 The next item of business is a debate on motion 17011 in the name of Alison Johnstone on addressing Scotland's GP recruitment and retention challenges. Can I invite those members who wish to speak in the debate to press the request-to-speak buttons now, and I call on Alison Johnstone to speak to and move the motion. Eight minutes please, Ms Johnstone. Thank you, Presiding Officer. I don't think that anyone in this chamber would deny that Scotland's GPs are facing considerable pressures at the moment. Those pressures impact practitioner wellbeing, but they also have huge ramifications for the recruitment and retention of GPs. The results of a survey commissioned by the Royal College of General Practitioners in 2018 revealed that over a quarter of GPs are unlikely to be working in general practice in Scotland in five years' time. If those who reported to be likely to leave general practice in the next five years, one in three said that it was because it was too stressful. Those figures are a stark warning that Scotland's GP workforce is teetering on a cliff edge. I recognise that the Scottish Government has taken steps to tackle recruitment issues, such as the new GP contract, initiatives such as ScotGem and increased training places, and I applaud those efforts. However, retention must be urgently addressed. We must take care of those who are already on the front line, or we may struggle to retain the workforce that we have. The chair of the BMA's Scottish General Practitioners Committee, Dr Andrew Buist, said that the contract was aimed at making general practice more attractive, but noted that, of course, those deep-seated problems, such as there simply not being enough GPs, were never going to be solved in a single year. That poses the question, how can we make things better for GPs while changes are being implemented? I acknowledge that the expansion of practice teams is a means of lessening GP workload, as other health professionals will now be delivering aspects of patient care. There was previously the responsibility of GPs such as vaccinations and pharmacotherapy, however it will take time to grow and develop those teams. Extra strain 2 is placed on GPs when patients are not informed of changes. I have previously mentioned in the chamber the fact that 35 of those who were surveyed by RCGPs spent consultation time explaining to patients why they had been offered appointments with other health care professionals instead of a GP. That places strain on GPs and patients who GP's report are becoming distressed, confused and angry at times. I urge the Scottish Government to hold a national conversation on changes to services to relieve that burden on practice teams who are having to deliver the message. That must be an urgent priority for the Government and I am very happy to work with the cabinet secretary on what form any information campaign might take. The GP contract acknowledges that speed is not the only aspect of access that matters to people and that being able to see a practitioner of choice also matters to some groups. It is therefore extremely important that patients are still able to see a GP when they need to and that the workforce is in place to enable that to happen. However, the same RCGP survey showed that if those who were likely to be working in general practice in one year, 20 per cent expected to work reduced hours. That represents a culture change within general practice as there has been a continued decrease in the proportion of GPs working eight or more sessions per week, from 51 per cent in 2013 to 37 per cent in 2017. Given the stressful working conditions that have already been mentioned and the fact that GPs frequently report working 12 or more hour days, that change is understandable. Until an appropriate workforce is in place to support that change, patients might find that they are waiting longer and longer to see a doctor. It is significant that the 2017-18 health and social care experience survey showed that the percentage of respondents who highly rated the arrangements to see a doctor was 67 per cent, and that is compared to 81 per cent in 2009-10. The Scottish Government has pledged to provide an extra 800 GPs over the next 10 years, and I welcome that commitment. However, that figure refers to head count only. RCGP estimates that Scotland will be short 856 whole-time equivalent GPs by 2021, so the Government's pledge falls short of what is needed and I therefore urge the cabinet secretary to introduce more ambitious recruitment targets in line with the Royal College's recommendations. The Royal College also says that there is a serious funding deficit for general practice, and general practice carries out the vast majority of patient contact within the NHS. Given that Scotland has an ageing population and GPs are seeing patients with increasingly complex health conditions, it is perhaps surprising that RCGP's latest figures show that general practice receives just 7.35 per cent of Scottish NHS funding, falling well behind the average funding of general practice in the UK, which currently stands at 8.8 per cent. RCGP has consistently called for it to receive 11 per cent off the NHS budget and ask supported by the BMA. That would represent approximately a 1 per cent rise every year for three years. The national health and social care workforce plan stated that the primary care workforce is uniquely placed to influence the level of demand for other care settings and listed cost effectiveness as one of the many benefits of strengthening primary care. Investment in general practice is therefore an investment in Scotland's entire healthcare system. Investing in general practice is investing in preventative measures. Lack of access to primary care often results in patients seeking assistance at hospitals. A better equipped well-funded general practice would be able to relieve some of the strain on busy A&E departments and beyond. One of the aims of health and social care integration is to shift care towards preventative and community-based services. Why then is proportional investment in general practice consistently below what is needed? The Royal College of Education says that this investment would result in an increased GP workforce, modernised fit for purpose surgeries, widened access to training and improved IT systems. In short, the resources needed to support integration and for GPs to continue to deliver the very best standards of care for patients in Scotland. Funding must also be targeted to tackle health inequalities. Scotland still has one of the lowest life expectancies in Western Europe, and there have been concerns expressed by GPs that no extra funding has been allocated to those practices serving the most deprived populations in Scotland. Affluent practices with the most elderly patients continue to receive the highest GP funding per patient per annum. RCGP has called for additional GP clinical capacity with appropriate funding for areas of high deprivation. For recognition of the specific workload associated with socioeconomic deprivation, and for community link workers to be prioritised for practices in those areas of high deprivation. Will the member recognise, as the BMA does, that the new contract is, in fact, weighted towards in terms of how the funding is allocated to areas of social deprivation and areas, i.e., those practices that care in particular for the elderly? I appreciate that every member of Scotland's population has an entitlement to the very best of care, but the cabinet secretary will be aware and the debate will emphasise that. I am sure that there are still concerns around particular areas of the contract. That is a concern that has been expressed to me by GPs. In conclusion, with proper funding and a bolstered workforce, general practice can make significant strides in tackling health inequalities, lessening the strain on other NHS services and continuing to provide excellent care to Scotland's population. I do not know if you moved your motion, Ms Johnson. I move the motion and my name. Thank you very much. I now call on Jeane Freeman to speak and remove amendment 17011.3. Cabinet secretary, six minutes please. Thank you, Presiding Officer. I am grateful for the opportunity to talk about the significant progress that is being made to reform primary care and general practice, and to acknowledge the challenges that we continue to face. Over 90 per cent of healthcare in Scotland starts and stays in primary care. It is a vital part of our health service, and I know that everyone in this chamber offers our thanks to the staff across the many different professions who deliver those indispensable