 We now move to members' business. Members who leave the chamber should do so quickly and quietly. The final item of business today is a members' business debate on motion number 13973, in the name of Jim Hume, on promoting sustainable GP recruitment. This debate will be concluded with any questions being put. I invite those members who wish to speak in the debate to please press the request to speak button now or as soon as possible, and those members who are leaving the chamber again to do so quickly and quietly. I now call on Jim Hume to open the debate. Mr Hume, seven minutes please. Thank you very much, Presiding Officer. I welcome fellow members, of course, back for the first members' debate after the summer recess. Unfortunately, I have to bring to the attention of the chamber, as many are aware. There are many issues surrounding the state of our general practices, as we have not seen progress in either the numbers of GPs or their working conditions. Scottish Lib Dems have taken a strong stance and have raised the issue many times. Of course, my colleague Willie Rennie conducted a survey earlier this summer, which uncovered some truly disturbing facts about the moods of GPs and the state of affairs in GP practices across South Scotland and the rest of our country. The issue of GP recruitment and the future of GP surgeries that are faced with a crisis is one that affects the health of nearly everyone. As general practices deliver, 90 per cent of patient care in the NHS receives less than 8 per cent of the NHS funding. Naturally, that has hard-hitting consequences on GPs and the increasing demands that they are facing with increasingly shrinking budgets. Their funding has been facing a near-constant reduction since 2007, from 9.2 per cent to 7.8 per cent in 2013. That has, of course, been further reduced by the inflation of 1.2 per cent. The preventative amounts that the Government is spending, while evidence suggests that investing in GP practices can save the NHS in Scotland around £200 million. In line with its 2020 vision, the Government first pledged in November £40 million for primary care in 2015-16, then said that £50 million will be spent through the primary care fund over three years. That is a reduction of £24 million per year from the amount that was originally announced. One of those elements of the scheme, the pharmacist independent prescribers, promises to recruit 140 new pharmacists. That is 10 pharmacists per health board. I do not deny that that is a welcome start, but it is the first step of a very long journey that will need to ensure sustainability. When we are already seeing health boards taking over GP practices, we need to face the real numbers and see what the real issues are. If the Government does not reverse its spending cuts from where spending cuts are the most hazardous, we will face a 2020 crisis rather than a 2020 vision. The Royal College of General Practitioners has called on the Government to provide urgently a clear strategy for sustainably investing in Scottish general practices. We backed that call today. We also backed the call from the British Medical Association, which has raised a warning flag over recruitment. One-third of GPs are currently considering retirement, while more than one in 10 are planning to move to part-time work. That will leave a number of practices unable to operate. Will the member accept that one of the factors impacting on retirement dates for general practitioners is the change in the lifetime allowance for pensions? That has been encouraging a lot of senior GPs to consider retirement, making problems worse. As far as I recall, the Lib Dems were in government when that was proposed. I can assure you that the replies that we had from GPs focus on far different issues rather than their pensions. We need to look far into the future to see that that is a real problem that is already facing us. 463 practices have at least one GP vacancy, while some have not been able to secure locum GPs for 15 days or more within a one-month period. Practices that are unable to see as many patients as need to be seen, appointments are being slashed, waiting lists for registration are getting longer and people are being sent elsewhere due to the reaching maximum capacity. I want to stress the importance of the issue. The Government risks turning GP services from an accessible first point of contact service for every Scot into an exclusive service that many will not have access to. I want to point out how important it is for the Scottish Government to work constructively with GPs and listen to what they are saying as we are at risk of losing the right to health for all Scots. My colleague Willie Rennie spoke volumes of almost four in 10 GP practices to find their workload unmanagable. Those are the real reasons, Mr Campbell. They also say that this is their greatest challenge. They say that. What is most telling, however, is that 92 per cent of respondents want the Scottish Government's quality and outcomes framework for primary care to be reduced or abolished, which is 92 per cent. Perhaps one of the most worrisome and discomforting facts was that one-third of GPs answered the question of whether they would choose to become GPs again with an unfortunate answer of no. That raises many questions about the future of our GP services. Why is the Scottish Government not ensuring that the right amount of resources is being put where GPs think that it is important? Why are we seeing less GP trainees, less retention of GPs across Scotland? Why are current GPs under so much stress and work pressures that many see their own health deteriorate? When the Scottish Government enables GPs to put professionalism