 The next item of business today is a member's business debate on motion number 10122, in the name of Alison McInnes, on your GP cares campaign. This debate will be concluded without any questions being put, and I would be grateful if those members who wish to speak in the debate could press the request to speak buttons as soon as possible. I call on Alison McInnes to open the debate maximum of seven minutes, Ms McInnes. I would like to start by thanking those MSPs who supported my motion and enabled it to be debated today. The British Medical Association's Your GP cares campaign emphasises that general practice is the cornerstone of the NHS and at the heart of every community. From professionals covering vast remote areas to large city practices, the service that GPs and primary healthcare teams provide is appreciated, the length and breadth of the country and admired across this chamber. A mid a wealth of specialisms and the involvement of departments across the health service and beyond, they are often the only constant during a patient's care, identifying symptoms, assessing needs, signposting to other services and co-ordinating a joined-up approach to patient's care. This continuity means that GPs are capable of developing the most acute understanding of individuals' overall health. Providing over 24 million consultations each year, they are integral to improving Scotland's health and wellbeing, and they are integral to the objective to shift the balance of treatment and care from hospitals towards primary settings. The Your GP cares campaign highlights the need for this patient's shift to be accompanied by an appropriate resource transfer, investment in primary care team personnel and practice infrastructure, and it draws our attention to the challenges posed by the changing needs of patients. In the gallery today is Dr Allan McDevitt, chairman of the BMA's Scottish GP committee, and he tells us that there are more patients to see, more test results to read and more paperwork, yet there are still the same number of hours in the day and many GP surgeries are simply overwhelmed. ISD Scotland data shows the number of patient contacts with GPs and practice nurses has increased by 10 per cent during the last decade, 12 per cent of registered patients now visit their local practice 10 or more times a year. The intense workload can in part be attributed to our growing, ageing population and the need to support people living longer with complex, chronic or multiple health conditions. Long-term conditions already account for the majority of consultations, but the prevalence of conditions such as dementia will soar as the number of people aged over 75 doubles during the next 20 years. The demands upon general practice are particularly acute in my own north-east region, and there is real concern that it is affecting GP's ability to best care for their patients. Official statistics show that six of the biggest 20 practices in Scotland by patient list size are in the north-east. Many serve areas with burgeoning populations, two possess more than 20,000 patients. Facilities are already creaking, and yet the third national planning framework published this week reminds us that the north-east population will grow by 23 per cent by 2035. A question mark still hangs over the provision of a medical centre for the new town of Chapleton, a development providing up to 8,000 homes. That has caused my constituents to fear in the nearby portlet and medical centre, already one of the busiest in the country, that it could soon be overwhelmed. Elsewhere, staff at Ellen health centre are striving to provide for a growing community. However, they are hampered by premises that are no longer fit for purpose, built when the town was a fraction of its cunt size. NHS Grampain says that it will be some years before it is replaced. Such situations are common across Scotland. Scottish Liberal Democrats believe that communities know best how to run locally responsive services, and it would be remiss of me not to note that the Scottish Government sees control of health boards' capital budgets. Stripped of powers to tackle infrastructure problems as they see fit, this year, NHS Grampain will receive less than 2 per cent of the non-formula capital spend for specific projects. The Cabinet Secretary for Health and Sport confirmed to my colleague Jim Hume that the proportion of NHS budget spent on primary medical services has fallen under this Government. Peeking at 9.1 per cent under the Liberal Democrat Labour Administration, spending has since fallen to 7.5 per cent this year. Now, general practice is the gateway to the wider NHS. Clinical decisions made here commit more than half of total NHS expenditure. The Scottish Government must therefore ensure that it is sufficiently resourced to take the right decisions, and it must ensure opportunities to build relationships with patients, understand the needs and effectively communicate what is happening. This must be enhanced, not diminished, as care shifts from acute to primary settings. Indeed, GPs' workloads have already soared as the profession struggles to attract and retain talent. Young doctors appear to be pursuing other specialisms. In Aberdeenshire CHPs, the number working part-time has increased by 9 per cent in the last five years alone. Worryingly, with more than a third of staff in their 50s, I am told early retirements are up, others are emigrating in search of a better work-life balance. The Scotsman reports this morning