Speech to BMA annual conference, Scottish Local Medical Committees
Health Secretary Shona Robison
March 11, 2016
Thank you conference chair for your welcome, and thank you to Alan as well.
Good morning to all of the local medical committees represented here, I am particularly grateful for the opportunity to be here today. This is a critical and challenging time for general practice in Scotland, but also one of opportunity.
First of all I am here to thank you. Everyone in this room, everyone in general practice, is committed to deliver the very best health service to the people of Scotland. You are the irreplaceable frontline in our drive to improve the nation’s health and wellbeing.
Secondly, I am here to explain what I intend to do about the challenges we face. This is not a choice between the now and the future. We need to talk urgently and practically about both, and how we take that journey together.
This is a year of considerable change, with health and social care partnerships becoming fully operational across Scotland in less than 3 weeks.
Health and social care integration is the context for delivering general practice for at least the next generation. It presents us with a huge opportunity to do things differently. It’s here that LMCs can play that vital representative role - something you’ve been doing since 1911.
Against that background, my vision is for primary and community care to be at the heart of the healthcare system, with highly skilled multidisciplinary teams delivering care both in and out of hours, across a wide range of services, from a wide range of sectors, that are tailored to each local area.
Just as we can’t talk about the future without tackling today’s issues, we can’t talk about services and professionals without talking about the people who use our services and how they too need to understand what the changes will mean for them.
I don’t just mean the increasing complexity and changing demographic of an ageing population. My vision is not just of a system that copes but of a system that enables the people who need healthcare to be more empowered and better informed than ever, able to understand better and take control of their own health.
So this is a vision for both professionals and services, and for patients and people. It’s what’s at the heart of the 2020 Vision for Scotland’s health and healthcare.
It’s a vision that enables GPs to focus on their patients; where other professionals better placed to take on elements of care – such as the letters welfare and housing agencies tell your patients to ask you for – are doing those things.
But a vision like this doesn’t just materialise and it doesn’t happen overnight. We will need to work hard to make it happen and there will be challenges along the way.
However we can map the journey we are on. That is why I want to deepen the partnership we have with the profession, with SGPC in particular, to create a collaborative plan of action to get us to where we not only want to be but where we need to be by 2020.
The next 2 to 3 years are a critical transition time.
Yes, we will need a funding plan. I have stated on many occasions that we will need to invest in the vision and that we will need to see a shift in the balance of investment toward community health and primary care. We are seeing that with our investment in this Parliament in health and social care.
Yes, we will also need a workforce plan. Our shared model of multidisciplinary working relies on community nurses and advanced nurse practitioners, paramedics, allied health professionals, pharmacists, practice staff, social care and third sector workers and those who work in new emerging roles. These teams will take some time to recruit and train. We need to understand the flow and timescales better.
To deliver a sustainable GP workforce for the future, we recognise the need to increase the number of trainees choosing general practice. We are building additional capacity by increasing the GP Specialty Training places by 100.
We will also introduce for the first time in Scotland a graduate entry programme for medicine with a strong primary care focus in its curriculum.
We are also working with universities, foundations schools and training programmes to maximise the chance of trainees selecting general practice as their first choice specialty.
There is significant evidence that time and a positive experience in primary care placements can increase the number of doctors who choose general practice as a career.
It’s not just about GPs. We have already committed £16 million funding to recruit up to 140 additional whole-time equivalent pharmacist independent prescribers. This is one of the first things we have done to enable you to focus on those patients who really need your clinical care. Much more will be needed and the workforce plans I mentioned will set that out.
And we will need an infrastructure plan that sets out our vision for community health, primary care and general practice estate and information technology.
I recognise that premises in particular is a major concern. Because of this I have asked a short life working group to be set up to explore the issues and options for change, and that these options are available to the new Government in time for budget considerations in the autumn.
This is not an easy issue, or one that will be resolved quickly, but as a first step the new Government will benefit from the group’s recommendations.
Any funding, workforce and infrastructure plans need to be based on reality which is why we have committed to work with local partners including GPs to design and test new models of care and new ways of working. This is a critical step in the transition over the next 2 to 3 years to make our vision a reality.
A number of tests are already up and running, for example Edinburgh Headroom and Govan SHIP and we have started to work with GPs in all 16 practices in Inverclyde. We are also testing the urgent care resource hub model recommended in Sir Lewis Ritchie’s report.
There is no one approach that fits the diversity of circumstances you and your primary care colleagues find yourselves in. Whether urban or remote and rural. Whether in hours or out of hours. Whether a Deep End practice or a practice in a more affluent area with many frail elderly patients.
While we are testing new ways of working we are already clear that collaboration and team work between GPs and with other professionals is going to be essential. GPs are critical to multidisciplinary teams. They need to be a key part of the clinical leadership in those localities, working effectively together in “clusters” to maintain quality and improve outcomes, and to be fully engaged and involved in the strategic planning of local health services.
And it is for this reason that today I am announcing an investment of £5 million to fund every Practice Quality Lead to have protected time to participate in cluster working. Starting in 2016 at one session a month, increasing to two sessions by 2017.
As the needs of our communities get ever more complex, this role for GPs becomes ever more essential. But just as health and social care integration means a change in structure, the idea of GPs as clinical leaders will mean a change in culture and working practice.
Not all of you will want to explore the full potential that the leadership role offers. That’s fine. There is not a one size fits all approach. And we must continue to explore leadership roles across all our primary care health professionals.