back to the profession, then many of those questions will surely have found their answer. If the Scottish Government wants to listen and implement some substantial solutions, there are a number of recommendations given both by the Royal College of GPs as well as the BMA. Seeing an investment in the tools that GPs have in their disposal to lead the development of new models of care would enable them and empower them to provide better services to their patients. Whether it is the newly announced investment of £500,000, which I did welcome into the programme for improving outpatient services with better technology or enabling GPs to work alongside advanced nurse practitioners in their practices, it is important to recognise the leading role that GPs are playing and must continue to play in communities and urge the Government to improve support and resources to ease the workloads and pressures of general practice. That includes, of course, reducing the administrative burdens. We know that GPs currently work not only more hours than they should during a typical work day, but they are also responsible for the administrative work when the practice closes up for the day. Instead of being forced to do tasks that are not related to medical practice, GPs should instead be able to spend more time with their patients, have closer work and relationships with other professions and be able to face a good interface with other experts who are involved with their patients' care. With the advent of social care and health integration, we can and should prioritise that. I want to close by expressing once more my concern for the future of our general practices in south Scotland and the rest of the country, and also my respect and gratitude to all our hard work at NHS staff and the hope that, by listening to the facts today, the Scottish Government will decide to act to prevent the cornerstone of our healthcare from reaching a crisis. Thank you very much. Now I call on Hans Allan Malik to be followed by Chick Brody, four minute speeches. Thank you very much and good evening, Presiding Officer. I would first of all like to thank Jim Hoog for bringing the debate today here because I think it's a very important debate and I also want to thank the national health service for the service that they currently provide in the danger of me forgetting at the end of my speech. I have to say that the general practitioners survey is a linchpin of the national health service. Therefore, when the British Medical Association stated that the shortfall on our general practitioners would impinge on patient care back in March, I'm surprised that the government didn't respond to that earlier. I think it's important to try and encapsulate the actual difficulties not only our GPs are facing but the public are facing. My colleagues have highlighted the number of issues facing our doctors today, the fact that vacancies are not being filled. I know of a practice in Glasgow where they're looking for somebody to fill a vacancy and they fail to do so up until now and the fact that the morale is very low amongst our doctors I think is quite shocking because we depend upon them to boost our morale. We depend on our doctors to be there for us to ensure that we are not suffering from all sorts of ailments and if they themselves are feeling under pressure, if they are feeling that they have inadequate resources at their hands to treat their patients, then that sends a very, I think, a very poor signal to our citizens. Inequalities in Glasgow are probably the greatest. We talk about services to communities which are sparsely populated, long journeys to travel, people have either patients have to travel long distances or the doctors have to travel the distances and then not to be able to get the service that they are hoping to get at the end of that journey is pretty detrimental. I would have thought for it for any community but also in densely populated areas such as Glasgow. I see more and more people now who are complaining about either not being able to get appointments or when they get appointments they feel that they are rushed in and out of surgeries because of pressures on doctors time and I think sometimes what is really important is that not only do we need to ensure that the doctors feel that they are valued, that they have the resources at their fingertips but also the patients when they go and see the doctors feel that they are being listened to and they are getting a good proper hearing. No patient feels comfortable if they go in, doctors say, what's wrong with you, start struggling, here's your medication out the door, that's not what a lot of people think they're going to see the doctor for, sometimes just good advice is very valuable for them and sometimes they don't actually need medication but it depends on what the doctor has at their resource. A lot of the things which are now happening for example when doctors say that they would rather not be in this job or in this career if they had another opportunity, I remember people used to want to give the right arm to become a doctor. This was a profession that people actually tried very hard to get into because they wanted to serve the communities, they wanted to make a difference where they lived and if that's not happening then it's a bad day. Therefore a proper policy developed which looks at all these various issues that the pressures are now being put upon needs to be done. The Scottish Government really needs to take up this conflict, really needs to take up this challenge and has to work with the doctors more closely than they have done so far. Talking to doctors is not a bad idea, let's please do that and let's hope