients to have more say about their care.

I believe that community is the key to achieving those aims. Labour is committed to eight new hospitals and to building community services. Janis Hughes talked about some of the new initiatives and some of the new money that will be invested in them. We understand that we must tackle health in deprived areas. The primary care strategy outlined today is crucial. It is also crucial that we recognise that community is the key for the work that we want to do in deprived communities.

Yorkhill children's hospital, in my constituency, plays a critical role for children who live in deprived areas. Sixty-three per cent of ill children come from the five most deprived postcode areas. The hospital does not work only in the acute sector. It is a critical part of the primary care sector. It recently opened a new community centre for children in Glasgow, and believes that that can do more than anything to tackle the ill health of children. The opening of such a community centre does not seem to have the glamour of the opening of a new hospital, but it is as important. Evidence suggests—especially with cancer—that when Scots have symptoms they do not always present themselves to their GPs early enough. Evidence also shows that community facilities can encourage people to do that.

Will the member take an intervention?

A quick intervention.

Does the member approve of Greater Glasgow Health Board's prospective plan to move the two Yorkhill hospitals down to the Southern general in Govan?

I do not think that it would be fair to give my view in this debate, although I have a strong one. The integration of child and maternity services is crucial. That is the model in which I believe, wherever it is sited. I do not believe in the collocation of children and adults. That is much as I can get away with saying in today's debate.

Mary Scanlon quoted a consultant who said that the Beatson oncology clinic was a slum. The clinic is in the process of moving to a new building at Gartnavel hospital. By the end of the year, it will be able to treat double the number of cancer patients that it can now. It has been widely known for some time that the clinic is moving lock, stock and barrel to a new hospital. We are making progress.

Janis Hughes and Margaret Jamieson talked about the importance of expanding the role of nurses. The skills that nurses have, and their willingness to perform some of a doctor's duties—under the right conditions—are not recognised. Under the Labour Government, the removal of performance-related pay and staging awards and the return to national pay bargaining have been crucial in raising the morale of nurses and improving their conditions. That will assist in the recruitment of nurses.

I am glad that Mary Scanlon has returned—she missed Janis Hughes's comment that the phrase "that lot over there" was unparliamentary language. I agree that we should improve the way in which we refer to one another in the chamber. I am being polite when I say that if there is one subject that people were angry about during the 18 years of Tory rule it was the suspicion that the Tories were about to privatise the health service. The Tories must recognise that.

I applaud the motion before us:

"That the Parliament applauds the vital contribution which community-based health professionals make to the health and health care of the people of Scotland".

I will talk about two types of health professionals: chiropodists and—the Deputy Minister for Health and Community Care will not be surprised to hear this—dentists.

Before I go on about chiropodists, I should declare an interest. My wife is a state registered chiropodist who runs a busy private practice in Banchory, in my constituency. The problem is that it is a very busy private practice. She would have preferred to work in the national health service, and sees a tremendous number of elderly people who cannot get treatment on the NHS.

There are real problems associated with podiatry—or chiropody—services. Without going into too much detail, many elderly people who are unable to look after themselves cannot get appointments to the podiatry service more than once every 12 weeks. People are suffering and in pain and they need to be seen more often than that. There are too few chiropodists working in the NHS—the problem is a lack of investment. Similarly, there are too few dentists in Scotland.

The podiatry service in the NHS is not as it should be, and we must consider a long-term solution. There are too few chiropodists. Another reason for the state of the service—on which, although it is a reserved matter, the Executive should have a view—is the closure of the profession. There is nothing to stop someone as eloquent as Mary Scanlon taking up a scalpel and operating on people. She could even undergo a correspondence course in chiropody. If she paid enough money and passed the course, she could become a "qualified" chiropodist. The punter in the street—and members, I am sure—does not know that that is possible. There are many entries under qualified chiropodists in "Yellow Pages", but they are not state registered and they would be unable to work in the NHS. It is amazing how many people think that those qualified chiropodists would be able to work in the NHS. That is a problem.

I believe that there is a motion at Westminster, and a proposed bill—

I commend the member for raising the problem of chiropodists, but does he have the same concerns about opticians?

I would if I knew enough about opticians. I only got glasses two weeks ago—it is the strain of the job. I am not aware of the problems with opticians, but they may well be the same.

I know something about chiropodists and dentists and I ask the Scottish Executive to consider the problems and, where necessary, to put pressure on the Westminster Government to do something about the closure of the chiropody profession and to get more state-registered chiropodists into the system.

It would be remiss of me not to direct the deputy minister's attention to the problem of the lack of dentists, especially in Grampian and the north-east of Scotland—we have discussed that in the chamber before. I was heartened by what the deputy minister said about trying to link training between the Dundee dental school and Aberdeen. He is not making eye contact with me, but I am sure that he is listening.

The member should put his glasses on.

I will put my glasses on so that I can see the minister.

He is looking at you now.

It would be helpful if the minister would comment on any progress that has been made since the members' debate before Christmas. I thank members and the minister for listening to me. It is important that we consider those two professions—chiropody and dentistry—and whether we can improve the situation in the long term.

Like my colleagues, I welcome the opportunity the debate affords us to re-state the Parliament's commitment to patient-centred health care and to recognise the contribution that primary care staff make to that objective.

It is worth remembering that there remains in Scotland an almost unique contribution to primary care, which few countries have retained: the principle of the home visit. I often speak late in the debate, when others have said what I had intended to say, so I am relieved that there is a subject left that has not been covered.

