 I encourage those members leaving the chamber to do so as quickly, as quietly as possible, and I encourage members in the public gallery to leave again quickly and quietly as possible, and as we move on to the next item. There will be a member's business debate on motions 129 for the name of Douglas Ross on SAVAR's surgeries, Muradinbestarys i hyn my чего, and books women to go off in sales syrup. The debate will be concluded without any questions being put. Rwyf ni'n meddwl i'n gwych ar yr hollwch gyda'r gweithio uchau i Hollyrute. Felly, rwy'n meddwl i'n meddwl i'r ddenislaith, Rona Grant, Nes Tuggl, Heso Grant, ac Liz Macnocter, ar y cwrthogau ysgolwch, i'n meddwl i'r gweithio i'r gweithio ar y cyfaint. Rwy'n meddwl i'n meddwl i'n meddwl i'r ddunkan Abbey, ar yr cwrthogau ysgolwch, ond mae hyn yn ei gael iawn. Felly mae'n ardu allan oherwydd oherwydd, mae chi'n gael iawn y gael iawn, fyddwch mwyn ac yn cewdd eu gwentiau, a hetfawr i chi i'r ddeichas gyf Ừ Iawn i'r ddechrau Sfoddolol. Felly byddai rŵn oedd ei bobl aqurion i chi i chi i gael iawn, a phethau i chi i gael iawn ac i chi i chi i chi i chi i chi i chi i chi i chi i chi i chi i gael iawn. Mae angen efo o'r gael iawn, dechrau'u gael iawn a bandangol, Those surgeries serve the communities of Duffas, Cummingsdyn, Rosile and the Outlying Rural Areas as well. So today the campaigners are not just representing Hopeman nice and Burghead, and those other villages, but 1,500 people who signed the petition to reinstate these vital GP practices. Their voice is now being heard in the Scottish Parliament, but it has taken us too long to get to this stage. yn gweld i'r rhaid o'r erdwag penedig y byddai'r campuennu? Ond rydw i'n gofio bod ar y dyfodol ystod yn mwy o'r respond commanderau a fyddai'r Gymdeithasol Cymru yn nhw anhil drwng mwy o'r ffeyddiaeth a gynweddig i gydig i gydigol yn ei gynwedd gyda'r gwybod hynny. Byddai'n gydig i chi i gydig o'r mwy o'r arbu yma felly i archifredinu ei gael argyfrifoedd pwrdd nesaf. Maen nhw'n gweithio yng Nghymru, ond wrth yng nghymru, nid nhw'n angen i'r ddeudio i'r Ffalt. Ond wrth yng Nghymru, o'r 14 wrth yng nghymru, ar y brwysau ar yng Nghymru, mae gennym ni'n meddwl o'r regulatiad Covid. Ond mae gennym ni'n meddwl o'r pryd o'r pryd o'r pryd o'r Llywodraeth Llywodraeth i'r newid. March 2020, now here we are, March 2024, those surgeries never opened their doors again. Indeed, the Hoatman premises has now been sold and the Berghead one, the lease, has been handed back. Berghead in particular, we have a local family so determined to continue with the presence in the village there that they offered to work with the health board, with health and social care money to offer that property, to put in the improvements needed, but that was rejected. That offer still stands today. They have offered the first year free of rent if the health board would go back to Berghead. But since then, that temporary closure has continued and we know there has been so much work done by the saver surgeries group and campaigners throughout that time. However, where the frustrations really come alive is the lack of any tangible, significant and realistic engagement with the health board and health and social care money. It is almost shocking to have to remind the chamber that a consultation was done, but it was a sham. It was a consultation in name only, a tick box exercise. How else can you describe the outcome when 85 per cent of residents who responded to that were against the closures that those surgeries are still shut? When 100 per cent of the people at the public engagement events said they wanted the facilities to remain open in Hoatman and Berghead and they remained closed, then it was nothing more than a tick box exercise. At a cost of more than £11,000, it is so frustrating that the voice that is so articulately making the case for those surgeries to be retained has been ignored in this way. It is also important and the campaigners have been very clear that, while this is a local issue in Murray and my motion refers to the Highlands and Islands, I know that there are members across the country who are feeling the same impact with local services in their own area. That is an issue that deserves to be addressed here in Parliament because the closures of local GP surgeries have an impact on national policies set by the Scottish Government. I will give way to a couple of members in a moment and I want to come on to how the closure of those local facilities hampers what the Scottish Government is trying to do with their national policies, but I will give way to Richard Lochhead. I thank Douglas Ross for giving way and congratulate him on securing this important debate. I also join Payne Tribute to save our surgeries campaign, who are here today for promoting the interests of their communities. I concur with the member's concerns as expressed in his opening remarks. Does he agree with me that it is really important, given that