Section 29 — Contractual arrangements for the provision of primary medical services

Tobacco and Primary Medical Services (Scotland) Bill: Stage 3 – in the Scottish Parliament at 3:30 pm on 27th January 2010.

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The Deputy Presiding Officer:

We come to group 5. Amendment 11, in the name of Mary Scanlon, is grouped with amendments 12 to 14 and 17.

Photo of Mary Scanlon Mary Scanlon Conservative

In 2003, Labour, the Scottish National Party and the Liberal Democrats not only supported the inclusion of measures for commercial providers in the Primary Medical Services (Scotland) Act 2004, but robustly defended those proposals against Scottish Socialist Party amendments. Amendment 11 seeks to retain the commonsense approach of the bill that was agreed by all parties but the SSP only six years ago.

Despite commercial providers being able to set up shop, so to speak, in Scotland, none has chosen to do so, to date. Our ageing population, the increased availability of treatments and increased public expectations all result in increasing demand for general practitioner services, year on year. Despite the acknowledged increased need, the BMA and the Scottish Government propose a measure that is designed to prevent the possibility of alternative sources of provision.

Community Pharmacy Scotland—open all hours in every high street and village in Scotland—stated in its written submission:

"There is no guarantee that the existing practice model will survive for another 10, let alone 60 years and without the possibility of alternative methods of provision the situation could arise where medical services could not be provided for people living in 'hard to doctor' areas such as remote and rural regions or in areas of deprivation within our cities."

The increase in calls to the Scottish Ambulance Service and in accident and emergency presentations are undoubtedly a result of the new GP contract, which has resulted in many, and increasing, numbers of GPs opting out of providing out-of-hours care.

If part 2 of the bill were to be deleted and existing legislation to remain, GPs could hold surgeries in pharmacies, for example. A vote against the amendments would guarantee monopoly provision by one provider that is represented by one trade union negotiating with Scotland.

The European states that have the most successful health care systems have developed successful partnerships with the private and voluntary sectors not only to provide general medical services but to tackle public health issues.

Scotland has no commercial providers, so Helen Eadie and I visited a walk-in centre at Canary Wharf and a health centre in Tower Hamlets that are both run by the independent company Atos Origin. The walk-in centre is open from 7 am to 7 pm and serves 80,000 employees at Canary Wharf, local people and tourists. It has reduced the amount and financial cost of work absenteeism by reducing preventable ill health, and it allows accessible attendance at GP appointments during the working day. The number of people who present to local accident and emergency units has also reduced significantly. Surveys show that 97 per cent of patients have found the care to be good or excellent, and the primary care trust has a member on the Atos board to ensure good partnerships and working relations.

In Tower Hamlets, which is the second-most deprived area in London, the primary care trust discontinued the previous contract for the health centre GPs because they did not meet key performance indicators and did not serve the needs of the community, more than 30 per cent of whom are Bengali. If Atos failed to achieve the required standards for patients, it would simply lose its contract.

The primary care trust confirmed that Atos has better software and better attention to detail. It gives monthly reports to NHS London and has better data management. The health centre regularly meets key performance indicators on issues such as complaint response and generic prescribing. More focus is placed on addressing health inequalities, marketing is better, staff turnover is lower and continuity of care is better, because the provision of doctors and staff is more stable. The centre meets all its targets for health checks, immunisation and screening and the management of chronic disease has improved considerably.

The Deputy Presiding Officer:

You should finish now, Ms Scanlon.

Photo of Mary Scanlon Mary Scanlon Conservative

People often do not present early for diagnosis because taking time off work to see a GP can be difficult, if people commute to work, for example. A walk-in centre allows for early presentation.

I fully support the current independent contracting of GP services in Scotland and commend the excellent work that is done day and daily.

Finally, one regret from the London visit was that we could not see the Atos mobile units in rural areas, because of time constraints.

I move amendment 11.

The Deputy Presiding Officer:

I use my power under rule 9.8.4A(c) of standing orders to extend the deadline for debating group 5, to allow the debate to be completed.