that more than 30 practices across Scotland are operating on an open but full policy, only accepting registrations on a limited basis. Dr McDevitt tells us that many would not be able to take on a new doctor even if they wanted to. The Scottish Government must therefore intensify its efforts to attract and retain GPs and reverse the losses experienced during the last three years. In closing, we cannot expect GPs and practice staff to spend more time with patients and provide more appropriate care closer to home without sufficient resources, additional staff or appropriate facilities. As the nature of primary care changes, it is imperative that health boards and GPs are capable of responding to local needs and demands. They must be empowered to provide integrated, sustainable primary healthcare services. Services rooted in communities, focused on every aspect of patients' health, deliver in a fitting environment and of the highest quality. I would be grateful if the minister could therefore tell us whether he considers the current distribution of total NHS expenditure to be appropriate. Will the minister hand back some power over capital spending, back to boards, or will he ensure a fairer allocation? I would welcome details of how he intends to attract and retain the staff that is required to deliver shared objectives, including enhancing preventative care, reducing hospital admissions and tackling the unacceptable number of delayed discharges and, indeed, integrating adult health and social care services. Thank you. We are quite tight for time today, could I ask members to keep to the four minutes, please? Malcolm Chisholm to be followed by Graham Day. I would like to congratulate Alison McInnes for bringing forward this important debate and, obviously, support the UGP Cares campaign. I think that it is running in tandem with one from the Royal College of General Practitioners called Put Patients First Back General Practice, and it was actually from members of the Royal College of General Practitioners that I learned some of the details of this at a meeting some time ago. I think that the key thing here is to look at the percentage of NHS spending going into general practice, and it is declined from somewhere over 9 per cent a decade to go to somewhere over 7 per cent now. That, of course, is at a time when the number of consultations in primary care has been going up. Again, Alison McInnes quoted a general figure of a 10 per cent increase over the same period. Much of that, of course, is from practice nurse consultations, but GP consultations have also been going significantly up. That is already happening, and, as we look to the future, the need for more work to be done in primary care will be accentuated. There is the growing elderly population. Obviously, there is a whole policy shift of the balance of care towards primary care, which has been supported by successive Governments over the last decade. Also, the issue is mentioned in the motion in relation to delivering preventative care and the integration of health and social care. Clearly, there is a big challenge for the NHS. The fundamental thing is that the proportion of resources going into primary care is going to have to shift significantly. I realise that that is not easy because we all know about the pressures on the hospital services as well, but it is quite clear that that shift has to take place. I know that the Government is beginning to engage with that. For example, when I wrote to the Cabinet Secretary for Health and Sport about that, he referred to shifting some money—£36 million—from the quality and outcomes framework into the core GP contract. I think that that is not extra money for general practice, but clearly it means that that money can be spent differently. Although I think that the quality and outcomes framework has been a generally positive development since the first GP contract 10 years ago. The other opportunity is, of course, the new GP contract, which I think is currently being negotiated in Scotland, and that presents a great opportunity to address some of those issues. I will be interested to hear what the minister says about progress on that. We have particular challenges in Edinburgh and my own constituency in relation to this. Alison McInnes referred to the burgeoning population of the north-east of Scotland, which I am pleased to hear about, but I think that the part of Scotland with the most rapidly growing population is Edinburgh. I get quite a few letters from constituents of mine who are finding it difficult to access a practice in my constituency. Obviously, in due course, they all do find somewhere. I am glad that NHS Lothian is opening up a new practice in the Leith community treatment centre, but that is not going to address the problem. The health board realises that. It has commissioned two reports, and it has said that we need 33 new GP surgeries in Lothian in the near future. Obviously, we will all be keeping a close watch on what those reports recommend. I hope that they come up with proposals very soon. It is not just the actual number of practices, but the quality of practices. Almost a third of existing GP buildings in Lothian need extending or modernising. I am told by my own GP, who is absolutely superb, that her practice, my practice, is actually atop of the list for that modernisation work. Obviously, I have a close personal interest in that, which I should declare. We also have the more general issues about the difficulty of recruiting