that we can improve upon the service and the pressures that other people have that can stop. Thank you very much, Presiding Officer. Thank you very much. I now call on Tric Brody to be followed by Malcolm Chisholm. Thank you Presiding Officer, may I firstly thank Jim Hewn for bringing his debate forward this evening. Presiding Officer, as always general practice is central to the future of the national health service in Scotland. It is of course the front line for many people yet the recent BMA Scotland conference for Scottish local medical committees discussed the issue that many general practices are certainly not just to recruit doctors but also to get locum cover. General practice is or can also be a very cost effective part of the Scottish healthcare system. Recent calculations by the Royal College of General Practitioners has shown that even investing another £72 million in GP consultations in the UK would lead to a saving of £375 million arising to £708 million by the end of 2019, which translates into a possible saving of £70 million in Scotland. That is done by looking at a creative way of freeing up time for general practitioners. The Scottish Government recognised that when it announced in June this year increased funding into primary care of some of £50 million over three years. That increased investment provides an initial impetus to encourage GPs to try new ways of working over the next three years, helping to address the problems of recruitment and retention that are so common to primary care services. Alan McDevitt, the chair of the BMA's Scottish GP committee, also raised another important opportunity in increasing primary care funding, which is the evolving health and social care integration plan. Mr McDevitt states that, quote, investment in leadership training will provide GPs with additional skills to influence the design and delivery of efficient community services for their patients. He further went on to state that the recruitment of additional pharmacists working with GPs will provide much-needed support. I hope that, in the long term, investment could be extended so that every practice in Scotland would be able to have a practice-based pharmacist. Both practice-based and community pharmacists are uniquely placed to work with GPs to improve patient care and safety and to play an important role in the long-term management of patients with chronic diseases. I wrote to the Cabinet Secretary for Health suggesting that we should have triage nurses in pharmacies in this world of instant society so that lesser illnesses could be treated in the pharmacies and freeing up time for GPs. In March this year, the RCGP and the Royal Pharmaceutical Society issued a joint statement on GP practices. It highlighted the important role that practice-based pharmacists can have in creating efficient general practice services. There should be investment in recruitment and training of pharmacists based in general practice that would be of considerable value in reviewing patients' medication, managing polypharmacy, managing medication issues for the housebound within the newly integrated healthcare system, linking effectively with community pharmacists and medicines reconciliation across the interface all with significant benefit to patients' health and safety. This could improve care, save the NHS a significant amount of money and alleviate pressure on GPs. Thereby creating a free-time investment opportunity. The RCGP and RPS also work together on how community pharmacists and GPs can work together to improve patient care. They set out recommendations for benefits to patients in improving liaison between community pharmacists and GPs. Finally, there are already a number of initiatives across Scotland that promote collaborative working with community pharmacists. In the Highland Community Pharmacy, health care improvement Scotland also has a national patient safety programme. Much has been done to improve GP recruitment and retention, which I commend. We would like us to look at much wider vehicles to provide a more extensive landscape as to how we can create the retention and recruitment of GPs. Thank you so much. I now call on Malcolm Tism to be followed by Alex Rowlands. As the motion states, 90 per cent of patient interactions with the health service are with primary care services. Since the whole direction of health policy for over a decade has been towards more services being delivered in community settings, that percentage can only be set to increase. That is really the background to the very serious concerns that I am sure everybody has about the current situation. I found that in my constituency. Recently, the most stark example being the leaf-link medical practice, where three GPs left and they could not replace one of them. The result of that was 2,000 patients being told that they had to leave that practice and being sent somewhere else and the health board taking over the running of the practice. Of course, that is not unique in Edinburgh in terms of the health board's intervention. More nationally, of course, we know some of the alarming figures. I suppose that part of the background is the percentage of the budget on GPs being 9.8 per cent, for example, 10 years ago, and the latest figure that we have, or the 2012-13 figure anyway, being 7.8 per cent. That in itself is grounds for serious concern. The overall number of whole-time equivalent GPs is flattening, and the applications for the GPs training posts last year fell by 10 per cent. Clearly, something must be done, and I am sure that the Government accepts that as well. We probably need a whole range of measures, for example, just to pick out one incentive for graduates