services day in, day out in every community in Scotland. We are working hard to deliver our strong commitment to primary care, but there are challenges and I am keenly focused on those. It is important to recognise that those challenges are not only the recruitment and retention of GPs, but also the recruitment and retention of the wider primary care team with all the multidisciplinary skills that patients need them to have. The guiding principle is the right one, that people should see the right healthcare professional at the right time in a way that suits them. Those new teams, including practice and district nurses, health visitors, pharmacists, allied health professionals, mental health professionals and link workers, enhance patient care, provide the support for our GPs that they need, and deliver on that guiding principle. The new GP contract has been in place for one year. It is a landmark contract in Scotland's first and was developed and negotiated in partnership with the BMA and received a 71 per cent support from its members. Increased business risk and workload were identified as key reasons for stopping people wanting to be GPs and encouraging them to leave the profession prematurely. The new contract works to reduce risks around premises and staffing. The creation of those multidisciplinary teams of healthcare professionals works to ensure that the GP's workload is focused on those patients where the GP's particular clinical skills are the ones that are needed. The new GP contract, in its widest sense and in its critical application, sits at the core of our reform of primary care and central to the new contract is developing the leadership role of GPs locally. That includes the development of locally agreed primary care improvement plans covering all 31 integration authorities. Neil Findlay. What is the minister's say to my constituents in Stonyburn, who now no longer have any GP practice for the first time since the creation of the NHS in 1948? I met representatives of the community council at the start of the Easter recess and was able to assist them in some way in order to make sure that some of the services that they are concerned about could be made available to them in a sustainable way, and I will continue to monitor and secure that engagement. Exactly for those purposes. All GPs, Urban and Rural, need to see the benefits of the new contract, that it brings reduced business risk, improves workload and, critically, delivers the right care that a patient needs from the right health professional, and how services are delivered should fit local circumstances. The scope of local flexibility in the national contract is a central part of the work that we have commissioned in the working group chaired by Professor Sir Lewis Ritchie, and we have asked that working group to agree exactly what that scope is. That involves the BMA, representatives of rural health boards and integration authorities, and critically rural GPs. We are investing substantial sums in our reforms of primary care and general practice, and by the end of this Parliament, we will have committed to increase annual expenditure on primary care by £500 million a year, with £250 million of that increase invested in direct support for general practice. I know that, while we have a focus on developing the multidisciplinary teams, we need to deliver enhanced services. We also need more GPs. We have committed to recruit at least 800 more GPs by 2028. We need to train, recruit and retain. Between 2015-16 and 2020-21, the Scottish Government will have increased medical places in Scottish universities by 190 places, with the majority focused on primary care. Those include ScotGem and 60 additional places for the academic year 1920 at Aberdeen and Glasgow. We have set up bursaries for harder-to-fill posts, which have seen a steady increase from 60 in 2017 to 101 in 2018, and we are taking specific steps to improve recruitment and retention of GPs in remote and rural communities. Last April, we published the first-ever primary care focused workforce plan. We introduced and expanded practical services aimed at supporting GPs, including coaching and mentoring, and in the area of rural GPs' special financial packages to encourage relocation and to encourage retention. We have developed a targeted GPs recruitment marketing campaign, and at the RCGP conference last year, we addressed another practical problem that we addressed when I launched the national GP recruitment website, GPjobs.scot, and we will work to ensure that all existing vacancies are picked up and advertised there. On that commitment of increasing the number of GPs, we are seeing early signs of success with latest figures indicating a record number of GPs working in Scotland. The GP headcount in 2018 was 4,994, 70 more than the year before. In conclusion, I believe that all the actions that I have outlined and the other time prevents me from covering are the right ones for us to take, but I am also listening to primary care professionals, patients and members of the chamber. If there are more steps to be taken to ensure that essential services are not only protected but helped to flourish, we will take them. Across the chamber, we all recognise that enhanced primary care services with general practice at the heart of them is the bedrock of the NHS, and I move amendment in my name. I say to members that there is a little time in hand for interventions at which you will get your time back on. I will call on Miles Briggs to speak to and move amendment 17011.2. I thank Alison Johnson and the Green Party for bringing forward this important debate today during their debating time. It was November 2017 that the Parliament last had the opportunity to debate the GP crisis in Scotland when Scottish Conservatives brought forward our own debate and called at the time for 11 per cent of funding to go direct to general practice. Since then, we have not seen progress in that becoming the reality. Over the Easter recess, I spent time in Highlands, Murray and Aberdeenshire meeting with rural GPs. The overwhelming message that they gave me was that they feel that the new GP contract is not working for them and that their concerns have not been listened to. I thank the member for giving way. I accept his point that rural GPs face particular challenges. Would he also accept that the depend GPs who deal with the 100 most deprived areas also face big challenges? Miles Briggs, I was coming to that. I think that this is where the Government has been amazing in being able to unite both sets, because I know that deep end GPs are equally not happy with the contract as well. Despite being responsible for delivering the vast majority of patient contract within our health service, general practice in Scotland continues to face understandable and considerable underinvestment following its 9.8 per cent share in 2005. The latest figures show that general practice in Scotland receives just 7.35 per cent of Scottish NHS funding, falling well behind the average funding of general practice across the UK, which now stands at 8.88 per cent. We are only able to boost GP workforce by significantly investing in general practice, ensuring, as Alison Johnstone said, that manageable workload levels can be put in place. A serious funding deficit exists for general practice. That is something that I think that the Government needs to recognise, without which general practice cannot fulfil its potential and achieve the goals that all of us want to achieve. In the face of over a decade now of consistent cuts to the percentage share of NHS Scotland's spending being made available to provide general practice with those services, RCGP has been calling consistently now for 11 per cent of the annual budget of the Scottish NHS to be delivered in general practice. As the briefing for today's debate makes clear, the funding gap in general practice is unsustainable, and action should be taken urgently to preserve patient safety by resourcing general practice with 11 per cent of the budget. There has perhaps never been a greater need for clarification in Scotland on the funding for general practice and the role and capacity of wider multidisciplinary teams. There is a great potential if we fund general practice properly. As the RCGP briefing points out, new roles in general practice support for practices, teaching and training development opportunities, digitally enabling care across our communities. That is what we should all be looking to try to deliver. From the outset, Scottish Conservatives have raised concerns regarding the new GP contract with the former health secretary and with the new