I lived in the United States for a couple of years, and I assure members that over there a person's only chance of a home visit is if they are dead—and that visit is by the medical examiner. Home visits to the very ill, the elderly and the frail remain part of our health service and we should be proud of that. They are a tribute to community health professionals. I use that phrase advisedly, because—as many have said this morning—it is about the team that looks after the needs of our most vulnerable at home. The service is valued not only by patients, but by the professionals in a caring NHS.

A few months ago, I was fortunate to participate with the minister in a consultation exercise with service users from my area, who gave their views on their experience of the health service. Part of the exercise was to ask people how the primary care aspect of the service could be improved. I can sum up their general views by citing the four priorities that people identified for improving the primary care sector. Some have been mentioned this morning. First, people want more convenient times for surgeries, so that those with work commitments can attend appointments without having to take time off work. Secondly, people want easier access to appointments with GPs and health professionals. When a patient requires to see a GP, they should not have to wait two weeks for an appointment.

Thirdly, people expressed an interest in having more time with the GP. For most GPs, consulting practice is to detail the problem, then examine the patient. Some patients felt that there was insufficient time to conduct an examination. If the patient leaves the consultation with a doubt about the diagnosis or treatment, they are likely to take longer to recover and to return for another appointment. It therefore makes sense—for the patient and the GP—for the patient to leave the surgery feeling positive about the consultation.

Finally, people want quicker test results, which seems to be a spend-to-save proposal. If we consider the value of quick assessment and diagnosis, set against, for example, time lost in absence from work as a result of anxiety and stress, the benefits of one-stop clinics will far outweigh the initial costs.

The minister asked for some examples of good practice. Let me say a word about some of the achievements of the primary care sector in my constituency. Tomorrow evening, I will be attending a Royal College of General Practitioners quality award presentation at Townhead surgery in Irvine. Townhead is one of five practices in Ayrshire that will receive that quality award. Those awards are about more than just framed certificates on a wall; they are about actually improving the delivery of care to patients. That is why we must recognise practices that do that well.

I thank Margaret Jamieson for pointing out that it is Irvine, in my constituency, that will be the pilot area for the electronic transmission of prescriptions initiative. That is important, because establishing a communication flow between GPs and community pharmacists, and electronically linking those pharmacists to NHS Net, will greatly benefit patients and GPs and will result in a more robust management of medicines.

The Presiding Officer is signalling that I have run out of time. I thought that I had five minutes.

I am sorry to interrupt you. The clock did not start when you did, so I am afraid that you are further ahead than you appear to be.

In that case, I will quickly conclude.

It is important to send a message from the Parliament that we commend the work of our community health professionals and that they have our unreserved support and thanks. I support the motion.

Although members have complained, rightly, that it is cold in the chamber, if they had been in Moffatt High Street on Tuesday morning, they would really have known what cold is.

Unlike David Davidson, or even Mike Rumbles in a surrogate fashion, I am not speaking as someone with any expertise in the health field. However, I felt empathy with a GP whose comments appeared in the British Medical Association Scotland survey, "The reality behind the rhetoric". He said:

"Today: started 8.20am, finished 7.05pm. No tea break, no lunch break. Did not finish proper work. Spent 50 minutes reading today's mail alone. Fixed toilet holder in practice before coming home. This will probably be most significant achievement of the day."

Many of us can empathise with that. The issues that have been touched on in relation to GP morale are very important.

Never, other than when one requires the use and support of a GP, does one appreciate what they do. Recently, my daughter was rushed into hospital at 11 o'clock at night with suspected meningitis. The fact that the GP had come out and immediately given her injections helped to ensure that she recovered fully. When one has such experiences, one realises how important GPs are in our communities.

Let me say a little about my personal experience of local health care co-operatives, of which there are four in Dumfries and Galloway. It is interesting to see how differently they operate. The one in Annandale and Eskdale is operating very well and everybody is involved. Another one, in the Nithsdale area, seems to be much less visible and much less keen to invite people from outside to contribute. Many people can play an important role in LHCCs. At one meeting I attended I was struck by how many people in the pay of the national health service are not involved in front-line medical treatment, but work as promotions officers or in sundry other positions. It is important to keep the focus on front-line care.

Another specific Dumfries and Galloway issue that I have raised with Malcolm Chisholm is the practice of using district nurses to provide nursing care to people in residential homes. That is a matter of increasing concern. The area's district nursing resource is being severely depleted by the need to provide nursing care in residential homes, rather than having people reassessed as requiring nursing care and moved to a nursing home. That problem must be resolved.

I have been pursuing a number of information technology issues, which I have raised with the Executive on several occasions, mainly through written questions. I was disappointed by the answer that Susan Deacon gave to one of those questions. She said:

"To date, there has been no systematic evaluation of why videoconferencing facilities in GP surgeries are not more widespread."—[Official Report, Written Answers, 13 December 2000; Vol 9, p 241.]

That must be done, particularly in rural areas and particularly for mental health issues, which Adam Ingram mentioned. The opportunity for a patient to link up with a psychiatrist while in the presence of their GP could have great merit. I would like an evaluation of videoconferencing.

Irene Oldfather talked about a greater extension of the use of IT generally, and I would like that to happen. Other questions that I asked provided me only with further acronyms. I was told, for example, about the ECCI, which is being supported by the SCI—the ECCI being the electronic clinical communications implementation and the SCI being a programme of work called Scottish care information. Although that is all very worthy, the underlying factor that is of greatest concern is that the software that is currently used to link GPs' surgeries with outpatient facilities is described as limited. Much greater emphasis must be put on IT in that area. IT can play an enormous role in primary care, particularly to link it to secondary and other care, and I would like the Executive's efforts to be more focused.