to enter GPs training. However, the big issue that has to be addressed is workload. Jim Hume referred to his survey, which overwhelmingly put workload as the number one issue. Of course, that is partly related to the overall number of GPs—that is fairly obvious—but it is also related to what GPs do and who they work with. In some ways, some people may be surprised that workload is such an issue, because, of course, after the new contract was introduced, which I was involved with at the time when I was a health minister, some people were saying that they have got it easy now and they are not having to do all that out of urge. That was the kind of mood music among a lot of people in the Parliament. However, we have to understand, as the years have passed, several things, including demographic change—more people in the population simply—including older people with complex medical conditions that have to be looked after by GPs and primary care more generally, and the shift towards primary care, which has not happened as much as we wanted, but has still been happening. To some extent, the Government has addressed the issue in the programme for government in general terms. It talked about developing clusters, and that is a good thing, so that the skills and expertise of GPs are shared across the practices. Of course, we need to embed general practice in the wider primary healthcare team and expand the wider primary care workforce, including practice-based pharmacists. Instead of the clusters, I should also have made the point that, in a way, it is fairly obvious that that needs to be aligned with the locality integration arrangements, and there is a good opportunity to do that. Of course, the co-off is much talked about as well. Some GPs, I note, want to abolish it, others want to disassociate it from practice income. I have to say that when the GP contract came in and I was getting a bit of a stick for those new contracts in those days, the consultant's contract and the GP contract, I was quite pleased that some of the extra money for GPs was related to doing specific things via the co-off. I notice that even GPs who are critical of it have said that it did transform the management of care, certainly for some practices who were perhaps lagging behind the best practices, no doubt the best practices such as Dr Simpson say that we are doing many of those things anyway. My own view would be that we need to keep the good bits of the co-off and still relate it to practice income, but clearly not all GPs agree with that. The final last point is that infrastructure is clearly very important, and one particular concern in my constituency is the development of the north-west partnership centre just on the edge of my constituency, which will have a new GP practice as well as many other services. That, of course, has been delayed because of the changes to the funding arrangements for the hub programme. I know that that is not totally within the control of the Scottish Government, but if the minister cannot say something about that, I really would expect the cabinet secretary to be making a statement about that to Parliament in the very near future. Presiding Officer, can I, like others, congratulate Jim Hume on securing this debate? It is a motion that should and I think obviously does concern each and every one of us. I would like to think that it is an issue that can be addressed by a genuinely cross-party approach as my party has been advocating over the last few years. The statistics that surround the subject really speak for themselves. If Scotland's predicted growth up to 2020 reaches its maximum, we will require 915 more GPs. If it reaches just its minimum, we will still require a further 560+. Let's take the average and assume, as the motion itself does, that we will require somewhere around 740 or 50 more GPs by 2020. That is quite a challenge, especially when you take into consideration that fewer medical students are opting to go into general practice every year, that two thirds of all GPs could retire within the next five years, and that 20% of GP training positions were not even taken up this year. If this isn't yet the crisis that the BMA claims, then it is certainly a major problem that demands urgent attention. I would suggest the first thing that needs to be done is that much more needs to be done to take action to improve recruitment and retention of GPs. Too many currently go abroad because of improved salaries and conditions, and they don't return. Too many GPs, 92% in the survey that's been spoken about, believe that consultation times are inadequate. 69% said their workload has a negative impact on the care received by their patients, so surely we need to review urgently aspects such as the box-ticking activities that GPs have to undertake that could just as easily be undertaken by nurse practitioners and others, especially as patients who need more specialist care are increasingly transferred from hospitals to their local communities. It seems to me that the current structure of primary care is not geared up to deal with the current policy of more and more people spending their latter years in their homes rather than in a hospital. That particularly impacts on rural constituencies such as my own of Galloway and West Dumfries. Across the local health board region of Dumfries and Galloway, there are currently around 12 GP vacancies out of a required establishment of 130. That's near enough 10%. Some of those vacancies are proving extraordinarily difficult to fill. The further west you go, or if I could put it another way, the more remote you become, the harder it becomes to fill those vacancies. Recruitment becomes harder, retention