 The next item of business is a member's business debate on motion 7505 in the name of Jamie Greene on GP recruitment in West Kilbride and across Scotland. This debate will be concluded without any questions being put. I could ask those members who wish to speak in the debate to press the request-to-speak buttons now. I call on Jamie Greene to open the debate seven minutes or thereabouts, Mr Greene. First of all, I thank MSPs from across the chamber for supporting my motion, thus enabling today's very important debate. From the outset, I make it really clear the valued contribution that all front-line NHS staff provide in the provision of healthcare in Scotland. West Kilbride GP surgery in North Ayrshire fell into crisis recently. In March of this year, two of its GPs announced that they were leaving the practice. In August, the three remaining doctors took the sad and very regrettable decision to hand back their practice. The surgery is now under the control of the local health board and has been manned by locums. Since April this year, it has been operating on an on-the-day appointment system. These are known to be two-sea practices, as they are called in the NHS, and they are thought to cost almost twice as much to run as a general practice. In West Kilbride, adequate locum coverage is available until the end of November, but there are gaps in the December rota and to date we have no detail has been provided as to what happens next year or indeed beyond. This has left many local residents feeling understandably distressed and worried. In the departing letter to local residents, the West Kilbride GPs noted, and I would like to quote from their letter, they said, that there has not been sufficient support in the form of further doctors and due to our significant concerns over the sustainability of continuing to deliver a safe and effective service, we took the serious step of handing back our general practice contract to the health board. That same letter closed with the following quite poignant words. They said, general practice can often be more than a job. It is hard for us to be leaving the families that we have been involved in over the past years. So may I therefore pay tribute to Dr Struthers, Maxwell and Barber on behalf of the local community and thank them for their many years of service. Presiding Officer, this is a much wider problem. There is a problem across all of Scotland and no doubt we are going to hear some stories from other members about that today. We know, Presiding Officer, that 52 practices have returned their GP contracts to health boards. Since 2007, the number of patients being treated in 2C practices across Scotland has jumped from 83,000 to 160,000, a spike of over 90 per cent. Now, why is that important? The knock-on effect is that our A&E and acute services have seen huge increases in demand as people struggle to get access to a GP. The GMB union described the ambulance service as at breaking point. Before any member of the Government bench, and I note that there are few and far between today, stands up and says to the chamber that this is a problem in England and Wales too, then let me save you the bother. The provision of cradle to grave healthcare in Scotland has been devolved to this Parliament for 20 years. The SNP has been in government for 10 of those years and indeed the First Minister was in charge of health for five of those years. The situation today has been a long time coming. The statistics speak for themselves. It is a fact that general practice in Scotland receives a lowest share of NHS spend anywhere in the UK. It is a fact that more than a quarter of practices in Scotland have a GP vacancy. It is a fact that three quarters of those vacancies have been so for more than six months. 90 per cent of GPs in Scotland think that their heavy workload is having a negative effect on the quality of care that they provide and just 7 per cent think that 10-minute consultations are adequate. The Government might stand up today and mention the additional £250 million investment in general practice that it has promised, but it is vital that there is a commitment to recurring and sustained investment in primary care and indeed a measurable plan on how it will address the recruitment problem. If they do not want to listen to me, they should listen to the experts. The BMA and the RCGP have provided many MSPs with detailed and constructive recommendations, which I urge the Minister to take into account. This problem did not happen overnight. Repeated warnings from across the board all pointed to the crisis that we face today—a chronic underfunding of general practice and a training and recruitment pipeline that has not met demand. It is the perfect storm. Given that a third of GPs plan to retire within the next five years, today's crisis will be tomorrow's disaster. There is a duty on this Parliament to do more than just talk. There is a duty to act and there is a duty to listen and it is a shame that the health minister herself is not here to listen, but act we must, act we must and now we must do it. The clock is ticking, Presiding Officer. I hope that by bringing this debate to the Parliament today, the Government will focus its eyes once again on this crisis. I thank Jamie Greene for securing this debate. I expressed my concern at the way in which, for weeks, the Tories have repeated the same factually incorrect mantra about the future of West Kilbride