Primary Care

Part of the debate – in the Scottish Parliament on 3rd March 2021.

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Photo of Brian Whittle Brian Whittle Conservative

I am delighted to close this crucial debate on behalf of the Scottish Conservatives. Such an important topic deserves more time than the short debate that we are now having. Nonetheless, it has been a good and consensual debate across the chamber.

I thank my committee colleagues for the consensual way in which we have managed to work during this parliamentary session. It has been an honour to serve with them.

I have long suggested that a change in the way in which we deliver healthcare has to happen, because the current trajectory is unsustainable. The increasing percentage of the Scottish budget that is allocated to health has to reach a ceiling at some point. That is against the backdrop of Scotland’s unwanted ill health tag—we are the unhealthiest nation in Europe and the unhealthiest small country in the world. The impact of that on the wellbeing of the people of Scotland, not to mention the Scottish economy, is significant.

If Covid has taught us nothing else, it has surely taught us about the impact that health has on the economy. Poor health also specifically impacts the outcome of a positive Covid-19 diagnosis, with obesity, diabetes, chronic obstructive pulmonary disease and heart conditions present in an overwhelming number of Covid deaths.

Shifting investment further upstream toward a more preventative approach is essential to the sustainability of our health service, and the committee’s report agrees. There is a need for a shift in primary care to focus more on the needs of local communities and less on ill health, and for a shift on health that is closer to the community rather than on the secondary healthcare system.

To be fair, the Scottish Government has accepted that as the direction of travel that it would like to follow. The issue is that the practical steps that will be required to attain that ambition are yet to be put into play.

The most basic need to enable our GPs to be as effective as they can and want to be is the need for time. They need time to spend with patients to fully explore their needs. Crucially, a variety of treatment options should also be available to the GP to allow them to treat the patient in the most appropriate way.

The roles of allied healthcare professionals, pharmacists and occupational therapists need to be integrated to a much greater extent into GP multidisciplinary teams. A simple example of that is that a physiotherapist is more likely to be specifically qualified to deal with musculoskeletal conditions than a GP, as the cabinet secretary mentioned. Given that one fifth of all patients present with MSK conditions, it would seem logical that, if a GP had the ability to triage those cases to a physio within the practice, not only would the potential outcome for the patient improve, but the GP would save a significant amount of time that could be spent with other patients.

The same could be said of dieticians, opticians and mental health practitioners, who will be needed increasingly post-Covid. We need to have those alternatives to the overuse of medicating poor mental health.

Continuity of care is a challenge for GPs, but the committee’s report states:

“by better utilisation of the other healthcare professionals, including AHPs, we consider increased continuity of care should be achievable”.

It goes on:

“We are clear AHPs, and others, play an invaluable role in enabling people to live an active life and encourage the Scottish Government to include the full range of staff involved in supporting health care when planning future workforce.”

The work that the third sector and others do to support patients must be fully integrated and incorporated into local planning, and that must include the ability of GPs and HSCPs to use social prescribing, giving patients the potential to be active participants in solving their health and wellbeing issues. The committee states:

“Efforts must be made to make social prescription accessible to all, including making better use of ... community facilities”.

It adds:

“We reiterate the recommendation made in our December 2019 report, Social Prescription, an investment, not a cost, that 5% of Integrated Authority budgets should be allocated for social prescription.”

Public Health Scotland has a significant role in working with GPs and public agencies to enable and encourage that direction of travel.

In the current crisis, there is a clear and present danger to the third sector. Too many organisations are at a financial corner and may not be there when we come out of the Covid pandemic, which will be when we need them the most.

We all agree on the outcomes that we would like. That is extremely positive. So far, however, there has been little from the Scottish Government in response that suggests that plans are in place that can lead to those crucial outcomes and deliver primary care for the next generation. I look forward to hearing the cabinet secretary’s response.