becomes harder and the issue itself therefore becomes harder to solve. On top of that, the risks to both in-hours and out-of-hours services also increase and become very substantial under these circumstances. To the board's credit, advanced nurse practitioners are being appointed to try to plug some of the gaps, but the board accepts that if it is to manage age-related and chronic conditions outside acute hospital settings, a comprehensive primary care GP coverage is absolutely essential. If that coverage continues to decline at the current rate, the default position will simply be higher hospital admissions with the real possibility that there simply won't be enough hospital beds. Simultaneously, the planned integration with social care services will not be able to achieve its full potential without the required GP workforce. That doesn't paint a very pretty picture, Presiding Officer. What we must have, I think, is a clear strategic direction to try to reverse the decline in recruitment and retention. On that note, I was really interested in the First Minister's announcement this afternoon that 10 pilot schemes of new models of primary care to be introduced across Scotland would strongly recommend and suggest that one of them is located in the west of my constituency, where, if nothing else, it would be extremely well tested. I hope that that initiative works, Presiding Officer, because if it doesn't, then the crisis that the BMA is talking about will have become a very serious reality. Many thanks. I now call on Dr Elaine Murray to be followed by Mark McDonald. Thank you, Presiding Officer, and I start by thanking and congratulating Jim on bringing the issue to the chamber, because, as Alex Ferguson has said, a lack of GPs is a significant issue in Dumfries and Galloway, albeit a more significant issue in his constituency than in mine, but is sufficiently problematic to have been referenced in the BMA briefing specifically about Dumfries and Galloway in its briefing. One of the reasons that we have been told by the chief executive of NHS Dumfries and Galloway is that more graduates are interested in specialisms and that specialist medicine is more attractive than general practice for a whole host of reasons, and it is difficult to get people to go into general practice. The shortage of professionals is not confined to GPs in Dumfries and Galloway. We know that there are shortages, for example in recruiting teachers and there are shortages in recruiting social workers. Some of those shortages in professions are around the opportunities for the partners of professionals. That is an issue with a shortage of professional jobs, but within other professions there have been initiatives to try and grow more of those professionals. For example, Dumfries and Galloway Council paid for the training of social workers with the University of Glasgow, and we have recently had an initiative called Grow Your Own Teacher in Dumfries and Galloway, where people are being encouraged to come out of other professions within education and train as teachers. That is not as easy to do with GPs that you cannot really grow your own GPs, particularly in an area where there is not teaching hospitals and there is not medical courses on offer at the universities. We see things, for example, like attempts to recruit from other countries. That always makes me slightly anxious, though, because we are recruiting from countries where those GPs are needed in their own country and we are taking often from countries that are worse off medically than we are. I have to say that I, too, am concerned about recently trained GPs going off abroad, maybe into private practice, and I wonder whether there are some ways in which we can dissuade people who have been trained by the taxpayer here in Scotland or in the UK from taking those skills that they have recently acquired and taking them into private practice perhaps abroad. That is my idea, which comes from me. It is not Labour Party policy, so I hope that nobody is going to take it as that. I wonder whether there is a possibility of training other suitably qualified professionals to bring them into medicine. My daughter has degrees in psychology and she is training as a mental health nurse. I know a number of young people with degrees in history or in chemistry, even, who train to become lawyers after they have graduated. I wonder whether there is a possibility, for example, of well-qualified scientists managing to be retrained into medicine, perhaps with an indication that they go into general practice. I am not suggesting, for example, that lots of scientists leave science because we know that there is actually a shortage of scientists as well. However, people with that sort of training might be able to be retrained. We know that there is a loss of people from science. There is a loss particularly of women from science whether there is a possibility there. I did run the possibility of retraining other people past the chief executive of the NHS in Dumfries and Galloway. He was a bit concerned about it. He felt that people who were not adequately trained in medicine could be risk averse and could then just refer everybody on to consultants and create workload problems elsewhere. I do think, particularly in the sciences, that people who are trained to a high level in science have an expertise of assessing the evidence and making evidence-based decisions. On the table, I will probably completely horrify the entire medical establishment in Scotland by making the suggestion, but I wonder whether that is something that could be examined as to whether or not other professionals might be able to be trained. It would be shorter, it would