new GPs will be coming into the workforce in the near future, that NHS Education Scotland will work closely with NHS Grampian to ensure that those new GPs are channeled towards the areas that are most in need, such as Burkhead, Hoatman and the rest of Murray? I know that if we can attract those new GPs to Murray, they will want to stay there. They will want to work in our community. They will want to work with the residents of Hoatman and Burkhead, so I fully endorse everything that Richard Lochhead has said. This has been a truly cross-party issue. There has been no party politics played here. I think that the fact that the leader of the Scottish Labour Party, the SNP health secretary, myself and others have all met with campaigners, Richard Lochhead, as well. They have worked right across the political spectrum because their case is far more important than party politics, and I think that that is credit to the saver surgeries campaigners. I will give way to Craig Hoy. Mr Ross, for giving way, is he aware that in my own region NHS borders is facing the prospect of cutting front-line budgets by 10 per cent and NHS Lothian faces £120 million black hole? As a result, Dr Joe Smail, a GP at Trenent medical practice, has written to me, warning that NHS Lothian is now set to increase facilities management charges on the practice by 600 per cent. She says that in order to cover this new cost on the practice, they will potentially have to lose around 3,200 GP appointments per year. She goes on to warn that we would no longer be able to provide primary care services for our patients and would have no other option but to hand back our contract. Does the member share my concerns that the chronic underfunding of GP services, particularly in rural and remote areas, is seriously undermining the delivery of patient care? I do agree with that. We have seen that throughout the country and it is a worrying trend that seems to be continuing. I spoke before the interventions about how the impact of local closures led to a problem with implementing national policies. We look at multidisciplinary working. That cannot happen when you close local facilities. The Scottish Government is supposed to be against a centralisation of service provisions, yet people in Holtman and Burkhead are now supposed to go to Lossymouth. I will come on to that very briefly in a moment. 20-minute neighbourhoods, that is something that the Scottish Government has promoted. That is not possible when you are closing surgeries like Burkhead and Holtman. I want to briefly finish with an excellent policy briefing that I received from Age Scotland ahead of this debate, and I am grateful to them for it. I asked for more specific Murray figures. They tell us that 44% of over 50s in Murray had to wait a week or more to access GP appointments. They have gone on to say that although Lossymouth is around a 50-minute drive each way, many older people are unable to drive or do not have access to a car from Holtman or Burkhead to Lossymouth. 21% of over 65s did not own or access a car in Murray. They go on to say that the journey by bus from Holtman and Burkhead to Lossymouth is not direct. For some, it could take four hours, round-trip four hours for potentially just a 10-minute appointment. That is the impact that it is having on local people. They also said that 44% of over 50s in Murray who had to wait a week or more to access GP appointments is almost double the national average of 23%. That is why this is having such a big impact. Finally, they say that this whole closure programme goes against Murray's own health and social care strategic delivery plan 2023 to 2025, which has a key focus on the progress of integration agenda by increasing access to community-based health and social care services. Murray's health and social care joint commissioning strategy for older people states that older people will be able to live more independently as long as possible in their own homes. They cannot do that if we are closing down local GP surgeries. I am grateful for your indulgence for allowing me a few more minutes. I reiterate my heartfelt thanks to the saver surgeries campaigners who have tirelessly put up and put forward the case for the reopening of these facilities or some kind of healthcare facility in the two villages. They have worked their socks off. We are proud of them throughout Murray for everything they have done. They are now in their Parliament here at Holyrood to hopefully get reassurance that their message is being heard at the highest possible level, but it cannot just be heard. It must be acted upon. We now move to the open debate. I call first Emma Harper to be followed by Rhoda Grant up to four minutes. I want to start by thanking all of Scotland's GPs for the invaluable work that they do to support people across Scotland with their health and wellbeing needs. I worked as a nurse for over 30 years and absolutely know how valuable and