Finally, I want to respond to what Pauline McNeill said, although she is no longer in the chamber. Let me make it absolutely clear that, to use the vernacular, us lot—the Scottish Conservatives—are absolutely committed to the health service as a public service, not a private service. I hope that we do not need to keep saying that every time we have a debate on health care, because it is absolutely clear.

I thank all the Presiding Officers on behalf of the security staff, who have told me that they are grateful that they have been allowed to put on their coats and to take shelter in the coffee room. Their uniforms are far too thin for this weather. Perhaps such permission could be given automatically in future, because we do not want to risk people's health any further. We in the Parliament are in this together, fighting Scotland's oldest enemy—the weather.

I take up a point made by my colleague Sandra White about medical treatment for the homeless. Just yesterday, I was passing by St Giles and going very slowly, as I was finding it hard to keep my feet. There was a man sitting outside in the shelter of the cathedral, just on the cold, wet pavement. He was such a frail man. I was going so slowly that he caught my hand as I went past and simply said, "Help me. Help me." I stopped and spoke to him, and it turned out that he was ex-Royal Navy. He had done about 20 years in the Royal Navy. His life had gone downhill for family reasons and because of ill health, and he had not received any medical treatment. In fact, he was apprehensive about seeking treatment for a long list of complaints. I could see by his face just how ill that man was. He was a Dickensian picture in this day and age. I appeal to the Deputy Minister for Health and Community Care to have words with his colleague to see what more can be done to encourage people—who may very well die on our streets in this severe weather—to have faith to come to clinics, where they will be welcome.

I have one or two other points. There has been no mention of the cardiac transplant unit at Glasgow royal infirmary. It closed, supposedly temporarily, almost a year ago. Frail, sick Scots are being diverted to Newcastle, which puts an extra strain on them, to undergo transplant operations. How many fewer have been operated on in Newcastle compared with previous years in Glasgow? I am told just a handful. Perhaps the deputy minister could give me accurate figures and comparisons with previous years, when people could get transplants at Glasgow royal infirmary.

I have heard little mention of another neglected group of people who are out in the cold—multiple sclerosis sufferers. There is still postcode medicine for them when it comes to the new treatments that are available. There are still just eight specialist MS nurses in Scotland. Many sufferers are quite young and some of them are mothers, who struggle to stay on their feet, raise their families and keep out of a wheelchair. Those people are being overlooked.

I must declare an interest in relation to the next group of overlooked people that I want to mention. I am chair of the proposed cross-party group on chronic pain, which has had marvellous support from members of all parties. We are talking about 500,000 Scots who are being overlooked. That is the number of people who suffer chronic pain in one form or another, whether daily or weekly, according to the Pain Association Scotland. Those 500,000 people are right at the bottom of the NHS's list and of the health agenda. Some of their pain is acute pain that started after an accident, but the majority is caused by arthritic diseases and back pain. Nicola Sturgeon's amendment refers to the stress on GPs. That stress is added to by the GPs' knowledge that the person sitting opposite them, suffering from chronic pain, has little chance. GPs know that that person will not see a specialist pain consultant for four to six months. Back pain alone is one of the most common reasons for people visiting their GP.

There is stress also on the few pain consultants we have in Scotland. There is only one full-time pain consultant in the whole of the country. The pain unit at Ninewells hospital in Dundee is so overstretched that it must squeeze cancer patients into what is supposed to be the doctor's brief lunch break. It is reckoned that 50 per cent of cancer patients do not get adequate pain relief and there is a six-month waiting list for a first appointment for all other chronic pain sufferers. Try to imagine how it affects doctors and nurses when they have to send people away to suffer some more. Back pain alone costs British industry a minimum of £6 billion a year. It is therefore cost-effective, never mind humane, to relieve pain. I appeal to the deputy minister to change his mind on my plea for an audit of pain facilities in Scotland.

To round up, let me give a brief example. Anne is a young mother from the east end of Glasgow who has such chronic back and arm pain that she can no longer hug her children. Anne screams into her pillow at night to try to muffle the noise that her husband must hear. Anne's husband and family suffer along with her, witnessing their loved one in pain. Anne told her husband one day, "Just get out. Save yourself. Don't go through this agony with me." Her husband stayed, but why should people have to suffer so much? I appeal to the deputy minister to put chronic pain at the top of his agenda.

First, let me endorse Dorothy-Grace Elder's final comment about the importance of putting chronic pain at the top of the NHS agenda. That is very important indeed.

To return to the debate, for me what vindicates more than anything else the approach to primary care that is set out in the NHS plan is the fact that even Nicola Sturgeon almost managed to sound positive about it. I say almost, because very quickly she reverted to the norm and became the nippy sweetie that we have grown accustomed to her being.

Nicola Sturgeon focused most of her remarks on the recent BMA survey of GPs in Scotland. It is important that we take on the issues that were raised in that survey, because it is true that it paints a very different picture of the state of primary care in Scotland from that perceived by the Executive. It is a classic case of the same events being viewed from two radically different perspectives.