be quicker and less expensive than training people from scratch and whether that might be a possible one of a number of possible solutions. I now call on Mark MacDonald to be followed by Dr Richard Simpson. Thank you very much, Presiding Officer. Having spoken a little bit about the issue around primary care and my contribution during the programme for government debate and, indeed, speaking about it during a health debate that we held prior to the summer recess, I thank Jim Hume for bringing the issue back to the chamber. I am interested in the comments around workload. One of the things that I have spoken about in the chamber in the past, and Malcolm Trism has alluded to it, is how we can perhaps better align primary care services to perhaps reduce GP workload by having people being appropriately triaged to other services, where that is the more appropriate place for their conditions to be dealt with. Some GP practices that I know from my constituency are speaking to people at the point that they request an appointment and are redirecting them to, for example, pharmacy, if that is the more appropriate place for them to be seen. Some GP services, I do not think, do that yet. That might be a contributing factor to some of the workload issue. Certainly, a percentage of the workload might be able to be redirected elsewhere and dealt with in a different environment. I think that the issue around how we utilise other primary care professionals is something that needs to be examined. I am confident that, through the work that the Scottish Government is undertaking, to look at redesigning how primary care is delivered, that will happen. There are good practice examples out there. The minister will be familiar with the middle field healthy hoose in Aberdeen. I think that an example of good practice and good use of nurse practitioner services could perhaps be remodelled in other areas, depending on circumstances. My colleague, Rod Campbell, raised in his intervention around pensions, is relevant to that. The conversations that I have been having locally with GPs, particularly those GPs in their mid to late 50s, suggest that that is a decision that they are now facing as to whether they continue to work in general practice and take the pension hit that will follow as a result, or retire early in order to benefit from their pension as a result of the changes that have been brought in by the UK Government. That is not a decision that one would want those GPs to have to be facing, but there is a financial element to the decisions that they now face in terms of retirement. We also have to look at the fact that the make-up of the GP workforce has changed over time. It used to be a predominantly male full-time workforce. It is now a predominantly female part-time workforce, and there are a number of reasons behind that, which probably do not have time to go into in detail. I acknowledge that you shake your head at that point, Presiding Officer. Do not worry, I was not going to go into detail. One of the things that needs to be looked at is how GP services are structured to deal with that change in the workforce, but also how we attract graduates in. That is a point that has been raised on a couple of sides of the chamber. Some of the discussion that I have had with medical students and medical student representatives has been the question of partnership, which has been a decisive factor for many in making their decision. I agree with the point that Dr Murray makes about being also about specialisms being perhaps more attractive, but I think that the view that there may be a requirement to take on the role of partnership and not feeling that that is something that graduates would want to do. That is why I think that looking at a confederated model where perhaps practices control a number of premises rather than one individual premise, so that you could have perhaps a smaller cohort of partners, but operating a number of practices where you could then employ those GPs is something that needs to be examined, and I know that it is being examined certainly by the health board in Grampian. I think that there are a number of things that can be done. I think that the programme for government makes some encouraging signs towards those reforms that are taking place, and I am sure that that will help in addressing some of the issues that we do face in our general practices at the moment. Thanks so much. Anna Cohn, Dr Richard Simpson. I am very glad that we are now debating general practice and I welcome Jim Hume's motion and the survey that he did. He knows that I did a survey this summer, as did the BBC. There has been a lot of work done on trying to collect the data. The first point that I would like to make is why on earth did we not have this data very clearly available before. The growing crisis has not just emerged out of nowhere. I warned in 2010 that we should be considering a separate GP contract because the NHS in Scotland is now so radically different from England, and yet we still have a UK contract. I am glad that we are now going to have a separate contract in Scotland. Let us look at the factors. I am not going to talk about the solutions. I am publishing a document tomorrow with a comprehensive list. It is not actually comprehensive, but it is a consultation document of all the suggestions that I have received over the summer. I received 400 replies from doctors representing 330 practices. Actually, when the survey closed, there were another 49 practices responded. The factors that are around are very clear. First of all, there has been an increase in the population, roughly 170,000 since the SNP came to power. If it is one for 1,500, that means