essential and important our GPs and the multidisciplinary team are who work in the GP practices. I am really sorry, Presiding Officer, that I will not be able to stay for the whole debate. I thank the PO for agreeing for me to leave as I have a long-standing meeting that I had already arranged. I also want to pay tribute to Douglas Ross, as he has done as well, to our saver surgeries group. I welcome that some of the members are here in the gallery. It is clear that saver surgeries, such as many community action groups such as Galloway community hospital action group in my own South Scotland region, are crucial in advocating for service improvements, for enhancements and advances for any healthcare delivery and that it should be delivered at a local level. No, I will not take an intervention because we have only got four minutes and I am really sorry that I have to shoot out here to meet the George Washington university students. The stats that have been described by Douglas Ross really highlight the challenges of older people in rural areas with travel, with getting to different areas. He described Lossy Mouth as a four-hour bus journey would be quite a challenge for older people. Turning to the motion from Douglas Ross and from looking into this case, I agree that Berghead and Hoatman surgeries closure had an impact on the local communities. The surgeries have been a feature of Berghead and Hoatman for many years and that was recognised by the local integration joint board, which carried out a consultation in 2022 to ensure that the voices of the community were heard. However, from my own casework, I am all too aware of how disappointing some of the approaches to IGB consultations can be so that, as this motion indicates, I can understand the concerns of the residents. I urge the IGB and NHS Grampian to ensure that the healthcare needs and indeed the voices of the people in smaller rural communities are being met appropriately. That can only be achieved through engaging with local campaigners, residents and members of the communities. I would expect that all partners work to this end. Our unfortunately challenges with the delivery of GP and associated services are not confined to the Highlands and across Dumfries and Galloway. I know that Mr Carson is sitting in the chamber because it is important for us as well in Dumfries and Galloway. It is also a very large rural region and we are hearing daily from the NHS board how they continue to struggle to recruit GPs to staff the region's rural surgeries. According to the ISD, the information service division, for which data is available, 100 per cent of GP practices in D&G are reliant upon local GPs due to recruitment challenges. However, some welcome recent improvements have been made. I am going to mention ScotGem, the Scottish Graduate Entry to Medicine programme. ScotGem offers people who are graduates in subjects such as pharmacy, nursing and science the opportunity to obtain a medical degree in a four-year graduate programme. ScotGem does have a particular focus on preparing doctors to work in rural areas of Scotland. The course launched in 2018 and, after the students' initial year of university, NHS D&G welcomed its first intake in 2019. The ScotGem programme is working well so far. The region in D&G supported 54 graduates, so that is pretty good news. The continuation of ScotGem, so I would ask that the cabinet secretary responds to tell us a little bit about the success and the commitment to continue with ScotGem so that recruitment can be made for our rural areas. I will stop there. I acknowledge the progress that has been made. Again, I apologise, Presiding Officer, that I am unable to stay. Thank you, Ms Harper. I now call Rhoda Grant to be followed by Edward Mountain in four minutes. Thank you, Presiding Officer. I also want to thank Douglas Ross for bringing this debate to the chamber and also joining him and the other speakers to commend the work of savers surgeries campaign. They fight to save their GP services within their community, which has been fantastic. They refuse to take no for an answer. I also want to thank Age Scotland for their briefing on the debate. As Douglas Ross said, those surgeries were closed, have never reopened, and now they will remain closed permanently. The branches not only cover Barchhead or Hoekman, indeed they encompass a population of around 7,000 people. Despite having no response from either the joint board or the practice or, indeed, NHS Grampian, the campaign group remained really pragmatic because they believed that there is a better local solution to be found. They have suggested nurse-led services, nurses available locally in the community for doing things such as taking bloods, physical checks and enabling older people who are not good with new technology to have video consultations with the practice at Lossymouth. However, that has fallen on deaf ears and they are being forced to travel from