The GPs' perspective is reflected in the survey. From experience, they know that they are being expected to do more and more work to deal with more and more patients and that they are being subjected to more and more pressure. They are right and we all know why that is happening. New medical techniques, such as keyhole surgery, which was pioneered at Ninewells hospital in Dundee, have slashed the number of patients who require a stay in hospital following surgery. I believe that 60 per cent of all non-emergency surgery cases are now dealt with as day cases. The same techniques have also led to a massive reduction in the length of the average post-operative stay in hospital. However, although patients can be discharged early from hospital or not be admitted at all, they still require post-operative care. That explains in part the new burdens that are being placed on GPs, which affect their experience of primary care.

That technical trend is being accelerated by the policies pursued by the previous and the current Governments, such as early discharge schemes, which try to get patients back into the community more quickly, and the plan for a new generation of walk-in-walk-out hospitals, which is mentioned in the NHS plan. Care in the community and the closure of long-term psychiatric and geriatric hospitals put far more patients back into the community, all of them in the care of GPs. Demographic changes take place all the time, which mean that we have not only more elderly people in society than ever before, but more infirm and frail elderly people than ever before. The growth in home care for the elderly, which every party in the Parliament supports, is another factor. All those factors add to the enormous pressures on GPs, who are the main providers of primary care in Scotland.

The changes coincided with the election in 1997 of our Labour Government, which was committed when it came to power to sticking to the spending levels that it inherited from the outgoing Tories. Inevitably, in what have come to be described as the hair-shirt years, there could not be a massive increase in resources for primary care services to match the increased work load that primary care services had to bear. I believe that that situation has led to the screams of pain that we are beginning to hear from GPs, as reflected in the recently published BMA survey. We can understand why GPs are screaming in pain about the coincidence of those circumstances.

The other perspective is that of the Labour Government, which sees that the hair-shirt years were necessary to sort out the chaotic public finances that it inherited from the outgoing Tories, to try to bring some sort of stability back into public finances and to create the economic stability that, alone, would generate the surpluses to release resources. The Exchequer is now beginning to build up those surpluses and, through the comprehensive spending review, resources are beginning to be fed into the NHS and the primary care system and will continue to be fed in during the next three years.

Time will tell whether the hair-shirt road that the Labour Government went down was the right one to go down and whether it will, in the long term, bring stability to public finances and make money available to support primary care. It is too early to tell at this stage. Remember what Chairman Mao said about the French revolution, 200 years after the event—that it was too early to say whether it was a success or a failure. We will have to give the Labour Government a wee bit more time—although I suspect that the voters will not give it 200 years—to see whether its policy works.

What we can do in this debate—although, of course, we do not have enough time to do it—is focus on what is right about the approach to primary care in the NHS plan. What is certainly right is the move away from the model of having the GP as the sole gatekeeper to the rest of the NHS services.

rose—

The Presiding Officer is signalling that I cannot give way.

It is right to move towards a model of integrated primary health care teams, which provide gateways to the rest of the health service. The proposals for nurse prescribing, family health nurses, a greater role for community pharmacists and, especially, for salaried GPs—who already do a marvellous job in the primary care services—should all be encouraged. If those proposals are to be a success, the new primary health care teams must be given leverage—some kind of commissioning power—that would enable them to fashion the services that are available in hospitals. That is not the same as GP fundholding.

Primary health care teams must also be given resources. Everything is contingent upon sufficient resources being made available in the primary care sector to enable all the proposals to work. I hope that the gamble of the hair-shirt years pays off. However, as a betting man, I know that it is necessary to go on previous form, and the previous form of capitalism is that it cannot serve the interests of the public service very well, so I would not bet on it.

Behind this excellent debate today lies the fact that the national health service—the universal access to health care in the public sector—is held dear by all parties in the chamber and, more important, by the public of Scotland.

It is not surprising that high passions are raised when debates about health care take place. This has been a superb debate. There have been some notably good speeches by my colleague Margaret Smith, Richard Simpson, Adam Ingram—if I may say so—and one or two other members.

Those speeches were in stark contrast to the opening speeches that were given by the Opposition leadership: we got the usual political rant from Nicola Sturgeon on behalf of the SNP and Mary Scanlon, on behalf of the Conservatives, attempted to defend the indefensible.

Health is, potentially, a quagmire for all Governments, not because they are incompetent or uncaring or because they pay insufficient attention to the detail of the problem, but because of several factors that we must take into account. The demand for health resources is rising faster than national economic growth, however it is measured. Changes take a long time to be effective; it takes six years to train a doctor and lengthy periods for similar professionals. In a consumerist age, people do not expect to be ill or dying without there being a remedy. The result is that there is a degree of dissatisfaction; doctors become demoralised and Governments get blamed.

That is one side of the coin. The other side is the new, modern facilities that are gradually appearing across Scotland—in Buckie, as David Davidson mentioned, in Edinburgh as Margaret Smith mentioned, and in my local health surgery in Rutherglen. That is right, because primary care—the family doctor, the community nurse and local services—are crucial; increasingly so, as Richard Simpson rightly said, as the pace of transfer from secondary to primary and intermediate sectors builds up. That process is likely to go faster than the professionals or policy makers anticipate.

There are problems in primary care—of change, of pressure and of resource. However, those problems are manageable and should not disguise the vast amount of good work that is being done by primary care professionals.

Are members aware of the current review of university funding? It is proposed to increase the amount of money, and the weighting, that goes into medicine. That may well be correct, but I understand that it is intended to do so at the expense of other specialisms, including the professions allied to medicine. That may result in more money going to train doctors, but threaten effective and sufficient training of professions allied to medicine. That is a particular problem in Glasgow Caledonian University and other universities of that sort.