that we needed about another 120 GPs just to provide a standstill situation in terms of population, but it is worse than that because the number, the demographic character of that population has also changed. There has been a 17 per cent increase in the number of over 75s, and it is the over 75s who have more complex conditions. That means that GPs have to spend more time with them. Why? Because the hospital services operate on a silo basis. They treat single disease entities not humans in holistic form. That is what general practices are good about. That is what GPs are excellent at. They are good at diagnosis, they are good at managing complex morbidity, but they do not have the time to do that. The reason is because the cof, which was useful initially, was a good part of the new contract. The first time general practice was paid for quality, the cof became an increasingly bureaucratic exercise. Two years ago, the document on cof ran to 226 pages. Even last year, with the cuts, it was 186 pages. Now, the other thing that has happened apart from the increase in morbidity, increase in population, increase in the number of over 75s, has been a shift in the balance of care, something that we have all wanted, but that has been completely and almost totally unresourced. Those are the factors in the background. What is the result? The result is today, trainee vacancies, 20 per cent as we stand here today this year, 20 per cent trainee vacancies, predominantly in the west of Scotland. Immigration is up. In my own practice, Bridge of Island, and the neighbouring practice of Dumblane, two of the nicest spots that you could want to practice in have lost one doctor each in the last 18 months to Australia. These are doctors in their 30s, and when I contacted them and asked them about it, they said, there's no way we're coming back. One of them said that he was going to just try it, but he phoned up and said, no, I'm definitely not coming back. This has been something that has been going on for some time. Malcolm Chisholm mentioned the reduction in the proportion of funding from 9.8 to 7.8 per cent, so it's not coincidental that, with a share of funding going down to general practice and the resources that they need to have to go up, there is a crisis. In 2011, the party said that we should have a national conversation. We called it the Beverage Commission for 21st century. This Government ignored that request and, indeed, so did the Conservatives. However, what the Welsh Government did was to establish the Beverage Commission. In 2013, it introduced clusters that are only now in the Government statement today that they're going to have clusters. The result of introducing clusters and a raft of other measures—which, in fact, I was discussing with the people in Wales—has resulted in the per capita population, GPs per population, rising in Wales in the last 18 months, whereas it's continued to sink in Scotland. I'm glad that the crisis that I've been recognised, the debate on BBC that I had indirectly with Maureen Watt earlier this summer, we were told, oh, there are more GPs in Scotland than ever. That's been the mantra for three years. However, the numbers of full-time equivalents have only gone up by 35 since 2008. I'm glad that the crisis is recognised. I'm glad that some funding is being applied. That funding, in my view, is wholly inadequate. We will need to do very much more. I will have my proposals published tomorrow. We are discussing that with general practitioners. Thank you so much. Maureen Watt closed the debate on behalf of the Government. Seven minutes are thereby, please, Minister. Thank you very much, Presiding Officer. We've heard much this evening about the difficulties which part of general practice finds themselves in. I will address those issues shortly. However, firstly, I want to make it clear that this Government attaches the highest value to Scotland's GPs and the work that they do. Scotland's population is increasing, as we've heard. We're living longer with multiple and often complex conditions, which will become increasingly the norm over the next years. I have every confidence that Scotland's general practice can deliver what is needed to meet the challenge of demographic change, but I also recognise that some significant changes need to be made to relieve the work pressures and to help with recruitment and retention, and we're working with GPs and have started to make those changes. Earlier today in the chamber, the First Minister set out the programme for government and highlighted the early success of the integration of health and social care, and that will ensure that as much care as possible is provided in community settings. The First Minister also outlined the importance of testing new models of care, building on innovation that is already being developed locally and integrating different types of care. We want to ensure that local community-based services are delivered by the appropriate range of health and social care professionals working together more effectively. That comes with a commitment to invest. In Scotland, we spend a record £12 billion each year on our health service, of which some £770 million is invested in general practice. We will be investing a recently announced £60 million primary care fund to transform primary care, building on great examples across the country of providing care for patients at or near home rather than in hospital. That funding will help to address immediate workload and recruitment issues through long-term sustainable change. Specifically, that fund will increase the number of medical students choosing to train as GPs and encourage those wanting to work in rural or deprived