Barchhead and Hoekman to Lossymouth. Those are short journeys and miles, but there is no direct bus service, so patients need to travel by bus via Elgin, and that can take, as we have heard, four hours, but not only that, that is a £9 bus fare. If you cannot get a bus, you take a taxi and that is £60. That is no way for an NHS free at the point of need if people have to pay those huge amounts of money just simply to see their doctor. There is a dial bus service as well and it was suggested as an alternative, but it requires to be booked the day before, so if you are unwell, you need an emergency appointment. It is absolutely unsuitable and it does not cover the whole of the surgery time, so it may be that you could get the dial bus service to the surgery but you could not get back home again. Add to this that Age Scotland tells us that 82 per cent of older people prefer face-to-face appointments with their GP. Therefore, those changes are more likely to impact on the very vulnerable. Age Scotland also tells us that 26 per cent of those with a disability or 47 per cent of those with long-standing health conditions in Murray do not have access to a car, so they are absolutely dependent on public transport. As we have heard as well, those villages are expanding and therefore are in more need of GP services. Anywhere else would be seen as a success story because we are always talking about depopulation in rural areas. We are growing populations and we really need to preserve the services to allow people to continue living there. The whole debate speaks more widely about closures and changes to services in rural areas centralisation. It means that people just are not receiving the same level of services if they live in rural areas. There are wider issues, as others alluded to. The 2018 GP contract was supposed to make GP services sustainable going forward. They actually had the opposite impact on rural GPs and the Scottish Government can see that it has demonstrated on front of them and yet they have not acted in looking at a rural GP contract. Those do not appear to be the problems at play here but we need to find a solution for the people of Murray. I would ask the cabinet secretary, will he make sure that the IJB meets with the campaigners, something that they have been looking to do? Will he also intervene to make sure that those people have access to local GP services in one form or another? I would like to thank Douglas Ross for bringing this debate to the chamber and for the contribution from Rhoda Grant. I would not say that she has done a lot of my thunder but she is obviously very well researched on the problems of the closure of Hoekman and Berghead surgeries. I would like to welcome the campaigners to their Parliament to make their voices heard. Let me be entirely clear that every GP closure is a disaster. Every single doctor GP surgery is a failure and every GP surgery that hasn't got a succession plan is doomed. We can't afford to have this. Let's be clear, some of the figures that are open in the public domain in the last 10 years, we've seen 89 GP surgeries closed. One in 10 surgeries, GP surgeries are now run by health boards and there's been a huge increase in the use of locums. In Murray alone, I mean I know the Abelair Health Centre, which is my health centre, got to the stage where it had to be taken over by NHS Grampian because there weren't sufficient doctors there and all the patients were leaving. It still hasn't been resolved but it's a huge concern to communities. I wonder to myself why this happens. Why do we get ourselves into this situation? I think that a lot of it can be put down to the point that Rhoda Grant made about GP contracts. The 2018 GP contract that was negotiated seems to work fairly well if you're in the central belt, maybe Glasgow and Edinburgh, but doesn't work for rural GPs, doesn't work for rural practices. If it did work for rural practices, we would see more GPs in these rural practices. What we know it hasn't done is it hasn't delivered the extra staff that was promised as part of it. We've also seen NHS boards removing vaccinations from local GP surgeries, something that GPs across the Highlands were against and we've seen them also removing secondary care from GPs, undermining GP practices, which frankly we can't do. I mean we've just seen and I'm delighted to say that I'm working with Mr Ewing and Rhoda Grant on the issues faced by grant and medical practice who've had funding removed from the building project that they've been promised and was almost completed. Frankly, that is a disaster for the local community and I have to say that in the five days that the petition's been open, I've never seen such a flurry of people trying to sign it and they can't all sign it online and there's paper applications to join it but I think there's well over 500 people signed up in the first five days. That's how important GP surgeries are so I trust that we will