health secretary and the unintended consequences which it will have on rural GPs. The truth is that when general practice works well, our national health service works well. That is something that we should all bear in mind and look towards and nothing more around that than recruitment towards general practice. For the last 12 years, SNP ministers have launched several schemes to try to recruit to general practice. The SNP created the programme in 2015 that aims to take forward proposals to increase the number of medical students choosing to go into GP training as well as encouraging them into rural practice and economically deprived areas. However, we have only seen recruitment of 18 GPs in two years at a cost of £2.5 million. That is simply not good enough and is continuing to fail our communities. GPs in particular have serious concerns about the proposals within the future contract. That is something that my amendment looks towards. Phase 2 of the GP contract must be cross-party and we must have an opportunity to highlight those concerns and get this right, especially as we face an election year. The Rural GP Association has already put those concerns to the cabinet secretary, I know. For some time now, it has been clear that SNP ministers have not truly understood the crisis facing general practice across Scotland, especially in our rural communities. As I said almost two years ago, it is important that we now look and take time to get this right. Parliament can send a message and a united message to ministers tonight that they need to take urgent action on general practice and funding in Scotland and do far more than they are currently doing to prevent this crisis growing even further. Until the Government fundamentally addresses the complaints and concerns that GPs are putting to all of us in this chamber, then general practice will not be able to flourish in Scotland. I move amendment in my name. Thank you very much. I now call Monica Lennon to speak to move amendment 17011.1. Ms Lennon, five minutes please. I believe that all of us appreciate the hardworking staff who work in our NHS and because we do, it is incumbent on all of us to address Scotland's GP recruitment and retention challenges. I am grateful to Alison Johnstone for bringing this debate forward today, but I am also grateful to the Royal College of GPs and the BMA for their briefings ahead of the debate, but also for the many members of the public who get in touch not just with me, but my colleagues and all of us to share their views and experiences. It is right in these debates that we show appreciation, but in the end of the day it is action that counts. The role of general practice in our NHS cannot be overstated. It is on the front line of healthcare carrying out the majority of patient contact and it acts as a gatekeeper to other parts of our health service. GPs dedicate their working lives to the health and wellbeing of others. That is an admirable commitment, but whether NHS facing crisis is also a challenging one, and increasingly so, GPs tell us that they are under unprecedented pressure amidst GP shortages. We have GPs facing increasing levels of stress and burnout, and that should worry all of us. The evidence that GP recruitment is in crisis is clear and mounting. There has been a failing on the part of the Scottish Government to address workforce planning properly. Steps to remedy those challenges are welcome, and we know that change will not happen overnight, but in the meantime it is GPs and our patients who are paying the price. In the last three years, more than 200 doctors chose to leave general practice due to significant workload pressures. It is a hard sad fact to accept that our valued GPs feel this way, and the bottom line is that Scotland cannot afford for this to continue. Out of ours, GPs provide an invaluable service in all of our communities, and that has the potential to ease pressure on A&E departments. Cuts to out of ours services and a shortage of GPs means that more people have to take themselves to A&E, and it puts more pressure on the service. Hospitals and medical centres in Glasgow were left without staff covering emergency out of ours GP services more than 200 times last year. Easterhouse, which raises high levels of deprivation, raised a shocking 977 per cent increase in the number of shifts that were not covered. Before 2017, there were no examples of shifts being left unsafed in Glasgow, so those figures do require further scrutiny and attention. I am not about to disagree with the member about the challenges that we face in our out of ours service, but will she recognise that it was, in fact, the 2004 GP contract, not one negotiated by this Government, that removed the requirement on GPs to provide out of ours services and that what we now have to have is the voluntary participation of GPs in those services and that, as GPs retire, many of those, as a member said earlier, many of the newer ones want a different kind of work-life balance, so we are seeing fewer GPs volunteering for out of our services, and we need to think differently about how we provide those services. Ms Lennon, we will give you your time back. I am grateful to the cabinet secretary for that input and commentary, but I do not think that it really cuts it when we have people in Easterhouse and really deprived parts of Glasgow who are wondering why they had out-of-hours access before 2017 and then have these problems now. We have to deal with 2019, cabinet secretary, and we have heard from my colleague Neil Findlay about the challenges his constituents face in Stonyburn, but the GP contract introduced last year was meant to ensure that GP recruitment and retention problems were alleviated. Implementation has been criticised and it has been slow and the BMA, we hear their call for an increased pace of change. The Scottish Government has had some difficulty around rural GPs and we know that last month, Dr Hog, Vice for the Rural GPs Association, walked away from the Scottish Government's task force due to a lack of progress saying that it has fallen by the wayside. Again, another cause for concern. I welcome some of the action that the cabinet secretary has outlined, but we need to see promises being delivered on, and it has not always been the case under this administration. The Scottish Labour Party supports the Scottish green party motion, and we can support the Scottish Conservative party a motion too, but we can't support the Scottish Government a minute, because we don't believe that the Scottish Government has adequately addressed the concerns of rural GPs and also because it fails to acknowledge a series of issues with GP recruitment. In conclusion, we must value and support GPs right across Scotland because of a robust, well-resourced GP service, while it uses pressures on other parts of the NHS. Ultimately, we provide people in Scotland with a better health service. We all need to value GPs and look out for their health and wellbeing. We cannot have GPs experiencing burnout. The cabinet secretary gave me a little bit more time, but I will finish now. We are highly concerned about increasing problems out of our GP provision across Scotland and the particular challenges in our rural communities. For those reasons, we call for any review of GP resources to include a specific reference that is focused on out of our coverage and rural service provision. On that note, I move the amendments in my name. I thank the Greens for securing time for today's debate. It is not something that we discussed enough in this place, but it is a matter of great importance. I was appointed as health spokesperson for my party on my second day in this place. Within hours, I became aware of the breadth and depth of the crisis. GPs are often our first port of call, but they are often the last consideration that we give in this place, and that has to change. To give an understanding of the metrics around the breadth of that crisis, we know that by the end of this decade, we will maybe have as many as 800 fewer GPs than we require as a country. A freedom of information request by my party revealed the depth of the recruitment crisis. In fourth valley alone, there is a post that has gone unfilled for the past two years. On Shetland, there is a position that has been advertised eight times with only one application, and in Dunfries and Galloway, a 22-month wait for another post to be filled. Those stories are replicated the country over. There are many reasons for that. In my constituency of West Edinburgh, we have not had a new doctor's surgery established for 45 years, despite a year-on-year proliferation of