Photo of Ross Finnie Ross Finnie Liberal Democrat

I will be brief. Liberal Democrats perfectly accept that we voted for the Primary Medical Services (Scotland) Act 2004, but the notion that members who voted for a bill six years ago are not entitled to reflect on current circumstances is nonsense. I have no doubt that I might now have reservations about some bills that I supported—genuinely—in 1999. That is just a fact, so we should not make such points.

Mary Scanlon's argument has been entirely consistent. She and her Conservative colleagues are entitled to support moves in the health service that they believe only the private sector can achieve. Some of her suggestions could be provided in general practice—the bill will not impede that.

Photo of David McLetchie David McLetchie Conservative

The argument is not about whether the private sector provides such services, because GPs in existing practices are members of the private sector. The issue is what model is used in the private sector. Ross Finnie must not confuse the argument.

Photo of Ross Finnie Ross Finnie Liberal Democrat

I am not sure whether that lecture has greatly improved my view on whether to support the amendments—if that was the intervention's intention. I know that David McLetchie always seeks to garner votes, particularly for lost causes.

What is at issue is our perception of the development of general practice. Of course, we all have grave reservations about the outcome of some of the contractual arrangements that have been entered into. However, with the exception of the Conservatives—who take a different, and perfectly legitimate, approach to the issue—members around the chamber see that the objectives can be achieved in a health service that does not necessarily have to accommodate the private sector. The Liberal Democrats will oppose all the amendments in Mary Scanlon's name.

Photo of Nicola Sturgeon Nicola Sturgeon Scottish National Party

I had expected other contributions to the debate, Presiding Officer.

Mary Scanlon may find this unexpected, but I thank her for lodging the amendments and acknowledge her consistency and sincerity in doing so. Her amendments are similar to the stage 2 amendments that led to a high-quality debate at the Health and Sport Committee; in fact, it was one of the best committee debates in which I have taken part.

That said, we will oppose Mary Scanlon's amendments because their effect would be to delete part 2 of the bill, which would undermine our objective of ensuring that all holders of primary medical services contracts—often the first and only point of contact between a patient and the national health service—are directly involved in the NHS. The bill expects contract holders to demonstrate that, first through the involvement of a medical practitioner or other health care professional, in the case of section 17C contracts, and secondly through the involvement of all contractors in the day-to-day provision or running of the medical services.

Members will be aware that I agreed to a stage 2 amendment that would leave open the possibility of health care professionals other than doctors holding GMS contracts in the future. The Health and Sport Committee asked for that key flexibility, which is most likely to apply to nurses, in its stage 1 report.

The stage 2 committee debate to which I referred was so good because it avoided some of the oversimplifications that have, at times, characterised the debate. Before any member rushes to intervene, I say that I am sure that I have been guilty at times of contributing to that oversimplification.

I agree entirely with the points that Ross Finnie made, and I am sure that he will agree that the debate is not simply about public versus private. In the main, GPs are independent contractors. The bill will not prevent companies from holding contracts, but it specifies the criteria that companies must fulfil, of which the most important are the involvement criteria. The criteria apply consistently to all forms of contract holders.

The best way in which to characterise the debate is that it comes down to a choice between wanting the people who provide our primary medical services to be directly involved in running those services, or saying that it is okay for them to have a more detached and arm's-length relationship with the NHS. Given the importance of primary medical services, I take the former view.

Mary Scanlon referred to a number of the flexibilities to which the commercial model has led south of the border. Ross Finnie was absolutely 100 per cent correct on the matter: in many respects, those flexibilities are to be welcomed, but they neither depend on nor are made more likely by the kind of model that the Tories advocate. For example, there is nothing in the bill to prevent the kind of development of community pharmacies that Mary Scanlon described. An important priority is to prevent patients from unnecessarily turning up at accident and emergency departments. We want to advance that regardless of the contractual arrangements.

Photo of Mary Scanlon Mary Scanlon Conservative

Community pharmacies have stated that, for example, high street chemists or Boots the Chemist could not employ GPs to hold surgeries on their premises. Are they right or wrong?

Photo of Nicola Sturgeon Nicola Sturgeon Scottish National Party

If Mary Scanlon reads the bill, as I know she has, she will see that any contract holder has to satisfy the involvement criteria. If they satisfy those criteria, they can hold a contract. That is the important point in the debate. We are not discriminating between different types of contract holder, but are stipulating involvement criteria, which is fundamental to delivery of the NHS services with which most patients have the greatest amount of direct contact.