medical practice, claiming that it is set for closure and worrying my constituents. To this day, we hear that the practice may only stay open until Christmas, which is simply not true. Undoubtedly, the practice has been through a tough year with GPs retirements and resignations, but let it be clear. At no point has NHS Ayrshire and Arn ever indicated that the surgery will close. Quite the contrary, I have always been reassured that the health board would not dream of leaving West Kilbride without a surgery and closure was and is simply not an option. Indeed, all other practice staff remain in place and the practice manager reports that patients have been very understanding of recent changes. The level of pharmacy input into practice has also been enhanced through the SNP Government's investment in primary care. I was reassured by primary care development support manager, Karen Grant, that at least two locom GPs are enjoying working at the practice so much. They hope to stay at least another six months and might become salaried. Locom staffing is not ideal for continuity of care, and work is on going to establish longer-term commitments to the practice. Ms Grant welcomes a £250 million incremental investment in primary care from the SNP Government enabling investment in multidisciplinary teams around practice, with three doctors on most days, sometimes two and today four. The West Kilbride surgery is now better staffed than for a long time. I commend practice staff for local health and social care partnership in NHS Ayrshire and Arn for their work in West Kilbride, and I thank them for their tireless efforts in utilising SNP Government initiatives such as the Scottish Rural Medicine Collaborative and attracting doctors to the practice. Those professionals must be sick of hearing that what they are doing is not good enough, regardless of what we have heard earlier this evening. At some point, the incessant stream of misinformation about the practice was so bad that several constituents asked me which surgery they should go to now that the one in West Kilbride is closed down. In late August, I felt compelled to issue letters to inform every single West Kilbride household of the real situation. That brings me to the utter hypocrisy of Tory politicians presenting themselves as knights in shining armour galloping to the rescue of patients in West Kilbride. Their party has cut Scotland's budget by 9 per cent with more to come, yet they stand up in this chamber demanding that the SNP Government does more with less. Meanwhile, their stewardship in England invites no faith in the Tory approach. In January, the British Red Cross declared that a humanitarian crisis was taking place in England's NHS, where junior doctors' strikes took place not long ago. The financial times revealed that GPs are leaving NHS England at a rate of more than 400 a month, with an estimated shortage of 12,100 by 2020. Recruitment agencies could be paid over £100 million with English NHS to find GPs to replace the 5,159 left last year, with half of those replacements being sought overseas. I wonder what impact the Tory Government thinks its isolationist Brexit rhetoric will have on attracting those doctors. Meanwhile, the SNP Government is working with Scottish health boards to train, recruit and retain GPs. At one GP per other 100 people, compared with one for every 1,380 in Tory England, 1,378 in Labour Wales and 1,436 in Northern Ireland, Scotland still has the best GP coverage per head of population in the UK by far. Measures to attract more include a £71.6 million investment in direct support of general practice, activities to attract junior doctors and qualified GPs to work in general practice, including a GP returners programme, the Scottish international medical training fellowship programme, widen access to medical education and so on. The SNP Government is committed to providing an extra £250 million annually and direct support for general practice by 2021, increasing overall primary care investment by £500 million. The GP recruitment and retention fund increases this year from £1 million to £5 million, enabling expansion and continued support to existing and new initiatives across Scotland. British Medical Association's Scottish GP committee chair Dr Alan McDevitt welcomed this as an, I quote, a very positive step in the right direction towards our shared vision of general practice. I trust that I have clarified what is really going on in West Kilbride medical practice, and I have every faith and a healthy future at West Kilbride. It was never up for closure, nor will it be. I call Miles Briggs to be followed by Alison Johnstone. Thank you, Deputy Presiding Officer. I would like to start by congratulating my colleague Jamie Greene for securing today's debate and for the good work he is doing in representing the concerns of residents in West Kilbride and about the future of their local surgery. It is entirely right that he is bringing these serious issues to our Parliament and to the attentions of ministers today. The GP recruitment crisis is one of the biggest challenges facing our NHS, and every MSP in this chamber will be acutely aware of the pressures on their local GP services in constituencies and regions across our country. As the motion correctly identifies, the Royal College of GPs Scotland warned in a submission to the Health and Sport Committee this summer that Scotland is facing a shortfall