new homes and populace within that. All the GPs' surgeries in my communities are on their knees. Some have had to restrict their lists or close them entirely. That is down to the fact that the proliferation of housing development that happens in my constituency has no consideration of who will treat those patients. There are developments on-stream right now for thousands upon thousands of new homes with no thought as to who those patients will turn to when they fall ill. We are not promoting general practice throughout the progress of our medical students as they go through their degrees. We are not recognising the pressures that we could alleviate very easily in general practice right now. The fact—and it is a subject that I have raised time and time again—that one-quarter of all appointments that are made to our GPs are done so due to an underlying mental health condition, where those GPs are ill-equipped or do not have the time to bottom out the psychological reasons for that appointment being made in the first place. We know that there are workforce planning problems. It takes seven years to train a GP, but workforce planning cycles in Scotland happen only every five. That leads to a problem of attrition where we fail to see when we are not planning effectively for the retiring cohorts of GPs and backfilling those places for new GPs to come up the ranks. I think that retired GPs perform some of the solution or offer part of the solution. I have visited in my constituency surgery retired GPs who said that they would be very happy to undertake one or two sessions a week if it was made easier for them to come back into general practice if they could keep their hand in far easier. I think that we need to box clever and listen to the goodwill that exists in our general practitioners who have retired. I commend the Government for the new contract. I think that there are aspects of it that have proven to be quite elegant and well received by the community. The issue around premises I think was a particular millstone around new entrants to partnership within general practice. The idea that people had to take on a mortgage of £80,000 just to become a partner in a GP surgery was an inhibiting factor on so many. I think that the solution that the Government has offered, along with the BMA and the RCGP in addressing that, is very elegant. However, there are issues around the contract too that I think we will only see begin to bite as phase 2 comes in at the start of the next parliamentary session, and that is particularly around the issue of financial compensation or recompense for GPs in areas of profound rurality, which is, Presiding Officer, those areas that are struggling, as I said at the top of my remarks, to recruit GPs first and foremost. I said at the start that GPs are the first port of call for many of our constituents when they fall ill, but they are all too often our last consideration in this place, and that needs to change. Thank you very much. I now move to the open debate and speeches of four minutes. That will be Mark Ruskell, followed by Emma Harper. It is clear from comments that the GP crisis continues to have a big impact across Scotland. Just this week, the Dunfermin and Repress reported on a local father who had to phone his surgery over 100 times in just one morning to try and get an appointment. Of course, it is not just primary care services that have been impacted by the GP's shortage. The delivery of out-of-hours care has been limited by a lack of GPs and also the contractual changes that have taken place over a number of years. In my own region, there have been two NHS boards carrying out major service changes to out-of-hours primary care, that is Fourth Valley and Fife. Their approach has been very different, however, and there are serious lessons to be learned for other NHS boards. In 2017, Fourth Valley NHS implemented interim measures, concentrating their out-of-hours service in one location at the Fourth Valley Royal Hospital in Larbott. Understandably, that caused concern and disruption for many people, especially for those in rural Stirling who are facing journeys of up to 40 miles to access these services. On the back of this, NHS Fourth Valley instigated a recruitment drive for a significant team of allied health professionals to complement and support GP provision, including out-of-hours. Earlier this year, 18 new advanced nurse practitioners, prescribing pharmacists and paramedics and other health professionals joined the NHS Fourth Valley team, the first of over 200 new staff who will deliver a multi-disciplinary model of primary and out-of-hours care at locations across the area. However, I would emphasise that this is a model that continues to be led by GPs. It is important that GPs display strong leadership and are supported by those multi-disciplinary teams, which they support in turn themselves. In contrast, NHS Fife implemented emergency out-of-hours provision last year, limiting services to just two locations in Dunfermlyn and Cacoddy. That was followed by a consultation that proposed a very limited set of options and no discussion about the role of GP-led multi-disciplinary teams. It has taken communities to put in two participation requests under the community empowerment legislation and a whole new series of consultation workshops for a new option to develop in Fife, which uses the same multi-disciplinary model Fourth Valley and other NHS boards that have been proactively adopting. The latest proposals that have come out of this participation will retain an evening weekend service at St Andrews community hospital using a mixture of GPs and health professionals with home visits to the most vulnerable and remote patients. Work is on going to hopefully design a similar model for Glenrothes. However, I have serious concerns at the ability to deliver an effective multi-disciplinary model with the current staffing levels in Fife. There has been no recruitment drive comparable to that in the Fourth Valley. With only five urgent care practitioners and five point four advanced nurse practitioners currently in the training pipeline, 10.5 staff for Fife versus 300 for Fourth Valley is a very worrying difference in our workforce planning. I am deeply concerned that it will put our GPs in Fife under further pressure. Meanwhile, what was supposed to be a temporary centralisation of services in Cacoddy has continued now for over a year with no date set yet for a new model to roll out. I have raised this issue in the chamber before and was heartened by the response from the cabinet secretary that there is specialist funding available for training advanced nurse practitioners and prescribing pharmacists. As the motion states today, we urgently need a review of GP recruitment resources and funding, including the allied health professionals, that are so vital to delivering a successful multi-disciplinary model for primary care. Those models are popular, and patients report high satisfaction levels. Communities such as Bridgivern in my region are actively lobbying their local health boards to see multi-disciplinary health and wellbeing centres built in their communities, but the inconsistency and lack of staff recruitment across certain NHS boards needs addressing right now. Emma Harper, followed by Annie Wells. I am pleased to speak in this debate, both as a nurse with over 30 years of experience and as deputy convener of the Health and Sport Committee here in Parliament. The new GP contract for Scotland, which came into force in April 2018, aims to help to cut doctors workload, ensure a minimum income guarantee for GPs and allows general practice to become a more attractive career. The contract is still in its infancy and we are now embarking on year 2 of its implementation. In 2018-19, the Scottish Government invested over £110 million in support of the new GP contract and wider primary care reform, all of which is extremely welcome. Last year, I attended the Royal College of GPs annual conference in Glasgow and I was able to speak to GPs, including Dr Carrie Lunan, who is the RCGP lead in Scotland, and I got to hear first hand from them about how they thought the contract would work. There is apprehension about whether the contract will work completely for rural GPs. Following those conversations and after discussions with former colleagues in the primary care sector, I wrote to all the GP practices across NHS and Freeson Galloway area asking for feedback on the contract and if there were any other issues that they wanted to bring up with me, which I could then relay back to the Scottish Government. I am pleased that today I have had