If Mary Scanlon chooses to press her amendments—as I suspect she will—for all those reasons and many more, I ask members to vote against them.

Photo of Mary Scanlon Mary Scanlon Conservative

I say to the Liberal Democrats that there is nothing to reflect on. There has been no change over the six years since the passing of the Primary Medical Services (Scotland) Act 2004; we have no commercial providers. Helen Eadie and I had to get on to a train to London to find one, because they do not exist in Scotland. I did not refer only to private providers. In recent years, Community Pharmacy Scotland has offered enormous benefits, providing minor ailments services and surgeries on our high streets. It was one of the main opponents of the approach that is proposed, because there cannot be a GP surgery on the high street unless the doctor owns the pharmacy.

The debate at stage 2 was excellent; I thank the cabinet secretary and other members of the Health and Sport Committee for their contribution to it. We should all be proud of that.

Should the opportunities for different types of provision not remain, and should the Parliament ban commercial providers of GP services, we will be denying patients throughout Scotland access to modern health services that are accessible during the working day. I will press amendment 11.

The Deputy Presiding Officer:

The question is, that amendment 11 be agreed to. Are we agreed?



Division number 6

For: Aitken, Bill, Brankin, Rhona, Brocklebank, Ted, Brown, Gavin, Brownlee, Derek, Carlaw, Jackson, Fraser, Murdo, Johnstone, Alex, Lamont, John, McLetchie, David, Milne, Nanette, Mitchell, Margaret, Scanlon, Mary, Scott, John, Smith, Elizabeth
Against: Adam, Brian, Alexander, Ms Wendy, Allan, Alasdair, Baillie, Jackie, Baker, Claire, Baker, Richard, Boyack, Sarah, Brown, Keith, Brown, Robert, Butler, Bill, Campbell, Aileen, Chisholm, Malcolm, Coffey, Willie, Constance, Angela, Craigie, Cathie, Cunningham, Roseanna, Curran, Margaret, Don, Nigel, Doris, Bob, Eadie, Helen, Ewing, Fergus, Fabiani, Linda, Ferguson, Patricia, Finnie, Ross, FitzPatrick, Joe, Foulkes, George, Gibson, Kenneth, Gibson, Rob, Gillon, Karen, Glen, Marlyn, Gordon, Charlie, Grahame, Christine, Grant, Rhoda, Gray, Iain, Harper, Robin, Harvie, Christopher, Harvie, Patrick, Henry, Hugh, Hepburn, Jamie, Hume, Jim, Hyslop, Fiona, Ingram, Adam, Jamieson, Cathy, Kelly, James, Kerr, Andy, Kidd, Bill, Lamont, Johann, Livingstone, Marilyn, Lochhead, Richard, MacAskill, Kenny, Macdonald, Lewis, Macintosh, Ken, Martin, Paul, Marwick, Tricia, Mather, Jim, Matheson, Michael, Maxwell, Stewart, McArthur, Liam, McAveety, Mr Frank, McCabe, Tom, McConnell, Jack, McInnes, Alison, McKee, Ian, McKelvie, Christina, McLaughlin, Anne, McMahon, Michael, McMillan, Stuart, McNeil, Duncan, McNeill, Pauline, McNulty, Des, Mulligan, Mary, Murray, Elaine, Neil, Alex, O'Donnell, Hugh, Oldfather, Irene, Park, John, Paterson, Gil, Peacock, Peter, Peattie, Cathy, Pringle, Mike, Purvis, Jeremy, Robison, Shona, Rumbles, Mike, Russell, Michael, Salmond, Alex, Simpson, Dr Richard, Smith, Elaine, Smith, Iain, Smith, Margaret, Somerville, Shirley-Anne, Stevenson, Stewart, Stewart, David, Stone, Jamie, Sturgeon, Nicola, Swinney, John, Thompson, Dave, Tolson, Jim, Watt, Maureen, Welsh, Andrew, White, Sandra, Whitefield, Karen, Whitton, David, Wilson, Bill, Wilson, John

The Deputy Presiding Officer:

The result of the division is: For 15, Against 104, Abstentions 0.

Amendment 11 disagreed to.