I urge the Minister for Health and Community Care and the Executive to keep a close eye on what comes out of that review. The matter has not yet reached the stage of being considered by ministers, but we must be careful that we do not, on the one hand, improve training resources for doctors while we cannot, on the other hand, train the chiropodists, whom Mike Rumbles talked about, and the other professionals such as nurses who are so important in delivering the teamwork, which is what counts in this sector.

I will support a couple of other points that my colleagues have made. There is a need to rebuild effective links between the primary and secondary care sectors. If GPs are to be the gatekeeper to other sectors of health care, they must be able to advise patients, so they must be knowledgeable about the facilities and resources that are available, where they are to be found and how best to access them.

Better communication between professionals and patients is necessary, especially in the mental health sector, which Adam Ingram talked about. Patients are confused, frightened and worried when they come to the health sector for advice; they want to know their options and the implications of their choices, and they want to be involved in the decision-making process. In the mental health sector, there may be adult sufferers who are difficult to deal with and whose carers have been driven to distraction by the problems but are not involved adequately and effectively in decisions because of considerations of confidentiality. We must find ways of overcoming that problem so that we can involve in a partnership all the key people who have to deal with those problems.

Does Robert Brown share the concern of the BMA, which stated in its recent document that about 30 per cent of GP consultations have a mental health component? That highlights the point that both he and Adam Ingram have made.

That is a good point. I have some knowledge of the matter, as from the legal side I saw the interrelation between mental health, psychiatric problems and physical problems.

We are touching on an issue about the empowerment of health professionals; I am not sure that I am yet seeing clearly in my own mind how that would best be achieved. Richard Simpson talked about the aftermath of the two-tier system and the fundholding professions. We must consider how to empower health professionals and the public to make decisions in this sector.

Janis Hughes rightly said that prevention is better than cure. That theme must underlie this debate. GPs do not deal only with prevention—they deal with many other matters—but it is important that we get the policies for this sector right. The NHS plan, the comments that the minister made earlier and the investment that is going into this sector are considerable steps in the right direction.

The modernisation of the NHS is a great venture. It is an inspiring and noble venture, which requires all our energies and political skills in this Parliament. We must back up the real work that is done in the community by our GPs and health professionals, to ensure that the service that the public seek from the national health service, which they so respect, is given to them. That is what this debate is about and, given the quality of the speeches, it has been a contribution to that end.

I am sorry to break the consensus, but today we have seen—as we saw on "Newsnight" last night—another example of Labour's year dot mentality. In 1997, Labour portrayed itself as the saviour—the only party that could save patients and GPs—and claimed that the NHS was due to break up in 48 hours. The self-righteousness that came from Labour stank from top to bottom. Labour was right and we were wrong; there was no question about it.

Since then, Unison and the GMB—certainly not friends of the Conservative party—the BMA and public opinion have all disagreed with the Government. The Government has, to date, produced 43 documents about health reform. Promises have been made and a fair few promises have been broken. The latest plan, "Our National Health: A plan for action, a plan for change", is couched in the sort of language that can be found only in the First Minister's dictionary of English.

The Executive has again moved the year that reforms started from 1997 to 1999. No matter that waiting lists, waiting times, staff levels, public satisfaction and professional confidence are all worse, not better, than they were under the Tories, the minister ploughs on.

One of the Labour Government's first white papers—"Designed to Care", which was published in December 1997—started the problems for doctors. All and sundry were brainwashed by the myth that fundholding was part of the evil empire. Never mind that many of the critics had never really opted for fundholding or given it much time to work. The internal market was branded in the same way that old Labour branded privatisation. Sam Galbraith and Susan Deacon never paused to think that a system that produced greater GP satisfaction was perhaps not bad, or that a system that treated more patients within nine weeks than today, or in which people did not have to wait as long as they do now, was okay.

In her enthusiasm, the minister has wrecked GPs' initiative and incentive. LHCCs were to replace fundholders, and the JIF was to be introduced. But where is the JIF now? It has gone; as Dr Richard Simpson pointed out, it has the shortest obituary in history. Who did the minister think would handle the administration if some of the bureaucracy of fundholding were removed? It has to be handled by somebody and today the doctors and nurses are doing that work. In many areas, LHCCs are becoming committees and subcommittees, taking community doctors away from treatment. A GP recently said that the local health care co-operatives seemed to have brought about only an exponential rise in committees, sub-committees, working groups and reports.

The Conservatives' structural reforms of the early 1980s were an attempt to address the failures of the old NHS-style consensus management to achieve strategic planning. It is interesting that Labour has not abandoned the innovation of purchasers and providers, which is the basis of the internal market. In fact, we still partly have an internal market. John McAllion supported the policy of giving some commissioning power back to LHCCs or sectors; however, that would create a purchaser-provider split and bring us back to the internal market.

Either we are in the internal market or we are out of it.

We still see nothing wrong with the internal market; it treated more people and saved money. In 1994, only 25 per cent of GPs were fund managers; however, they saved £68 million, which the GPs were empowered to put back into their initiatives and surgeries. That money did not go back to central Government.

I want to raise two points of interest. The NHS is treating 100,000 more cases than in 1997, which means that efficiency has improved without the bureaucracy of the internal market. Secondly, after five years of fundholding, I had 12 yards of paper that contained all my contracting data. That had nothing to do with clinical care and everything to do with bits of paper circulating round a system. We have got rid of that. Although some aspects of the internal market were very good, other aspects were very bad.