over six practices respond and I am in the process of meeting with them to listen and hear their thoughts about having processes that we can further improve with the contract. Last week, I met with the Charlotte Street practice in De Vries. At the meeting, it was clear to me that the GPs agreed with much of what the contract has to offer, but they did make it clear that they had concerns over some of the timescales for what some of the contract states. For example, the length of time it might take to implement the pharmacist into practices. I was able to make—it was clearly made from the GPs that I met both at the conference and from the GPs locally—that the way many believe that we should be recruiting GPs, particularly to rural areas such as in the south-west in my South Scotland region, is by improving transport infrastructure, both road and rail. I am sorry, but this harper is harping on again about the A75, 76 and 77, but the GPs did say that, if people who may have studied, lived and their families are maybe in the central belt, they could have easy access to Dumfries and Galloway and Stranraer and all the places in between by fast train links or road links, that they may be more inclined to work in Bonny Galloway. I am aware that the Scottish Government is actively working on recruiting and retaining our GPs. Just in 2018-19, the Government invested £7.5 million in that, which included £850,000 for remote and rural areas. For all the 160 remote and rural practices, the Scottish Government has made available golden hello payments to GPs taking up their first post in a rural practice and relocation packages of up to £5,000. GPs' recruitment concerns are not unique to Scotland, but this Government's commitment, including expanding the remote and rural incentive scheme and relocation funds, should have a real impact going forward. The investment of £7.5 million has allowed the Scottish Government to invest in the SCOTGEM programme, which will benefit Dumfries and Galloway in my South Scotland region. SCOTGEM, which is a partnership between St Andrew's University and Dundee University and NHS Scotland, is of course orientated towards the current NHS Scotland workforce requirements, particularly in remote and rural GP practice. 55 students in total were matriculated with St Andrew's University in August 2018, and I am pleased that the first group of secondary students will arrive in Dumfries and Galloway in August this year. Happily, five GP practices across Dumfries and Galloway are set to take part in the pilot year of the project, and I look forward to seeing its outcomes. In conclusion, I would like to thank the exceptional specialist GPs across Scotland, and I welcome the positive steps that the Scottish Government has taken to help with the recruitment and retention of GPs. General practice is the front line of the NHS, and it has been seriously let down by the SNP. After nearly 12 years in charge of Scotland's health service, the issue that we have with GP recruitment and retention is only getting worse. We know that that has been a long-standing issue, which the SNP has been repeatedly warned. Demand on the health services growing with the role of GP becoming more important. As the Royal College of GPs points out, general practices at the front line of the NHS carry out the vast majority of the patient contacts. GPs act as gamekeepers to the entire NHS. Despite that, however, the Royal College of GPs has estimated that there will be a shortfall of 856 GPs by 2021. More than 500 GPs have taken early retirements since the SNP came into power, with the number of doctors in training in Scotland having sunk to a five-year low. The Scottish Government has highlighted the measures that it has taken to combat this crisis, and, although I welcome schemes such as ScotGem. The evidence that she has for that assertion is that the numbers of doctors in training have sunk to a five-year low, because those are not the figures that I am working with. I will send the figures over to the health minister. The Scottish Government has highlighted the measures that it has taken to combat the crisis, and, although I welcome schemes such as ScotGem, it is concerning that it has taken so many years to reach this point, even more so given that the BMA warned of severe shortages of GPs in 2008. When it comes to retention, talks over the new GP contract between the SNP Government and rural GPs have revealed on-going tensions. The contract is still widely opposed by rural doctors, whose state, due to its focus on workload, unfairly benefits practices in wealthy urban areas with large elderly populations. Only last month, we saw Dr David Hogg, vice-chair of the rural GP Association of Scotland, resign from a working group set up by the Scottish Government. That was because of what he saw as a failure to suggest any pragmatic and realistic proposals to counteract the impact that the contract would have on rural services. The Scottish Conservatives have repeatedly made calls to try and counteract the problems general practice is facing. We have called on the SNP to spend more of the NHS budget on GP front line to meet the 11 per cent target. Our saver surgeries campaign makes clear the importance of properly funding general practice. As we have heard, in recent years, Scotland's general practice continues to face considerable under-investment, falling from its 9.8 share in 2005-06. The latest figures show that the general practice in Scotland received just 7.35 per cent of Scottish NHS funding, which being the lowest share of NHS spend in the UK. That additional funding would allow general practice for the future, allowing surgeries to invest more in improved IT systems, helping GPs and patients to save time and resources. It would also allow surgeries to modernise, become in fit for purpose buildings and act-like community hubs, where social prescribing becomes the norm. In addition to that, the Scottish Conservatives have also called for more medical school places to be available to Scottish-based students and for GPs to be given more time for appointments from 10 to 15 minutes to assist with patients with more complex needs. Only by properly front funding general practice can those changes be made. To finish today, I would like to reiterate our calls for the SNP to spend more of its NHS budget on the GP front line. At a time when demand on the health services is greater than ever, it is so vitally important that general practice receives the correct level of funding. Action is the gateway to the entire NHS, general practice and dire needs of our support. Neil Findlay, followed by Richard Lyle. General practice and the relationship that patients have with their doctor is key to the way that our NHS operates. Of course, to the trust that we place in it, people, including me, have great respect and great deference towards their doctor and anything that negatively impacts on general practice ripples throughout the rest of the NHS, resulting in more and longer delays at A and E. Treatment time guarantees being breached, delayed discharge, more pressure on staff, your students entering general practice and greater reliance on locoms, costing the NHS more, fewer appointment times, closed lists and, ultimately, poorer patient care. All of that is happening in Scotland today. General practice is therefore crucial to the wider NHS and it has been failed by poor planning, financing and mismanagement at a governmental level. Over the past decade, we have seen falling numbers entering GP training down to around 300. The Royal College of Education says that we are 850 shot. Two years ago, I held a drop-in session over the summer for GPs in my area. All of them—I spoke to 14 different practices—raised with me the crisis in recruitment. It is now worse than it was then. Some of them said that they were a resignation away from closure. Those are well-established, long-established practices in communities where doctors are highly valued. Others were completely reliant on locom GPs just to keep the doors open. Locoms across Scotland claim it up to £1400 a day and unloading over £500 a day. We also unload and see around 50 practices operating restrictions on their waiting list. That is not good enough. A quarter of practices report vacancies. A third who advertise takes six months to try and fill posts. Only last week, we had NHS Lothian announce that, in May, nine out of 23 days cannot be covered at the St John's out-of-hours GP service, because of staff shortages. If you want to intervene, by all means. The reason why there are challenges in out-of-hours services is that the 2004 GP contract is not