But what about the present? Transformative change isn’t possible if there are no solid foundations on which to build.
And while we have been working with Alan McDevitt and his SGPC negotiating team colleagues - Andrew Buist and Colette Maule - to develop a promising new vision for the future of general practice in Scotland they also make sure we don’t forget the here and now.
We have already negotiated transitional quality arrangements to take us from April this year through to April 2017. These light-touch arrangements focus on putting responsibility for the quality of patient care back in the hands of GPs and beginning to see the emergence of cluster working.
And you should be clear, while 2016/17 is a transitional year, there’s no QOF mark 2 in the pipeline – no other box-ticking alternative proposed. This is a reduction in bureaucracy, something I am committed to doing more of. That’s what you said you wanted, and we have worked with SGPC to make this happen sooner than we might have expected.
As Alan and my officials have gone around Scotland over the last year we have asked for ideas and solutions for reducing workload.
One thing you have told us makes for a bureaucratic headache, and difficulties in getting locum cover, are the performers’ list arrangements.
So we have been working with the NHS boards and I can tell you that we are working now to deliver a single national performers’ list as soon as practicable.
Reducing bureaucracy isn’t enough. We need to free your time and capacity in more fundamental ways by addressing demand. We need to work together to reduce demand and manage expectation – to take just one example, with a more comprehensive approach to obesity than we have had to date.
I know many of your days are filled helping patients with long term conditions such as diabetes. Government can help create the conditions that reduce preventable illness and workload.
And we need to change the culture of demand. You know better than anyone how many consultations in a typical day were avoidable. A recent study estimates as much as a quarter of appointments were judged by GPs respondents to be avoidable, most commonly because it would have been more appropriate for the patient to be seen at that time by another person in the wider primary care team. This is why the team approach matters.
That is why I have asked my officials to work closely with SGPC to identify workable solutions to your workload pressures in the short term would expect my officials to provide an incoming Government with recommendations early in the new Parliament.
But there is no “magic bullet”; it will take time, and it will depend on us growing the wider primary care work force with the skills mix and expertise that are needed to deliver the vision.
But I don’t want to just stand up here and offer you plans and schemes. Today I want to tell you about the real and practical measures I will be putting in place for 2016-17 - things you have told me matter, and will make a difference to you.
As a significant step into the future I am today committing £20 million of additional investment directly into general practice, because I recognise the need to provide more immediate support in preparation for that journey.
As I said at the start, general practice is a highly valued part of our health care system in Scotland, and we must get it back to being the profession of choice for more young doctors. We must also look after all GPs, at whatever stage in their career, to ensure the basics are right. Today I want to make a start by committing £2 million across three measures which start to address this.
The first measure is Occupational Health care provision.
I am committed to ensuring the health and well-being of all staff and so I have instructed my officials to work in partnership with Boards and colleagues in primary care to explore different options for providing more effective Occupational Health care provision for staff working in primary care.
The next is a new rate for backfill cover for Maternity, Paternity, and Adoption Leave.
In recognition of the fact that in this day and age we expect to see family friendly working arrangements across the NHS, so from 1 April I will be setting a new level of reimbursement. The new level will be £1686.45 per week, for a maximum of 26 weeks. This will be the statutory level of payment and I will be removing the discretionary arrangements.
I hope this will provide all new parents with the support they need in those exciting but stressful first months of parenthood, knowing that there is adequate funding for back fill.
The third measure involves setting up a service to provide every GP practice with oxygen cylinders for use in emergencies.
You have a motion on your agenda today about this. It strikes me that this is another distraction for you from the more substantial issues you face each day. This is a commitment to fix that.
Another issue which I know matters to you is IT. You need information technology systems that are fit for the future. The reprovisioning of GP IT is one opportunity for change.
I am also providing an additional £2 million in 2016-17 to improve your tech – updating computers or buying tablets for example. This is over and above the £4m we have already allocated from our Primary Care Digital Services Fund specifically to support improvements to your IT systems and processes.
Now I want to turn to the important question of pay and expenses.
The Doctor and Dentist Pay Review body published its report this week, recommending an increase of 1% to GP pay, net of expenses. I have accepted that recommendation.
The DDRB didn’t make any recommendation on independent contractor expenses, asking us to take that forward separately, and citing a lack of evidence on which to base any real estimates for uplift.
As part of our joint working with SGPC we will need to address this. We have made a commitment to explore transparency in more depth for 2017 and beyond, to try and gain a better understanding of the expenses pressures practices face, and how best funding might be matched to those for the future.
In the meantime I can confirm I will be adding £10.98 million to the GP contract for next year.
This provides for the 1% pay increase, which is worth £3.13 million, plus a 1.5% increase in expenses – a total of £5.25 million. It also allows £2.6 million to fund the cost of population growth in 2015-16.
I hope that what I have said today, and in committing an additional £20 million directly in support of general practice for next year, demonstrates the commitment of my government to supporting sustaining and enabling general practice to flourish.
The negotiations for the 2017 contract will get underway over the next few weeks, and I recognise the significance of today for you in setting the agenda for those negotiations, and the mandate you will give to the Scottish General Practitioners’ Committee.
I believe we can work together to build a bright future for general practice and hope that we can continue to work collaboratively for the good of GPs, the profession of general practice, and above all for the patients and people of Scotland.