GPs, the time lag for training, so there are many challenges here. Clearly, there has to be a priority for the Government to address those major issues. Many thanks. I call Graeme Dey to be followed by Nanette Milne. I begin by congratulating Alison McInnes for bringing this matter here for debate. The BMA Scotland campaign, your GP cares, highlights a number of important issues, although perhaps one has shone a light on that it perhaps has not intended to. The future delivery of services in our communities, especially rural communities, is worthy of consideration right now, not least of all because beyond any doubt, fractures have developed in the relationship between the general public and general practitioners. The principal cause of that, if my mailbag is anything to go by, is the difficulty people encounter when seeking to secure surgery-based appointments, let alone getting home visits. Now, having spent half a day shadowing a busy GP's practice in Canustia last year, I am not without sympathy for some of the challenges faced by those charged with delivering the services. There is unquestionably an issue over attracting locums and indeed the next generation of GPs. Demand for appointments in Canustia itself is 50 per cent higher than the national average. Ironically, up and coming GPs encounter a greatly reduced workload in surgeries based on some deprived city areas, compared to more affluent rural parts such as Angus, and that draws many to the conurbations. The likes of Canustia and nearby Moni Fife also have a growing ageing population, with the service demand that presents. Although NHS Tayside responded to this with a pilot project over the winter months, which aimed to assist in dealing with the dementia sufferers and prevent avoidable hospital admissions, and which was so successful as to be extended, those issues will not go away. Of course, there is the bane of any GP practices' lives—the patients who want a doctor to remove a splinter from their finger or to provide antibiotics for a cold, or who insist upon seeing a specific GP. It is, however, worth noting, that GP numbers in Scotland have actually gone up 5.7 per cent under this Government, and that the sum invested in primary care services in 2012-13 was 10 per cent more than in 2006. In the interests of balance, it must be said that, whilst additional resources, if available or practically redeployable, could alleviate and would alleviate the situation, so, too, would doctors working the kind of hours the world that wider public do. I met with a GP practice partner recently after they contacted me over the campaign. They pointed out that the levels of depression, stress and divorce alcoholism within the medical profession and told me that if we politicians would answer one plea from medics, it would be not to ask more of GPs because, as a profession, they simply cannot cope and would be put in a position where mistakes would be made. Yet they readily acknowledged that their present contracted working week consisted of just eight conical sessions with a further session set aside for paperwork. The general practitioners play a vital role in the health service, acting as they do as gatekeepers. We would not want them being placed under such strain that they were making errors, but are we really saying that that sort of working week represents an appropriate return on what, for partners in a GP practice, is a substantial salary, especially when there is an increasing demand for access to services that somehow has to be met? There is a case to be made for redeployment of financial resources as more services are delivered in our communities, but there has to be given take on that because the Scottish Government cannot somehow magic up additional sums of money for GP practices. I am a little disturbed by the angle that you are taking. You must surely understand that the GP's workload is significantly more than the patient contact time. I am simply reflecting the experiences that I have had in my constituency, Presiding Officer, talking to GP's. Given what he has just said, I wonder if the member would then suggest a working week or a number of hours or how he sees GP's work in his world. I am simply making the point that there has to be compromise here if we are going to make progress on that, and we have to look at it in the round. The BMA is quite entitled to speak out on behalf of its members, but so too are the RCNs. It was interesting to note from the briefing that the RCN provided at the head of the debate that, while the number of GP visits or visits to GP practices has increased from around £21.7 million in 2003-04 to £24.2 million in 2012-13, GP consultations had seen an increase of just 3.9 per cent compared with 31 per cent for practice-employed nurses. If we consider how health-related services should be delivered locally, we need also to look at the role that is being played by other organisations. An example of that is the community drop-in service being provided by Action and Hearing in Scotland. Since the service started in Angus in 2010, the organisation has retubed 2,700 hearing aids, carried out 2,200 inventions and distributed almost 26,000 hearing aid batteries, all reducing the workload of the NHS, evidenced by reviewed figures that show that, over the past three and a half years, service users, spared having to go to Ninewells, Astrakathro, have travelled 17,000 fewer miles. As things stand, that is not matched by funding moving from the NHS to action on hearing