negotiated by this—it is not all come on—it is the case that, as the BMA, as the Royal College, as the Lewis Ritchie, it will all point to that and the removal of the requirement of GPs to— Mr Finlay, I will give you extra time. The removal of the requirement of GPs to undertake out-of-hours services that, plus the cohort ageing and retiring, combines to produce that problem. Rather than rehearse the problem, where are Labour's solutions to this? I am still waiting. You have been in power since 2007, and now you are only getting round to addressing it. I do not think that you will get away with that one, minister. Having just had six years, six years where the NHS could not staff the children's ward in my local hospital, we are now told that it cannot staff the out-of-hours GP service. I do not know what you find amusing, minister, because it was six years that you went through that turmoil. Three different closures go and have a look at the record, minister. Patients in the current situation with the closure of the out-of-hours GP service are being advised to contact NHS 24. That is not good enough. That will impact on patient care, which will be compromised. I have raised several times the situation that I mentioned earlier at Stonyburn health centre. The community has had a GP since the very creation of the NHS in 1948. It no longer has a GP, thanks to the crisis under this Government's watch. What a proud achievement that must be for you, cabinet secretary. The elderly, the unemployed, the disabled and low paid now have to use a very poor public transport system to travel for appointments. For a young mum with two children, that is at the minimum cost of almost £7. Previously, she would have been able to walk up the street to her local surgery. What do you say to the young mum who came to me to say that she struggled to take her children to the doctor because of the cost? That is the health service of the 19th century, not the 21st century. The last of the open debate contributions from Richard Lyle. I want to begin this afternoon by reflecting on the general state of the national health service in Scotland. I would suggest that we have a health service to be proud of. During the course of me joining this place in 2011, the NHS budget has gone up from £10 billion to more than £13 billion. Unlike those who like to complain, particularly in this chamber, we get on with the day job and resolve the issues through local health boards, not in the chamber. I like no, I have no time. I like many others in this chamber. I get constituents coming to my surgery with health inquiries, which we resolve. Yes, when the organisation will be a delay in complaints, but it is solving each and every complaint that gives me a satisfaction of doing what I do for constituents. That is what we do. Sorry, I do not have any time. A health service has to cope with many issues, too numerous to mention in the time that I have available. I believe that the health service deserves more credit than what it gets. I regularly contact my local GPs when they are required. I get annoyed because time and time again we see political criticism of a health service in this chamber rather than trying local resolution at local level through health boards. Some of the main parties opposite maximise their opportunity to take a pop-up at the Government, no time, or a Cabinet Secretary. The SNP has the most significant investment plans in the NHS. No, I do not have time. The lack of answers by the people opposite could be the issue of the recruitment and retention of GPs in Scotland, Presiding Officer, which we are discussing today. I value each and every GP that we have. As a part-time job, I personally had the good fortune to be an out-of-hours driver for NHS 24 before I came to this place, driving a doctor to a house call, seeing at first hand how they cope the health needs of the population. Working at night and weekends, yes, I saw at first hand the work that the GPs do and also the work that goes in our local hospitals. Presiding Officer, to be clear, the SNP greatly values the contribution that the GP profession makes to the nation's health, and this is a Government that I am sure wants to make sure that they have the support that they need. That is why the new GP contract for Scotland, which only came into force in April 2018, helps to cut doctors' workload, ensures the minimum income guarantee for GPs and makes general practice an even more attractive career. The BMA in its briefing state has been considerable progress over recent times. Indeed, we are now embarking on year 2 of implementing a new contract. Figures from 2018-19 show that the Scottish Government invested more than £110 million in support of the new GP contract and wider primary care reform. In fact, a comment by Dr Andrew Bust, chair of the BMA Scotland's Scottish General Practitioners Committee, was that, at the heart of the new GP contract introduced last year, it was a clear aim to make become a GP a more attractive career choice and encourage more people into working in this part of the profession. That is absolutely correct. The commitment is matched by the Scottish Government announcements for GP premises accessing loan funding of £50 million through a GP premises loan scheme over the next three years. GP premises is a sustainable loan scheme that is in direct response to concerns raised by the BMA and aims to ease the financial burden that is associated with owning a practice in turn to help to improve recruitment and retention. That means that GPs who own their premises can apply for long-interest loans and free loans that are worth up to 20 per cent of the practice value. The scheme reduces the risk of premises ownership and sometimes raises a common concern among GPs. It is part of a move towards GPs no longer being required to own a property. A total of 172 practices have successfully applied for loans—around 50 per cent of the total eligible. I am delighted that a number of them are featured in Uddingston and Bellsill and across Lanarkshire. The Scottish Government has committed to recruit 800 GPs over the next decade. Indeed, by the end of this Parliament, the Scottish Government will invest in an additional £500 million in primary care. I believe that the Scottish National Party Government has a record to be proud of and that political parties should stop carping for the sidelines. We move to the closing speeches. I have no spare time letter at all, so David Stewart is up to four minutes, please. I also congratulate Alison Johnstone and the Green Party for securing this afternoon's important debate on Scotland's GP recruitment and retention challenges. In my view, it has been a well-informed and insightful debate about the crucial players in our primary care delivery, our GPs. As the BMA rightly argued, problems with GP recruitment and retention are, of course, deep-seated issues and there is no quick fix. Of course, current services of GPs have shown that around one in four practices have reported vacancies. Many members, including Neil Findlay, Miles Briggs, Monica Lennon, Alex Cole-Hamilton, Mark Ruskell and Annie Wells, argued that increased workloads were certainly to blame for some of those GP vacancies. Excessive workloads are cited by GPs as a major reason why some are leaving the profession and, equally importantly, not entering it in the first place. In the 2018 BMA survey, over 70 per cent of GP partners said that works substantially more hours per week beyond the opening times of the surgery. In addition, many members spoke of the risks associated with working as a GP, such as owning the practice premises and employing staff. In fairness, the GP premises sustainability fund, which is intended to make general practice more workable, is a good concept and is designed to reduce the risks that practice partners are exposed to. If it is very brief because I am quite tight for time. John Finnie. I am grateful for the member for taking intervention. Would the member recognise that there is a place that has happened in our constituency for the use of salaried GPs? David Stewart. Yes, I think that that is an important part of the model and I visit some of those myself in Wicca and in Thurso. However, I have also raised my concerns at the Health and Sport Committee about the increase in employer contributions for pensions by 6 per cent this month for GPs. That has caused—I have no time to debate—a technical issue, which is a change in the current discount rate. That will hit GPs and GP practices and may result in redundancies for GP staff. That is a reserved issue and I hope that the Scottish Government will get the full