Primary Care

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

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Photo of Emma Harper Emma Harper Scottish National Party

In closing on behalf of the committee, I will reflect on members’ comments. I note that our committee convener has chaired the committee well and I thank him for his contribution to the Parliament over the past 22 years. He has also been a great support to me as deputy convener.

It is important to note that much of our work in relation to the phase 2 primary care report was carried out before the Covid pandemic, so the report has been significantly delayed as a consequence of Covid-19. I thank all who contributed to the report, including my colleagues on the Health and Sport Committee and the clerks.

Many of the committee’s recommendations on primary care structures and accessing general practitioners and members of the multidisciplinary team have changed a lot due to the safer engagement practices that are required to reduce the risk of the virus spreading. The cabinet secretary has already affirmed that around 90 per cent of all health contacts take place in primary care, so it is important that we look at primary care and how we can ensure that we have the best processes as we move forward. We know that primary care is provided by many professionals in the multidisciplinary team, with GPs at the helm. From the outset, though, our inquiry looked at the Scottish Government’s vision for the future of primary care services, which states:

“People who need care will be more informed and empowered, will access the right professional at the right time and will remain at or near home whenever possible. Multidisciplinary teams will deliver care in our communities and be involved in the strategic planning of our services.”

The committee endorsed and shared that view and, through the inquiry and our report, has made a number of recommendations that we hope will inform and assist the Government’s implementation of its vision.

The need for change in social care is compelling, as demands and costs are predicted to grow sharply. We debated aspects of the report of the independent review of adult social care in Scotland, which was led by Derek Feeley, in Parliament the week before last. Scotland’s older population is living longer and folks have many complex health issues and multiple comorbidities. We know that the overall health and social care budget in Scotland in 2020 exceeded £15 billion and, for the first time, was 50 per cent of the entire Scottish budget. The committee and our witnesses are clear that we agree with the Government that that trajectory for increased resources cannot continue indefinitely. Mr Whittle raised the issue of financial sustainability in his earlier remarks.

To that end, our evidence indicated that primary care should take on a more patient-centred approach. One example that was cited was having more flexible appointment systems. I am very aware that our GPs already spend long hours in their practices. David Torrance spoke about the modern 9-to-5 life. I have checked with a few of our practices in Dumfries and Galloway, and I know that they are already offering appointments either side of the 9-to-5 schedule and that evening consultation hours have already been adopted. In many instances, flexible appointment schedule times were implemented pre-pandemic or pre-lockdown. That was good to see.

We have heard how the current heavy reliance on paper as opposed to IT systems has caused much frustration in primary care. Many IT systems do not talk to each other.

Easy and accessible signposting to other services that might be available as opposed to people always having to visit their GP was also suggested.

I support the Scottish Government’s response that it recognises the value of social prescribing and that it has established a working group to help to address that. Throughout the pandemic, we have heard about how important the third sector is to health and wellbeing and in helping to support physical and mental health.

The cabinet secretary has covered some of the key findings, including on community pharmacists, the £205 million for expanding and enhancing the multidisciplinary teams, and changes to urgent care. The right care in the right place at the right time is a commitment from the Government. The cabinet secretary also supported further funding for mental health and work on data improvements.

Donald Cameron focused on specific GP issues and the challenge of general practice recruitment, and Sarah Boyack mentioned the challenges for people with poor lung health, asthma and long Covid. The briefing that was submitted by the British Lung Foundation and Asthma UK dealt with those.

Alex Rowley spoke about the balance of funding between acute and primary care, and the bridging funding. I know that Alex Neil has talked about pump priming in previous debates.

Colleagues, including Brian Whittle in his closing speech, have mentioned addressing health inequalities and obesity. The cabinet secretary covered much work that is already under way and workforce planning. My colleagues Sandra White and David Stewart talked about the specific public engagement sessions that informed our report.

Presiding Officer, I am not sure of the time, but I am happy to conclude.