I do not know where Dr Simpson gets his statistics. The latest statistics from the information and statistics division show that, this year, 19,000 fewer people were treated from the waiting list than in 1997. In fact, we have to go back to the early 1980s to find a worse situation. Furthermore, in terms of mean waiting times, people are waiting five days longer than in 1997 and the number of people who have waited more than 18 weeks has nearly doubled from 8.6 per cent to 14 per cent.

According to every statistic for waiting lists and waiting times, the policies have failed. For example, the number of people who have disappeared to the deferred waiting list has increased by 7,000. We need to consider the statistics in the round—to use Susan Deacon's words—which means considering the statistics for waiting times as well as waiting lists. The time for the first out-patient appointment from the GP has risen by a third. It is important for people to examine such statistics before they say that the system works.

I agree that there is too much bureaucracy at individual GP practices. Perhaps we should consider what has happened in England, where commissioning happens at LHCC level and gives the co-operatives the power to flex their muscles. That said, we must recognise that that is the internal market, as it creates a marketplace between the LHCCs and health providers. We cannot brand the internal market an evil place that treated no one, when commissioning and the purchaser-provider split formed an integral part of it.

I will defend the internal market; although there was too much bureaucracy, we should not throw the baby out with the bath water. Mike Rumbles was spot on when he talked about the concerns of chiropodists; Mary Scanlon also mentioned opticians. We must listen when our GPs express such concerns. It is not enough to cherry-pick responses, as the minister did in her opening speech; we must consider the whole issue in the round. If we lose the GP gateways to our NHS, we will endanger the very fabric of its system. It is no accident that the title of the BMA report is "The reality behind the rhetoric". That report was produced in response to the Executive's 43 health reform documents and its announcements, which have often proved to be nothing more than rhetoric. The Conservatives urge the Executive to address the report's concerns, which is why I urge the chamber to support Mary Scanlon's amendment.

In concluding, I will address Janis Hughes's comments about our lot. Let us consider what Labour has confidently abandoned since our 18 years in power. It has abandoned its opposition to the regrading of nurses, to the general management, to the hospital trusts, to the purchaser-provider split, and even to some of the contracting configurations that have been introduced in England. Perhaps our lot did not actually do that badly in reforming the old NHS into a new, more efficient NHS that treats more people.

Our NHS is one of the best health services in Europe and, although there are funding problems that must be addressed, we cannot escape the fact that the Tories—our lot—changed the NHS from an old-style system that had problems trying to marry consensus management with strategic planning. The proof is in the pudding and the results so far on waiting times, waiting lists and first out-patient appointments show that the Executive's policies are not working. Perhaps the Executive should pause to think and to listen to our doctors. I urge the chamber to back Mary Scanlon's amendment.

There has been much to agree about in this debate, particularly on Nicola Sturgeon's reference to "that lot over there". The Tories question why they have to keep defending their previous role concerning the NHS—the answer probably lies in the question itself. The Tories' health service legacy has been to turn doctors into accountants and for Ben Wallace to maintain that there is nothing wrong with the internal market raises the same questions about how safe the NHS would be in Tory hands, however unlikely that is in the near future.

Is the member saying that the SNP will abandon the idea of commissioning or the purchaser-provider split, which are the basis of the internal market?

No. I am saying that the Tories cannot be trusted with the NHS.

Nor am I sure how much Labour can be trusted with the health service. John McAllion talked about needing a wee bit more time to find out whether Labour's health policy will work and mentioned the necessity of the hair-shirt years. However, John McAllion does not have to wear that hair shirt; instead, the hair shirts are worn by the tens of thousands of people who are waiting for treatment in the NHS.

That brings me to the motion. Everyone

"applauds the vital contribution of community-based health professionals to the health and care of the people of Scotland".

The SNP will not argue with that. However, as well as applauding, why does the Executive not listen to the views of those same community-based health professionals? I have heard nothing from the minister this morning that indicates that she is listening to their concerns. The health professionals would prefer her to listen to those concerns and act accordingly, instead of applauding but ignoring them.

The BMA survey on the views of GPs in Scotland on morale, service provision and priorities says it all and must make uncomfortable reading for the minister. I am sure that its timing caused her a great deal of irritation. Instead of lodging self-congratulatory motions, the minister would do better to reflect on the results of the survey. I remind her again of some of its findings.

The majority of Scottish GPs claim to suffer from low morale and claim that morale has decreased over the past five years. The majority of GPs say that they are now more likely to consider a career change or retirement than they were five years ago. The majority of GPs would not recommend the career to young people, which is a problem, given that we will have a shortage of doctors in the near future. Finally, a large majority of GPs believe that the level of stress in their jobs has risen in the past five years. The survey does not make good reading, but the minister is too busy with another conversation to listen.

The main change that patients and GPs want is for GPs to get more time to spend with their patients. That would improve the quality of care that people receive. GPs gave that idea priority in the survey, and patients also want that change. However, such a move would be dependent on longer consultations, which would require delegation to other staff to free up the GPs' time. That will not happen by accident.

One of the initiatives that the minister talked about was ensuring that patients get access to an appropriate member of the primary care team in no more than 48 hours. I agree that that is a good aim, but no deadline is attached to achieving it and it is difficult to see how we will get from the situation that we are in to the realisation of that aim. I have heard nothing on that from the minister; perhaps the Deputy Minister for Health and Community Care will tell us what the time scale will be and how that aim will be achieved.