funding from the UK extractor about that issue. There are also wider pension issues such as lifetime allowance, which particularly affects the retention of GPs, particularly those who are aged over 55. Another key element in recruitment retention in GPs, as we have heard, is the effect of the new contract in remote and rural areas. That was referred to in the debate and is also in our amendment. Dr David Hogg, who is the vice-chairman of the rural GPs Association, resigned from the Scottish Government working group last month. As he said, rural GPs, and I quote, are despondent about the new contract. Concerns were raised about the new funding formula that is based on number of appointments but fails to recognise the challenges that are faced by rural GPs, often to travel much longer distances to patients and to practices. In conclusion, the GPs are a crucial linchpin of the NHS, delivering services in the community and reducing pressures on acute and emergency services. We have a workforce crisis in the NHS and, as we have heard from many speakers such as Alex Cole-Hamilton, we are facing a shortage of 850 GPs over the next 10 years. Out-of-hours services are vital for ensuring that access to urgent care in the community is there when needed. We have seen cats in out-of-hours services across Scotland, but the big picture is that we know the reasons for the loss of GPs, the demographic changes, the demands of rural areas and the social economic challenges of the disadvantaged communities across Scotland. Although there is no quick fix, Scottish Labour supports the Royal College of GPs call to increase the proportion of NHS spending allocated specifically to general practice to 11 per cent in order to grow and maintain the workforce and fully support the highest possible standard of patient care. As Naib Evan famously said, the NHS will last long as there are folk left with fake to fight it. Brian Whittle, absolutely no more than four minutes please. Thank you, Deputy Presiding Officer. I thank Alison Johnstone, the Green Party, for bringing this debate to the chamber and giving us the chance to discuss an issue that the public are really concerned about. I wish we had more time to explore this, but it deserves it. This is a debate to the Deputy Presiding Officer that has been well rehearsed in this place, and we all know the numbers. As many members have stated, we are heading towards a shortage of greater than 850 GPs. After this, I am glad that Emma Harper is sitting down, because it is not like me. I am going to say well done to her for getting the A77, A75 and rail infrastructure into her speech. It is important, because the environment has an effect on where people work. I think that we have been talking about recruitment and retention, but in my view we have that the wrong way round. I think that it should be retention and recruitment. It is much more difficult to fill the bucket of water when it is full of holes. We know that more than 500 GPs have taken early retirement since 2007, and we also know that a third of GPs are aged 50 or over, as Alison Johnstone said in her speech. Would it not make more sense to ensure that we create an environment where our healthcare professionals can deliver the care that they are trained to do in the manner that they would like to be cognisant of their need to have that opportunity to have that healthy lifestyle? First and foremost, we should be looking to retain the experience that resides within our GP numbers while we look to backfill the shortage. That is made more relevant, given the BMA reporting that pressures on our GPs are increasing and that their mental health is in decline. What Annie Wells mentioned was that GPs need more time to deliver the service that they can. The shortage has been highlighted, I have to say, consistently to the Scottish Government by various experts, including the Royal College of GPs. Over a number of years, all the way back into 2008, the BMA said that a workforce crisis was imminent with too few GPs being trained to replace those who are retiring or leaving. We should not be surprised at that, but, during this time, the indigenous medical students in our medical schools have dropped dramatically. It is reasonable to assume that the place in which a qualified medical practice is more likely to relate to the address on the UCAS forum. I listened to Richard Lyle. I used to listen to him in the health and support committee to mention the point that his young constituents could not access medical places in medical school. In conclusion, 11 per cent of the total health budget going directly to general practice should be the very minimum target, especially given the drive towards community-based health, delivering it away from an acute setting. The RCPG expressed concerns about the lack of clarity over the Government's commitment to invest £500 million in primary care and warned that, if the long-standing underfunding and confusion that we currently experience is to continue, we will keep witnessing a considerable number of general practices closing. Neil Findlay expressed his issues around his constituency, and East Asia-Fenic has closed. There is a surgery in Trun that is closed in South Asia-Fenic, so I think that we cannot deny that there is an issue here. The solution is not an easy one, and it will take time. It is a multifaceted response that is required, including student places, especially for Scottish students, and we need to review that. A review of the GP contract, given its unpopularity in the rural GP community, we must accept that, and that has been highlighted by a number of members around the chamber, including Alex Cole-Hamilton, Miles Big and Monica Lennon. I think that technology will play an inevitable major role in the development of a solution, which is for another time. I think that the GP motion is an obvious first step in addressing the current crisis, so we will be supporting that motion. Thank you very much, Presiding Officer. I start by thanking members for the contribution of the debate, but I also particularly start with Mr Whittle for the very welcome recognition in my mind from him that there is a multifaceted issue that will require that kind of multifaceted response. I also make clear that I understand completely that there are key challenges in terms of the contract and how it is interpreted and understood, phase 1 of the contract, in addressing some of the issues that some GPs from rural practises are raising with us. I have committed—I hope that I made that clear in my opening statement—that we will look specifically at that and that is what we have asked the group chaired by Sir Lewis Ritchie to look at. I hope that we will make quick progress on some of those key issues. We will then look at phase 2 of the GP contract when we begin those negotiations informed by Sir Lewis Ritchie's working group's conclusions and those discussions with the BMA at what more we may do. Of course, that begins very shortly. I also thank Alison Johnstone not only for bringing the debate to the chamber but for raising the question of the national conversation. An issue that has been raised with me directly by the RCGP, raised with me by Emma Harper and confirmed to members that we are now actively working with the RCGP to look at how we will take that national conversation forward in order to ensure that many more of our citizens understand the positive changes that are brought by the GP contract for sure but also by the changes that we are making to primary care under reform there. In some instances, as the recent GP journal reported over a two-year period, it showed a positive increase in patient satisfaction. That is not to deny that there are areas where there are difficulties but there are areas where we are seeing the improvement of that. The national conversation should help us significantly. I do not believe that there is any basis for saying that we in government that I do not understand the challenges facing GPs and GP practice. That is not the BMA's view. While funding alone will not get us past some of those challenges or overcome the time that it takes to train and then to recruit to produce GPs, I hope that members will accept that our commitment as a Government to increase investment in primary care by £500 million over the lifetime of this Parliament will take spending in primary care to at least £1.28 billion. That is 11 per cent of the front-line NHS budget. By 2021, more than half of front-line NHS spending will be in community health service. £250 million of the £500 million that you have spoken about will be in direct support of general practice. Could