Primary Care

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

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Photo of Lewis Macdonald Lewis Macdonald Labour

Thank you, Presiding Officer. I am delighted to open this debate on the Health and Sport Committee’s report,

“What should primary care look like for the next generation?” The title of the report is deliberately framed as a question, and I start by thanking all those who offered their answers from the point of view either of patients and the general public or of the healthcare professions, whose views we also sought.

I also thank all those who have supported me in my role as convener of the committee over the past three years. They include the clerking team, ably led by David Cullum, who, like me, has three more committee meetings to look forward to—the same is true for one or two other members in the chamber; the researchers of the Scottish Parliament information centre; the press and public engagement teams; and other Parliament staff, including the broadcast and information technology teams, who allowed the committee to continue to meet throughout the pandemic; members of the committee, past and present; and those witnesses who have shared their expertise with us on a vast array of subjects.

I thank ministers for their positive engagement in general and for a quick response to this report, in particular. Although there are many areas of agreement, there are other questions that will clearly be for the relevant committee to pursue in the next session of Parliament—and, hopefully, for the health secretary to answer in the next session. I will mention Jeane Freeman by name because of the work that she has done with the committee over the time for which I have been the convener. It is appreciated.

Our starting point for the report was to ask the public what kind of primary care service they wanted to see; we then asked representatives of the healthcare professions whether the public’s vision could be realised and, if so, how. We received more than 2,500 responses to our public consultation; we ran a session with the Scottish Youth Parliament, which surveyed its members; and we held detailed discussions with public panels over two weekends in Aberdeenshire, Lanarkshire and Fife.

The public told us that they wanted to be able to access primary care just as easily as they can access a community pharmacy, with weekend opening and longer hours, and to be able to make appointments online. They were clear that patient data should belong to the patient and that new technology could help to improve patient care.

Covid-19 delayed our report, but it accelerated some of the changes that the public told us they wanted to see. The next challenge will be how to provide the personnel, the resources and the governance structures to embed those positive changes in the future delivery of primary care.

Contrary, perhaps, to some interpretations, our report is supportive of general practitioners and seeks to make best use of their valuable time in seeing those who are in need of the skills that only they possess while, at the same, time making best use of the skills of each of the other professions in the wider multidisciplinary team.

There is broad consensus that primary care should be at the heart of the healthcare system, that care should be delivered by multidisciplinary teams and that patients should be able to access the right professional at the right time, to let them remain at or near home whenever possible. The challenge is how to turn that shared vision into reality. We believe that there are key roles for health and social care partnerships, for multidisciplinary teams, including GPs, and for the public.

Health and social care partnerships, as integration authorities, are responsible for the whole range of primary and community health services and account for more than a third of the total budget for health and social care, which, in turn, accounts for half of all expenditure by the Scottish Government. Partnerships themselves recognise that primary care needs to change if it is to align with a community approach. Edinburgh Health and Social Care Partnership told the committee:

“Primary care is not established to focus on the priorities of local communities—its priority is the (ill) health needs of individuals”.

Partnerships can help to change that, through their strategic commissioning plans and the localities that they have established. Primary care improvement plans should be in place very soon—we might hear more about that from the cabinet secretary—and should reflect local needs and priorities.

Our report highlights early evidence from partnerships of the benefits that have been gained from changes in how services are delivered, such as improved use of GP time because patients are accessing other members of the multidisciplinary team.

GPs rightly want to remain at the heart of healthcare in the community. They recognise the key role of other professionals, from occupational therapists to district nurses. The change that we need is one in which doctors and patients reset expectations about who will help and in what way, so that support and care from each member of the multidisciplinary team is seen as of equal value when it is the care that the patient needs.

National workforce planning must take account of a shift in the balance of care from hospitals to the community. The committee is keen for the principles of the Health and Care (Staffing) (Scotland) Act 2019 to be put into practice as soon as possible.

The public told us that they want a more preventative approach and more emphasis on social prescribing, and those aspirations are reflected in our report. So, too, is the view of all healthcare professions and the general public that access to data in primary care must be improved, not least by having IT systems that talk to each other, so that health professionals can access information and patients have to tell their stories as few times as possible in order to receive the care that they need.

The Covid pandemic has been challenging for everyone who is involved in primary care—and health and care in general—but it can also be a starting point for the delivery of real and lasting change if we find ways to embed the improvements that have perforce been made in responding to the emergency over the past 12 months. I look forward to that happening, and I commend our report to the chamber.

I move,

That the Parliament notes the Health and Sport Committee’s 8th Report 2021 (Session 5),

What should Primary Care look like for the next generation?

(SP Paper 939).