loss, although the organisation will shortly be chopping the door of NHS Tayside. Meanwhile, one GP practice locally has, I am told, announced that it is no longer willing to dispense hearing aid batteries because staff do not have the time. There is a debate to be had on the subject, but it needs to be a balanced one, one that sees all sides willing to compromise in the interests of ensuring the needs of the patients are best met. I welcome this debate and I congratulate Alison McInnes on securing parliamentary time for it. I readily acknowledge the increasing demands on primary care at the present time, and the pressures that are causing for GPs and their practice teams, leading to difficulty in recruiting and retaining new entrants. Thanks to the BMAs, your GP cares campaign, those pressures are becoming more widely known within the Scottish community, and that is a good thing. There have been issues with primary care throughout my 11 years in the Parliament, and a decade ago I was happy to support the 2004 GP contract, which removed the 24-7 responsibility for patients from GPs, because at that time too, it was very difficult to recruit and retain younger doctors who, in growing numbers, were unwilling to accept the round-the-clock commitment of their predecessors. Over the ensuing years, there have been significant concerns, of course, about out-of-hours care provision, particularly in some of the more remote parts of Scotland, and NHS 24 took some time to settle in and be generally accepted by the public. The primary care medical workforce has become increasingly part-time, partly due to the predominance of female doctors who want a work-life balance that fits with their parenting role, but also due to an increasing number of men who combine general practice with other part-time appointments, for example in teaching or hospital work. In the meantime, patient demand has escalated, coupled with bigger list sizes, and the demographic change means that more patients are living longer with comorbidities and more complex medical conditions, and all of that at a time of financial stringency when spending has to be carefully planned and controlled. The NHS in Scotland has benefited from the UK Government's decision to protect the NHS budget and the Scottish Government's decision to ring-fence the ensuing Barnett consequentials for the Scottish health budget. My party, of course, hasn't agreed with all the Scottish Government's policy decisions on how to spend that money, for instance, on free prescriptions for higher-rate taxpayers who can afford to pay. However, we have campaigned for more investment in primary care through restoring a universal GP-attached health visitor service, and so we do very much welcome last week's announcement of 500 new health visitor posts, which I think will be of significant support to GPs, particularly in the more deprived parts of the country. Likewise, we were pleased with the recent changes to the Scottish contract, which have removed some of the bureaucratic box-sticking and allowed GPs to have a bit more face-to-face contact with their patients. However, in the face of growing pressures on the service, the Government's 2020 vision for more care to be provided in the community and the integration of health and social care, which will require to have GPs and the primary care team at its heart if it is to be successful, then I do think that there is to be a good hard look at how services will be provided in the future, with the Scottish community involved at the heart of the debate. I would endorse the BMA's concern about the need for fit for purpose primary care premises. In the north-east, we have seen a few excellent developments recently, such as the Calcesite and Woodside health centres in Aberdeen, and we look forward to the approved new health centre in Inverruri. However, there are concerns in my area, as Alison McInnes has rightly pointed out, with rapidly growing populations throughout Aberdeenshire, and new settlements being built, for example, around Port Leithan, without provision of the primary care facilities that will be needed by the increased population. There is a need to replace buildings, such as the Forrester Hill Health Centre in Aberdeen, where my husband used to work, which was state-of-the-art when it opened in 1979, but which is now well past its sell-by-date. The motion that we are discussing raises some very serious issues that cannot, I think, be dealt with adequately in such a short debate. I do think that they merit much fuller discussion in this chamber during a plenary session of the Parliament. I hope that the minister will pay heed to this, and, once again, I commend Alison McInnes for drawing the BMA's campaign to our attention. Thank you very much, Neil Findlay. I congratulate Alison McInnes on bringing this debate forward. As we heard at First Minister's question time on Monday, Brian Keithley, the well-respected out-gun chairman of the BMA Scotland, gave his farewell speech to the conference. In it, he compared the NHS to the Titanic and said that it was teetering on the brink, highlighting a whole range of issues from cancer treatment to care crisis to hospital food. He said that what I have seen over the past five years is the continuing crisis management of the longest car crash in my memory, and it is time for our politicians to face up to some very hard questions. Mr Findlay, could we relate that to your chief hope please? I am just about to, Presiding Officer. I want to put