areas. We will continue the enhanced returners programme, supporting GPs who wish to return to the profession and develop a programme for local GP leadership and networking. One of the things that you have touched upon is students wanting to go on to become general practitioners. I was wondering whether there is a possibility of working with the education institutions to see if we could actually increase places as well for general practitioners to try and relieve the short pressure that we are facing in the real, near future. Hans Alamake, I am an important point. For every student place that we have, there are 11 young people wanting that place. We have people wanting to go in to the medical field, but we need to be sure that we are getting the right people in as students the ones who want to live and work in their own communities and to be GPs. That is what we are working with the BMA and others on. We are consulting with others to increase the output from medical schools, encouraging and improving training in general practice. By the end of 2015-16, we will already have invested in an additional 10 million in enhancing primary care. That will be further supported by total investment of 50 million over the following two years. However, there are challenges. The Government knows that GP workload is increasing as is the complexity of healthcare. Where more is being delivered outside hospital settings, resources have not always followed. We understand that GP services in some places are stretched and that, at the same time, communities rightly expect more of their health services. Our plan is to transform our approach to primary care to ensure that, in the future, people see the right professionals more quickly. That is why we will continue to work with Scotland's GPs to design that new future. That is why a review of primary care out of our service was commissioned. That is why we need to redesign primary care in a collaborative and inclusive way, transforming and invigorating the workforce, creating new roles and supporting communities to innovate so that services are available where people need them. Scotland's GPs have a vision for the future of general practice and it is a compelling vision which this Government shares. That is a future where care is provided by multidisciplinary professional teams, planned and delivered within the localities that need them. That is a future where GPs are the expert medical generalists, the doctors making the critical clinical decisions about their patients but not necessarily being the first point of contact. We have been working with the Scottish General Practitioners Committee to redesign the contract and will have the first version in place by 2017. That is the timescale GP union leaders tell us that it is realistic and that negotiations on the detail will take place in 2016. As others have mentioned, we have a separate agreement in Scotland and English GPs are very envious of that. By 2017, we will have made significant progress to change the way general practitioners work. We will remove the annual churn of contractual changes and introduce the next version of the GP contract three years later in 2020, when the transformation in the way GPs work will be near complete. Our approach will build on innovations already under way that reflect local priorities. For example, in reducing health inequalities in Craig Miller and Govan, improving mental health in Fife and helping people to age well in Tayside. Equipped with this flexibility, care will develop in ways that match the needs of different individuals and communities in cities, towns, villages and rural areas. The integration of different types of care is already the practice at Clarkmaninshire Community Healthcare Centre. It provides primary care through three GP practices while also providing wider services such as outpatient services to inpatient wards, a day therapy unit and local mental health resource centre. The centre is also a base for district nurses, health visitors, community rehabilitation teams, health improvement and a wide range of support services and classes. We know that one size does not fit all. That is why we wish to test and seek views of new models of care, including those that might be delivered by multidisciplinary teams in a community hub-type arrangement, whether that is physical hubs or virtual hubs, but where professionals collaborate across the boundaries of primary and secondary care. All of that, of course, is focused on high-quality care and improved health outcomes, which will provide more connected, streamlined working within healthcare and across healthcare and social care and voluntary support services. Professionals will be able to support patients who are facing wider social issues, which are having an impact on their health and wellbeing, and clearer signposting, information and support so that people know where to go for the most appropriate treatment or follow-on service. The times come to start talking up Scotland's general practice to encourage more doctors to stay within the profession and to ensure that medical students choose a career in general practice because it is one that deserves to be admired and respected. It is time to create some excitement for the future of general practice in Scotland, and I know on social media that that is already the case with some of our young students. For now, the Government will continue to work with Scotland's general practitioners to deliver a model of sustainable general practice that is right, both for the profession and, more importantly, for the health of the people of Scotland. That concludes this important debate. I now close this meeting of Parliament.