Primary Care

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

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Photo of Jeane Freeman Jeane Freeman Scottish National Party

Thank you, Presiding Officer, for your generosity.

I welcome the report. Before I talk about it, I thank the members of the Health and Sport Committee with whom I have had the privilege of working—in particular, Mr Macdonald, the convener. I have found our engagement constructive, positive and helpful.

The committee’s report is a helpful contribution to our current work on reforming primary care, and I am grateful to the committee not only for the report’s contents but for the way in which the committee gathered evidence. The committee sought the views of not just health professionals but the public, especially younger people, who want to be engaged in how services are delivered now and in the future and who, in many ways, want their engagement to be different from that of older generations.

The committee raised a number of important questions and suggestions for how we can continue to strengthen primary care, and I have now formally responded. Much of what has been raised is, of course, for the next Parliament, Government and health secretary, but I hope that, as I say a few words now and in closing, I am able to give committee members reassurance that their report is being taken very seriously. Some of what they are asking for has already begun. Some of the thinking has certainly already begun.

Before I turn to the report, I restate my thanks to all primary care staff for their work, particularly during the past year. GPs and their practice teams, pharmacists, dentists, optometrists and allied health professionals have all responded tirelessly to the pandemic, continuing to provide essential services but also adapting to new ways of working—some of which point to new ways for the future—most recently, through their current and huge contribution to the vaccination programme. In many areas, such as digital, urgent care and multidisciplinary team working, the response to the pandemic has both benefited from previous investment in primary care and provided foundations for future reform.

I will now touch on some of the key findings from the committee’s report—first, on the need to bolster and secure the role of multidisciplinary teams as part of a growing workforce in general practice. Since the landmark 2018 GP contract offer, we have invested £205 million in expanding and enhancing multidisciplinary teams across Scotland, with the number of GPs also having increased by 234 over that period. That significantly helps us to ensure that people can expect to see the right person at the right time, whether that be, for example, by direct access to a pharmacist to manage medication or to a physiotherapist for musculoskeletal issues. That enables GPs to spend more time with those individuals who have complex care needs. In the current work on the redesign of urgent care, some of that investment is coming to fruition and we are seeing the real value of making sure that, in having the right care in the right place for individuals, primary care in its widest definition has an absolutely central role.

I also acknowledge the importance of improving access to general practice. For many, that is the first and often only point of contact with the health service when issues arise, and it is really important that we get that right. As I have said before in other places, for me, primary care in its widest definition is the foundation of our health service. It is where most of us will have most contact—for some, it will be their only contact—with our health service throughout our lives. It matters that we get that right—that it is accessible and that it addresses our needs. In saying that, I commend the work of our out-of-hours GPs, paramedics, dentists and other health professionals who provide urgent care services at evenings and weekends.

The report highlights that the citizen’s voice must be at the heart of shaping our reform programme. That was also identified as a key theme in the recent independent review of adult social care, and I completely agree with that. This morning, I was party to a discussion with very senior members of the Scottish Government health directorate, looking at how we will continue to respond to the pandemic and at how we will build on many of the lessons of that and on some of those foundations. Central to that was how we ensure at every level of our development of health and social care services that we are able to hear the citizen’s voice. In some ways, we can draw on lessons of how that has been done elsewhere in Government, but it matters greatly to me that we embed that approach as we develop innovative ways to hear what people are saying and to engage with them in the development of policy and in the reform of services that are vital to their health and wellbeing.

The report recognises the growing need for mental health support and the role of primary care in early identification and prevention. We are committed to further building mental health capacity and capability through the GP contract offer.

Social prescribing is also fundamental in supporting people to address the wider challenges that they face. That work was necessarily paused in response to the pandemic, but I am happy to confirm that it has been restarted and is being embedded into our thinking. We are well on track to deliver on our commitment of an additional 250 community link workers by the end of this session of Parliament, which is but a few weeks away.

The report also rightly identifies that technology will play an increasing role in services in the future. Throughout our response to the pandemic, we have seen major shifts in the use of television and video consultations where that is the right approach, without reducing the importance of having face-to-face appointments where that is the right thing to do for both the patient and the clinician.