in record my thanks to Dr Keithley for both his commitment and service to the BMA, but also for his willingness to be so frank. In fact, he agrees with what we have been saying for the last two years, because it is simple, Presiding Officer. The NHS in Scotland cannot go on as it is, and the Government cannot continue to pretend that it can gloss over deep-seated problems with spin and bluster. Just one of those concerns is GP provision, because GPs are in the very front line of the system. With people living longer, with multiple complex health problems and with rising demand and expectation, the pressure on our community GP practices grows by the day in my own region. In fact, there are 26 GP practices according to NHS Lothian that have either completely or partially closed their lists. Patients cannot get access to their local doctor. We have recruitment problems, especially in rural areas, and budgets have been cut by 2 per cent, as we have heard. Of course, it is in our most deprived communities that pressures on the NHS and GP practices are at their most pressing. I met recently with some Glasgow GPs, and they were operating in one of the deep-end practices. They told me about the vast number of complex and extremely time-consuming cases that they have to deal with, and yet that practice had gone without a health visitor for over a year, and he had never met the social workers who deal with their clients. I find that astonishing and thoroughly depressing. They also raised the issue of the inverse care law, which entrenches health inequalities, given similar levels of funding to wealthy health areas, as it does to areas of deprivation and poor health. I welcome the work of the deep-end GPs and the Your GP Cares campaign, highlighting the need to develop premises, strengthen practice teams and attract new entrants. Those are vital for all of our constituents. As a counsellor, I drove through a project in my community that brought together two GP practices, sports facilities, a library, a dentist, a café, a pharmacy, and brought in job centre plus and a range of services in a new purpose-built facility. That is how I see community services developing. The GPs are now prescribed swimming or gym sessions rather than drugs that refer on to housing in the job centre and have immediate access to dental and pharmacy services. GPs work collaboratively to deliver better outcomes for patients. That is the service integration that we are seeing in West Lothian, and I commend others to follow that example. Finally, I was surprised by the inference by Graham Day that GPs are not working flexibly or appropriate numbers of hours. I would ask Mr Day to reflect on that argument. It is a bit like people observing this Parliament and saying, why do we pay those people almost £60,000 a year, yet they are only air three afternoons a week? I think that the irony of his argument has passed him by. Thank you. I now invite the minister to respond to the debate. Michael Matheson, you have up to seven minutes, please. Thank you, Presiding Officer. Like everyone in this chamber, I want to offer my congratulations to Alison McInneson for securing time for this debate. However, as we have all done so far, I recognise the fantastic job that our general practitioners do in Scotland providing a vital important service at the very heart of our vision of delivering an integrated health and social care system. In recognising the key role that GPs play in our system, it is important that we make sure that we have a processing system in place that allows them to maximise the potential that they can play in helping to shape health and social care within a community setting. However, as a number of members have recognised in their own contributions, Alison McInneson made reference to, as did Malcolm Chisholm in his own contribution, about the start challenges that we face in terms of the demographic shift that we are facing as a country by 2033. The number of people over 75 is likely to have increased by almost 60 per cent, and with age, as with poverty, there comes a higher chance of having a long-term illness and the long-term conditions that many individuals will have at that point in their life. Those are real challenges, and we need to make sure that we do the right work in order to help to support general practice and the profession within the NHS to be able to meet those challenges. I want to make some reference to some of the actions that we are taking in order to help to support our GPs in meeting those challenges. We have been working closely with the profession to modernise the GP contract and to transform our approach to the delivery of primary care. In the 2014-15 general medical services contract in Scotland, we have been negotiated and agreed with the Scottish General Practitioners Committee. It brings direct benefits to both patients and in reducing bureaucracy for GPs by reducing around 30 per cent of the cough that Malcolm Chisholm made reference to. What that does is it helps to provide greater financial stability for individual practices by transferring around £36 million, which was assigned to cough into the core contract for those GP practices, placing a greater opportunity for them to meet judgments on how that resource should be used and to provide them with greater flexibility around clinical judgments and how they can best meet the needs of their patients. The contract has also enabled each GP practice to become involved in integration planning and decision