The role of the LHCCs has featured much in this debate. The survey shows that 68 per cent of GPs think that LHCCs have made no change to the quality of patient care and that nearly 60 per cent are pessimistic about their future development. Those figures are very disappointing, because LHCCs could and must be levers in the health service to drive improvements and improve local services. I do not always agree with what Richard Simpson says, but he made some important points about the LHCCs. Many members listened when he talked about the loss of innovation, as he touched on an important issue. We must consider how we can restore motivation and innovation to the health service without requiring a return to the internal market. That point was well made. Giving commissioning powers to the LHCCs would be one way of doing that.

I disagree with Richard Simpson's comments about waiting lists. He said that waiting lists were not a barometer of the health service, and that we were wrong consistently to raise the issue. The problem could be solved easily if the Minister for Health and Community Care acknowledged that it was a mistake to set the target in the first place. If she withdrew today the pledge that the Labour party made, I do not think that any member would raise the issue again.

Does the member accept that although waiting lists were a target of the Labour Government when it came to power in 1997, the Scottish Executive—which is a partnership between the Labour party and the Liberal Democrats—has targeted waiting times? What is important to people is how long they wait.

Mr Rumbles has his facts wrong. That commitment was made in the 1999 manifesto and it has not been delivered.

It was a Labour commitment—this is a coalition Executive.

Mr Rumbles should have learned that he must choose his friends carefully. The Liberal Democrats have chosen to be friends with the Labour party and must stand by the commitments that it has made.

Some important points have been made in today's debate. Although I attacked the Conservatives at the beginning of my speech, I agree with Mary Scanlon's view that when problems arise in the acute sector, they impact on primary care, and that there is a recycling of people through the system that is a problem for the health service.

Christine Grahame spoke about health managers not listening at local level. That was a constant theme throughout the debate, which Adam Ingram related to mental health services in particular. He spoke knowledgeably about the way in which mental health has become the poor relation in the health service, despite the fact that it is one of the Government's three clinical priorities. The Millan report has highlighted an over-stretched and inadequate service. Despite the hard work of many staff, and community pharmacists in particular, we have a service that, in many ways, is crumbling at local level. Like Adam Ingram, I have spoken to a number of carers. I met members of the Tayside Carers Support Project, all of whom said that they were trying to fit the person for whom they cared into services that were wholly inappropriate at local level because the services that were required were not available. As a matter of urgency, we must examine what is happening to mental health services.

Community pharmacists have been mentioned. We agree that their role must be extended and that their skills need to be utilised to better effect. The Executive has our support in its attempt to do that.

This debate has been useful in identifying the key issues for the primary care sector: staff morale; resourcing; structures, particularly the role of LHCCs; and the better utilisation of staff and their skills. We all want those improvements to happen. The SNP realises that the primary care sector is the key to delivering a better health service and preventing people from being admitted to the acute sector in the first place.

Janis Hughes said that prevention is better than cure. I am sure that everyone in the chamber can agree with that.

I begin as Susan Deacon ended, by thanking and recognising all the people who work in primary care. I am sure that I speak for everyone in the chamber when I say that.

One of the main themes of today's debate has been the changing role of people working in primary care and the empowerment that goes with that. Margaret Jamieson and Richard Simpson were two of the members who mentioned that, and the issue is referred to in Mary Scanlon's amendment. I would say to her, however, that the measures that she calls for in that regard are already happening.

The BMA survey has been mentioned; we take the concerns of GPs seriously. However, we should bear it in mind that that survey was conducted before "Our National Health" came out. The Royal Pharmaceutical Society of Great Britain said that the Scottish health plan that was outlined in that document presented

"a superb opportunity to improve the provision of health care in Scotland. By removing traditional and, at times, obstructive working practices and professional demarcations we can make major improvements to the quality of service delivered to patients."

While referring to the Royal Pharmaceutical Society of Great Britain, I should respond to the point that David Davidson and Shona Robison made, about Susan Deacon not listening or consulting, by pointing out that the society wrote to welcome greatly the minister's personal commitment to engaging the profession. People should be more careful when throwing accusations about.

We take the concerns of GPs seriously. However, I want to make three points about the concerns that have been highlighted today. First, as I said, the survey was conducted before the publication of "Our National Health". The briefing from the BMA today takes a more balanced approach and welcomes some of the Executive's initiatives such as NHS24. Secondly, we are dealing with many of the issues about which GPs expressed concern, including the need for more time with patients and for less bureaucracy.

My third point is in reference to Mary Scanlon's comment that the doctors are speaking out as never before. I remind Mary Scanlon and other members that, in 1990, the new contract that introduced the internal market and fundholding led to a threat on the part of the BMA of mass resignation—not early retirement.

As a reformed rebel from the back benches, does the minister now agree with his colleague John McAllion that commissioning should be reintroduced for GPs?

I will talk about developments in local health care co-operatives in a moment, and ask Mary Scanlon to bear with me.

As I have just referred to fundholding, we should now remind ourselves about how bureaucratic and competitive the situation was, as Richard Simpson mentioned, and about the extent to which fundholding gave rise to institutionalised inequity. We have no intention of going back to that.

I agreed with one point that Mary Scanlon made, when she said that the SNP was

"against everything and for nothing".

I thank Nicola Sturgeon for recognising improvements in primary care and for praising the importance of primary care. However, there is absolutely nothing about primary care in the SNP's policy paper. I wish that "paperlet" was a word in the English language, as that would describe its policy document very appropriately. There was little in her speech about primary care, except with regard to LHCCs, which I am coming to.