I ask for some clarity about what the other £250 million will be spent on? The rest of that funding is in all those other areas of primary care that I touched on in terms of the other health care disciplines that are required to create that multidisciplinary team. The allied health professionals, the mental health services, the health visitors and district nurses and so on, all of whom combine to create the important multidisciplinary team that is a core part of primary care reform. Out of our challenges are undoubtedly there. I need to say that there is no use in any member in the chamber in rehearsing those challenges for me when I understand them very well indeed. We are trying to address those in the context of the new GP contract and what I would like to be able to do is to address those on the basis of additional ideas to the work that we are undertaking that comes forward from colleagues across this chamber. Yes, I am happy to take an intervention. No, you are just closing. No, I am not happy. Two quick points. I am grateful to Emma Harper for looking forward and I look forward to receiving the detail from the practice that she is engaged with. I think that Mark Ruskell made a very strong point comparing Fort Valley and Fife and I want to say to him that I will look further at this and that the recent review of integration authorities commits us and COSLA in the next 12 months to actively work to improve consistency. Yes, there are challenges, but we have made significant progress. We have made progress in the commitment that we have made to increase GP numbers by 800. I hope that members would recognise that. There are issues for us to address in some of our GP practices in remote and rural areas, but the principle and the contract of addressing workload is the right one. However, it is clear that no services should transfer out of a GP practice unless it is safe to do so, and that the locality decisions are the most important decisions. Thank you. I will now call Nalison Johnson to wind up the debate for six minutes, please. Thank you, Presiding Officer. I would like to thank all members for their contributions to today's debate. I would also like to thank the RCGP and the BMA for those briefings, and to those GPs from across Scotland who have contacted me after learning of this debate this afternoon. The cabinet secretary has confirmed that she understands the issues and has spoken about us rehearsing those issues in this chamber, but it is important that GPs know that this Parliament is listening to them. Mr Finlay, your microphone is not on. To raise the point that I was going to give to the minister, does Alison Johnstone agree that it is a duty of members of this Parliament to raise those issues time and time again, whether the minister likes it or not? I agree wholeheartedly that that is our duty. Monica Lennon and Miles Briggs raised concerns regarding the impact of the contract on particular GP groups as did Emma Harper, and I think that their engagement and action on behalf of GPs is clearly welcome. Annie Wells spoke of the role of the GP as a gatekeeper, and Neil Finlay spoke about the knock-on impact that having insufficient numbers of GPs has across the NHS. He spoke of the many closures within the region of Lothian that he and I represent, but that is clearly a Scotland-wide issue. It is fair to say that Richard Lyle simply left us in no doubt at all that he is a loyal member of the governing party. I do not want to waste time here, but Emma Harper and Brian Whittle are becoming known as the A75 appreciation society in this chamber. I really do thank you all for your contributions. My colleague Ross Greer, in his region, Bargeron medical practice in Erskine, was left with no permanent GPs after the lead doctor resigned, because recruitment issues had made his position unsustainable. He was the fourth GP to quit the practice in 18 months. We have heard about cases like this across Scotland in the chamber today. The number of GP practices in Scotland has decreased by 8 per cent since 2008, and we all know the impact that this is having on patients. Will your departing GP be replaced? Who will you be seen by the next time you make an appointment? Will that practice have to close together? Has it already closed? The RCGB tells us that patients who receive continuity of care in general practice have better health outcomes, higher satisfaction rates and the health care that they receive is more cost-effective because they have built a trusted relationship. They acknowledge that new methods of working, including multidisciplinary teams, are part of the solution for falling levels of continuity for those who need it most, but they need successful implementation, as well as significant investment to produce more GPs. The expansion of the multidisciplinary team is welcome, but it is vital that GPs are available to work alongside other health practitioners. That is the holistic person-centred care that Scotland's people deserve. We have heard about the concerns of rural GPs with regard to the contract. The rural GP association believes that it fails to take into account the workload and services provided in the rural setting. In a survey, 82 per cent believed that the outlook for rural health care was worse under the contract. A third of its members reported that they were anticipating that services would need to be curtailed. There have also been concerns raised in the media about the change in the way that vaccinations are delivered in rural areas. It might lead to a fall in immunisation as patients have to make longer journeys to attend special clinics rather than local surgery. There is the epitome of the fragmentation of care that might occur. Those practices clearly operate differently from those in urban centres, but I appreciate that the cabinet secretary has said that she is in talks with the BMA about how to take account of those concerns in phase 2 of the contract, but 98 per cent of Scotland is considered rural and a fifth of its population lives in a rural area, so that is urgent. As I have previously discussed in the chamber, there was one fierce competition for every GP position, several applicants for each post, but now it is the case that there are practices with no permanent GPs and increased GP training places are not being filled as we need them to be, so we need to make general practice in Scotland an attractive career that appeals to people and one to which GPs who have taken career breaks will return. The health and care experience survey that I mentioned earlier reported that 83 per cent of people rated the overall care provided by their GP practice positively. The service provided in our GP practices remains outstanding, and I am sure that we have no doubt at all that this is down to the efforts of our fantastic practice teams. We should take every effort to promote the fact that general practice in Scotland is a challenging, competitive, worthwhile, rewarding career that will offer the opportunity to deliver excellence every day, but we live in a modern world. People desire more flexibility in their working patterns, and general practice is not immune to that, and there are an increasing number of GPs who are not working full weeks. Practices have worked on a small business model since the 60s, and that might be the preference of many GPs because more and more do not want to be partners, so new ways of working could make being a GP a more attractive career to a greater number of people, so we should take care to promote the many different forms that working in general practice can take. In closing, working with and listening to Scotland's health professionals will enable us to develop and deliver a healthcare model that will better support those working in the NHS, helping them to keep our growing and ageing population well. We need to listen to GPs when they tell us what will improve conditions and patient care. The need for 11 per cent, at least, if NHS funding, is a whole-time equivalent of GPs. In the sufficient numbers, targeted funding and a national conversation are all calls coming from the front line, and I sincerely hope that the cabinet secretary will heed those messages and implement a review of GP recruitment, resources and funding as soon as possible. That concludes the debate on addressing Scotland's GP recruitment and retention challenges. It is time to move on to the next item of business, and while everyone is quickly shifting their seats, I say that, by the time we are settled, there is absolutely no time at all to spare in the next debate, and I may even have to cut time off some of the open debate speeches.