making by way of a lean GP to link with the local partnership organisations, which is a key part of the role that general practice needs to provide in going forward. Each practice as part of the contract will undertake a review of access and also participate in a programme of quality improvement. The 2014-15 contract also places greater trust on the professionalism of GPs. I believe that it gives us a good platform for some of the further development work that needs to take place in order to find and create a sustainable general practice provision in Scotland. Overall, this Government's ambition with the GP contract is one that will enable GPs to get the time to do what they really want to do and to work with individuals to ensure that their medical care is right for them, their families, their carers and within their local environment. Malcolm Chisholm, Mr Chisholm, could you move your microphone? The contract has actually been finalised. He talked about the 2014-15 contract. I wonder whether there are still negotiations or is that it now for the first able future? Minister, I hope that you caught that. We have agreed for the 2014-15 contract the issues about building and going forward and how we can make sure that the contract moving forward is one that we can shape the reflex, the needs for general practice in Scotland going forward. We will do that with the Scottish General Practice Committee in order to develop that to make sure that it reflects the values that we have and to tackle issues such as recruitment and retention, as was highlighted by Alison McInneson and Annette Millan in their own contributions. There is also a range of work that can take place out with the contract in order to modernise general practice. It should be recognised that there is a tremendous amount of very innovative and improvement exercises that have already been undertaken at a local level. We are working with a number of practices to understand what works and how it works. We have also provided £1 million this year to the primary care modernisation programme in order to look at how we can make sure that we build on areas in which good practice has been identified. The first stage of that involves a programme with the strategic assessment of primary care by each of our health boards, which should be conducted at a local level and should form part of their local planning process for 2014-15. We are also co-finding a programme of work that has been led by NHS Highland in order to develop and test models for healthcare delivery, which is sustainable within remote and rural areas. There are some £1.5 million in order to allow them to test out different models of how we can meet the challenge of recruitment and retention, particularly in rural areas, and the model of care that can best meet the needs of those local communities. I turn to the point that Alison McInnes made and was also referred to by the net mill and around the planning of housing developments in local areas. The pressure that can then place on local service delivery. Health boards are key participants in the development of local development plans. That is to allow for the planning of sufficient healthcare provision in relation to any local development plan that has been taken forward by a local authority. Scottish planning policy makes it clear that local authorities must take account of the availability of public services and infrastructure when assessing sites for new housing developments, including areas such as primary healthcare provision. Those must be seen as being part of the core purpose of carrying out that local assessment process. I will give way to the net mill. The net mill will briefly please the minister in his final minute. Thank you for taking the intervention. Would the minister accept that there is a time lag between the developments that we are currently faced with and the projected medical facilities some years down the line? There is going to be a significant gap in the middle, which is what I was worrying about with Alison McInnes and myself. That is why that has got to be a key part of local authorities and their local planning process, which goes years ahead. That is why it is in the planning policy in order to make sure that that should be happening effectively. If local authorities are not doing that, then from what Alison McInnes appears to be suggesting from a sedentary position, is the case that that is a matter that has to be pursued vigorously with a local authority to ensure that it is part of their local development plan and that it has been taken account of. I recognise some of the specific pressures that are being experienced. I am conscious that the Presiding Officer is keen for this debate to finish on time. I say that there are a range of other areas that we are taking forward work and providing resource support to general practice in Scotland. I hope that the Presiding Officer has set out today some of the challenges that we as a Government are seeking to take forward as part of our delivery of the 2020 vision for health and social care. Members can be assured that we see general practice as being key to delivering the best quality of healthcare that we can for individuals at a local level. We will continue to work with partners in the BMA and within the healthcare sector overall to make sure that we continue to deliver that in the years to come. That concludes Alison McInnes' debate on the GP care campaign. I now suspend this meeting of Parliament until 2.30pm.