Nicola Sturgeon asks for 1,500 more nurses. In the health plan, we have already committed to 1,500 nurses over and above the previous proposals. That comes on top of the 210 specialist nurses who were recruited this winter.

The subject of waiting inevitably came up. We of course recognise that more needs to be done. As the SNP is keen on quoting from our 1997 pledge card, I remind members of what it says. This UK pledge says:

"We will cut NHS waiting lists by treating an extra 100,000 patients".

In Scotland alone, there have been more than 100,000 extra operations since 1997. The fact that that has not led to reductions in waiting lists is because of the great increase in the volume of treatment. I am in no way complacent about waiting, but I ask members who quote pledges to do so accurately.

I will do just that. It is good to see the minister with a pledge card. There are very few of them in circulation these days—and I wonder why. Having quoted that pledge accurately, could the minister also accurately quote the pledge contained in Labour's 1998 pre-manifesto for the elections to this Parliament, which said that Labour would reduce waiting lists in Scotland by 10,000 before the next general election? The minister was elected on that pledge—when will he deliver on it?

If SNP members are reduced to quoting from pre-manifestos, it shows how desperate they are.

Our commitment to primary care is not just in our policies and proposals, but in the resources that we put in. Susan Deacon reminded us of the global figure for health: an increase from £4.7 billion last year to £6.7 billion by 2003. Margaret Smith reminded us that within that is the £33 million for the new primary care premises that are to be provided, especially in deprived areas. There is also the £18.5 million for personal medical services, which Susan Deacon announced last week. I can assure Mary Scanlon that that is additional money.

Margaret Smith also referred to the excellent work of LHCCs in her constituency. We should consider the best practice that is developing in LHCCs. In cases of best practice, GPs are working together better than ever before with other players, such as community nurses and pharmacists. LHCCs also serve as a focus for public health activity and for the important health promotion work to which Janis Hughes referred.

An important point of clarification is needed. I understood that the minister had been quoted as saying that much of the £18.5 million over three years would be recouped, because GPs on existing contracts would opt for the new salaried contracts. Will there be 50 additional GPs or will there be changes in the contract?

I merely repeat the point that, although obviously there will be some transferred money, the £18.5 million is additional to any money that would be transferred.

We are awaiting the report of the LHCC best practice group. We will then produce proposals that will fulfil the commitment that we have made to strengthen the role of LHCCs.

In response to Ben Wallace's point, I say that £13.5 million has already been put into LHCC development. With reference to Richard Simpson's proposals, I say that we are already involved in detailed discussions on both funding and the levers for change to which various members have referred.

Several members also spoke of personal medical services. On that I pay tribute to the Conservative party, because four years ago this very month Lord James Douglas-Hamilton and I were working on the National Health Service (Primary Care) Bill in the House of Commons. In many cases, the National Health Service (Primary Care) Act 1997 has improved access and quality. It has developed new arrangements for service delivery, reduced bureaucracy and led to better and more flexible services, for marginalised groups in particular.

Sandra White and Dorothy-Grace Elder raised the issue of homelessness in that regard. Sandra White mentioned the homelessness pilot in my constituency. I am sure that everybody recognises its success. Very soon we shall issue guidance on health and homelessness and name a health and homelessness co-ordinator.

David Davidson asked us to apply PMS to dentistry. I assure him that that is already happening, as there are 40 salaried dentists. That will go some way to meeting the concerns that were expressed by Mike Rumbles. I assure him that progress is being made by Dundee dental school in getting students into areas of Grampian.

Adam Ingram, Robert Brown and Shona Robison all raised the important issue of mental health and primary care, of which we are mindful as mental health is one of our key priorities. We want to build on the work of the mental health framework, in which primary care may not have been highlighted enough. That is why the health plan referred specifically to the further development of extended mental health services in primary care. The health plan recognises that severe and enduring mental illness is only the tip of the iceberg and that we need to do a great deal of work in primary care to deal with the broader range of mental health problems, to which members have referred.

There are good examples of best practice in LHCCs and primary care generally, on which we want to build. On Monday, at Glasgow Caledonian University—to which Robert Brown referred—I was told about a mental health promotion project by community nurses in Glasgow. That emphasised the importance of health promotion in primary care, which is a point that Janis Hughes made.

How long have I got, Presiding Officer?

You have 12 minutes.

In other words, I have one minute left.

I will repeat some of the themes of the debate. Clearly, the priority at the heart of the agenda is better access. Several members talked about primary care gateways rather than GPs as gatekeepers. I have referred to NHS24. I also remind members of the pledge that people should be seen by a primary care worker within 48 hours.

Another main theme has been changing roles. Time forbids me to describe the new roles of nurses and pharmacists, but various members have referred to them. We all recognise the importance of empowering those primary care workers in new ways.

As Susan Deacon said, much of the content of today's debate is not the material that grabs headlines—we can but hope that we will be proved wrong—but it makes a real difference to the patient's journey and the quality of their life. I hope that I have convinced members that we are in the business of proposing solutions as well as identifying problems. It is unfortunate that the SNP is so engaged with the latter but not the former.

Lest I am thought to be too soft on the Tories, however, I remind members that many have short memories, but we do not. It ill befits the party of bureaucracy, whose actions led to the threat of mass resignations by the BMA, and which talks under William Hague's leadership of creating a two-tier service and hiving off large sections of the NHS, to criticise us for not having made all the improvements that were necessary in 1997. We have made a great many improvements. We have made an important start and I am sure that the people will ensure that we are allowed to carry on with the task.