get a chance to discuss that in time but we need a review. We need a review of the mechanism of how we run our GP surgeries and we need a review of the GP contract. The problem is that when the government negotiated the GP contract there is no review process within that so it looks like we're going to lurch on and on and on with declining GP numbers and contracts that don't work across rural Scotland. That to me is a huge mistake so my plea today and I'm delighted to be part of this debate on a wider scale across Scotland, let's review the GP contract, let's get a new workforce plan out, let's deliver to the GPs the extra workforce that we promised, let's stop removing the very sensible additional services that they provide and then we wouldn't be faced with the disasters that the closure of GP practices like Hopehead and Burgwyn of course. Thank you very much. I now call the final speaker in the open day, Fergus Ewing, around four minutes, Mr Ewing. Yes ma'e, I congratulate Mr Ross for bringing this debate forward on the essential spirit in which everybody has participated. I used to with my late wife Margaret to live in Lossy Mouth just along the road from Burghead and Hopeman and nearly visited the Burghead surgery many many years ago when I was dive bombed by a seagull who managed to make contact with my ear in the breeding grounds just beyond Burghead which I'm sure our visitors will be aware of but seriously if Margaret had been here she would have been campaigning alongside people in all other parties as she did with the mum campaign and others over her 19 years as the parliamentary representative. Presiding Officer, the motion and Mr Ross did refer beyond Burghead and Hopeman to the wider highlands and the motion refers to serving local communities so I hope it's an order for me to to refer to the campaign currently being mounted on a cross-party basis by myself, by Edmonton, by Rhoda Grant, all of whom are here to persuade the cabinet secretary for health to overturn the decision to halt the refurbishment of the Granton health centre, a project which we understand from our conference call with NHS Highland this morning was substantially completed. £2.4 million, £2 million of the work had been done and it was cancelled because of £400,000. Now we've been besieged with letters locally all making the same point that people can understand the cancellation of projects that haven't started, a motive though that is. I mean many many excellent campaigns the Belfort for example but for a project that's nearly completed it makes no sense because it'll end up costing an awful lot more and my specific plea without laboring all this is that the meeting I requested last Friday take place very soon if possible next week or thereafter I know it's the recess coming up soon and the reason for that cabinet secretary is that Morrison's the contractors are still on site they're champing at the bit to complete the contract but if we don't sort this out quickly they will have to remove their two ported cabinets from the site they will incur further abortive costs and the abortive costs will which we will intimate to the cabinet secretary will mount and exceed the notional capital savings which is £400,000. I think ways could always be found in government I know they can to sort this out so I wanted to make that plea and just the other brief point I'd make is to back up really what Mr Mountain says about the GP contract and it wasn't popular in the Highlands it was a metropolitan concoction really and in particular recently Dr Adrian Baker from the Nairn GP practice has been arguing in fact for the last three years with successive health secretaries I may say to restore the right for GPs who wish to do so to provide various services which the GP contract is taking away from them including vaccination and in the case of vaccination my understanding is that the NH Highlands own internal report found that moving the service back to GPs would not only secure the greater number of people having vaccinations and protection particularly against measles where the centralised provision is resulting in a dangerously low level of cover so moving it back to GPs would be better for the patient but it would also save several million pounds several million pounds now I'll deal with the cabinet secretary if he grants GPs the right to restore their vaccination services and thereby taking up my vice he's saved several million pounds I'm happy with that as long as he makes the modest contribution of 400,000 pounds towards the grant and health centre thank you Mr Ewing I now call on the cabinet secretary to respond to the debate cabinet secretary around seven minutes thank you very much indeed Presiding Officer first of all can I thank and congratulate Douglas Ross on on bringing this debate today and like him and everybody else that spoke spoken welcome to save our surgeries campaigners to our national parliament today looking forward to meeting with us with them after this session because I recognise as Douglas Ross and others have the very doubty campaigning efforts that they have undertaken the fact that they are here today as a testament to that campaigning effort in spite of the situation that the the branch surgeries are in Douglas Ross rightly outlined the fact that one facility has closed one the leases has expired but I think that the very helpful suggestions that were made by Douglas Ross and indeed by Rhoda Grant which so spoke of pragmatism I think is something that something I'll return to but I think is is very welcome I want to respond if I can to the points that have been made and what I think is very fair debate the fair point raised by Douglas Ross around the wider area being served by Burkhead and Hopeman and the situation that will be faced not just by the residents of those villages but by the wider area as well I also recognise the offer that has been suggested through Douglas Ross that is available in terms of a property and doing so free of rent for a period on the consultation point that Douglas Ross Ross raised he will be aware that my predecessor Michael Matheson obviously instructed a review by Evan Beswick from Argyll and Bute health and social care partnership that report is imminent I understand that the campaigners may well have seen an early draft of that which I understand they feel to be fair I would expect NHS Crampian the health and social care partnership to take due cognisance of what is in that report and to respond accordingly I also think Richard Lochhead makes a helpful suggestion as well regarding new GPs there's been some commentary in this debate around where we are with GP numbers we've got 1200 new GPs in training which is a positive move forward we've seen an increase in GP numbers since we announced the position to which to see it 800 from 2017 going forward we're not exactly where we want to be but we're making progress and I think the suggestion that Richard Lochhead makes and the evangelical advocacy that I would expect of Richard Lochhead and Douglas Ross around the beauty of Murray and the reason that you'd wished to locate yourself there that we can see what is possible with regards to some of those GPs coming through also very helpful briefing a very grateful for the briefing that came from Age Scotland that was referenced by colleagues across the chamber as someone who grew up in a rural island community I more than recognise the challenges of access to public services healthcare services in particular and I will do in just a second and indeed the expectation that there is amongst residents that you have to travel some distance in order to access some of those services because by their nature you can't safely deliver all of it in those areas however I think that their point around and the point that's been raised today around the need to make sure and I concur with it that we see services being provided as effectively and as locally as possible is absolutely one that I concur with I'll give way first to Finlay Carson and I'll come back to Finlay Carson Richard Lochhead very much appreciate the treatment intervention I think there's a theme coming out here you know I heard Emma Harper talk about action groups trying to enhance services but that's not what it's really about it's about saving services whether it's GP services whether it's maternity services whether it's saver cottage hospitals there's a complete crisis in rural Scotland and a lack of delivering services close to home as possible as you would wish to see but is this not a time to to review the NRAC formula because it certainly doesn't seem to be working I know you've given us assurance it that we take place but can you accelerate that process to make sure that rural health boards get the funding that they need comments to the chair cabinet secretary thank you president officer I think Finlay Carson makes a fair point about ensuring that we continue to see services being provided as locally as possible in terms of GP provision and I pay tribute to general practice managers, GPs themselves, those in the multi-disciplinary teams that serve our constituents incredibly well whether they're in rural and island communities or indeed in urban Scotland and I point Finlay Carson to the remote and rural GP working group that was chaired by Professor Salewis Ritchie in response to the concerns about rural GPs of the 2018 contract we're still one of the recommendations there was around establishing a centre of excellence for more than rural health care and following the business case development that national centre for remote and rural health care was launched in October has been delivered by Nez and the Scottish government is providing funding of £3 million in 2026 but I take the point it's something that I'll go away and look at and come back to Finlay Carson I'll give way to Richard Lochhead Richard Lochhead can I thank the cabinet secretary for giving way in his constructive response to the debate so far he may be aware that Glasgow school of art have a campus in my constituency of Murray and that hosts the rural centre of excellence for digital health and care innovation and that my instigation they've been discussing with the Murray health and social care partnership the possibility of a project to look at innovation and the delivery of rural health services using Murray as a pilot as being prompted by what's happening in Burkhead and hopefully in that area I understand they're looking for around £30,000 to take this forward there may be some question marks over how that's going to be funded I wonder if the cabinet secretary could look into how that could be funded because the whole of rural Scotland would benefit from the outcome of that research project cabinet secretary can give the time back for that thank you for that officer I thank Richard Lochhead for his intervention and for pointing out the situation that's being faced there I'm conscious that Jenny Minto has met on this I'm happy to take away in concert with Ms Minto Richard Lochhead's ask and see if anything can be done in order to see that continued because this is obviously an opportunity for us to learn more and to be able to see what can be done in rural communities and I go back to the briefing from Age Scotland because I recognise the point made by them in terms of access to public transport access to a vehicle and the statistics that Douglas Ross pointed to in terms of car use in that particular part of Murray and how that increases the challenge when we see facilities such as those in Hopeman and Burkhead close and that makes it a particular challenge in this part of Murray due to the public transport link so while Rhoda Grant rightly points to the dialabus option that is not suitable for same-day appointments so I think again this is why I think Evan Beswick's work is going to be really important and why I would encourage the health and social care partnership in NHS Grampian to engage with that engage with the campaigners around any practical suggestions that there may be for how that can be overcome if I've got time present obviously I'll give way to Douglas Ross. Douglas Ross. I'm grateful to the cabinet secretary for allowing the intervention and I think there will be great comfort taken by campaigners and people in the area with the approach that the cabinet secretary has taken to this and that encouragement would go even further if he will look to use his influences cabinet secretary for health to accept these are local decisions that will be taken by NHS Grampian in health and social care Murray but with the cabinet secretary stressing the importance of facilities in these villages that will make a big impact to the campaigners on what they are seeking to do and they're also not looking for all singing all dancing GP practices to be reopened great though that would be and I would absolutely support it there are other opportunities to have some healthcare facilities in either or both of Burghead and Hopeman that doesn't need to be a full replacement service that could make a big impact to local people in the villages cabinet secretary I think that's a helpful suggestion and one that's characteristic of the way that Douglas Ross opened this debate which was fair and pragmatic I'm happy to take that consideration away and I think working with NHS Grampian health and social care partnership because this is a local decision and there are practical issues that need to be overcome in terms of who runs these facilities how it is staffed if that is something that could be got to so I can't make any promises to Douglas Ross or indeed to the campaigners I wouldn't wish to do so but I think a consideration where there is a suggestion where there are a practical areas of change that can be brought forward to benefit those communities recognizing the demographic and geographical challenges then I think they should at least be considered and they should be considered in consort with those local communities so in closing president officer I wish to thank everybody who's participated in this debate to Douglas Ross again for bringing it forward and in particular to the local campaigners who have ensured that Scotland's national parliament is considering an issue that is being faced by colleagues across Scotland to differing extremes it's an issue in terms of branch surgery closures that I have faced with in my constituency as well their doubty campaigning means that we've had it under consideration today they were going to have a further conversation shortly and while I can make no promises about what the future holds I hope that at least they will feel that their voice has been heard today and going forward thank you thank you very much cabinet secretary that concludes the debate and I suspend this meeting of parliament until 2 15