of 828 GPs across Scotland by 2021. Just this week, it has updated that figure, and that shortage is now standing at a projected 856 by 2021. RCGP was highly critical of the Scottish Government and the impression that it gave that an extra £500 million would be invested directly into GPs by 2021, when the actual real figure is half of that, with the rest being invested in primary care. It stated starkly that, if the long-standing underfunding and confusion that we are currently experiencing is to continue, we will keep witnessing a considerable number of general practices closing and transferring the running of their practices to health boards due to the insufficient resource through which it remains solvent. Patients will continue to be found queuing outside practices for the uncertain opportunity merely to register with a GP. Ministers need to heed the warnings and act urgently. Jamie Greene's motion refers to the problems in my own Lothian region, and those are significant in a part of Scotland where the population is rising fast and consequently demand for primary care services is increasing dramatically. Within NHS Lothian, over 40 per cent of GP practices are either full or not accepting new patients and are restricting registration. That is the crisis that we face, Mr Gibson, in Scotland, and something that I hope members across this chamber will start to recognise. Patients regularly contact me to explain about the difficulty in securing non-emergency GP appointments, as Jamie Greene has identified. The situation here in the capital is particularly serious. A report on the future GP provision of premises required that, over the next few years, it will be considered by the GP practice, by IJB and Edinburgh on Friday, again contained serious warnings about the pressure on local services as the capital prepares for an additional 55,000 people to live here by October 2026. Since 2009, the GP list size in Edinburgh has been growing at approximately 5,000 a year, the equivalent of a new GP practice annually. The report states that, while primary care has been very flexible in absorbing the new population, that elasticity is now exhausted in most areas of the capital. It is clear that significant investment is indeed needed in new and expanding GP practices across Edinburgh and Scotland if we are to avoid a meltdown in GP services, which would lead to additional pressures on our emergency and acute health services. The Scottish Government has known about the GP recruitment crisis and the demographic challenges that are facing many GPs for years now, and the consequence of its failure to do more in terms of the national workforce plan are a concern to all of us across Scotland. I acknowledge that the Scottish Government is taking forward a new graduate entry medical course, and I have welcomed the elements of that, especially the bonding that will hopefully make sure that students in due course who take up bursaries will in fact return to service in NHS Scotland. However, a huge concern remains for me, and this might answer the minister's point, remains the fact that a percentage of Scottish domiciled students studying clinical medicine in Scotland—those who are most likely to stay and work in our NHS after they have graduated—has now fallen sharply under this Government from two thirds in 1999 to just over half this year, because an effective cap on the number of Scots able to study medicine. To conclude, Presiding Officer, I again welcome today's debate and the opportunity to talk about this critically important subject. Scottish Conservatives will continue to press the Government and never shy of bringing these issues to our Parliament as we work to see an investment in our GP sector. I apologise to the chamber in advance, as I will have to leave before the conclusion of the debate. I thank Jamie Greene for bringing this important matter to the chamber this evening. I and my Lothian colleague Andy Wightman have been alarmed by the number of constituents contacting us because they cannot see their GP, whether they cannot register on a list or simply are unable to get an appointment. In Lothian, as Miles Briggs pointed out, like many parts of the country, constituents have been severely affected by the issue, from Musselborough in the east to Rathow in the west, and in practices at Bangham, Kirklessdon and Leithlinks, challenges have been faced. Not only have we heard when making an appointment to see a GP, I have heard from constituents who have had to queue up on certain days at certain times just for a chance to register with a GP. That is, of course, the very last thing that our GPs want. Last year, Dr Elaine McNaughton, from the Royal College of GPs, told the Health and Sport Committee that professionals, as I am quoting, have spent 10 years highlighting the retirement bulge. The Government has been too slow to listen and now the effects on patients are becoming all too clear and the effects on GPs themselves. Warringly, as today's motion notes, the Royal College of General Practitioners estimates that there could be a shortfall of 828 GPs across Scotland within the next few years. I bear in mind that the Scottish Government has taken recent action to improve access to careers in medicine, particularly the new Graduate School of Medicine, which will help to embed students within a primary care training pathway and facilitate their placements in remote and rural regions. However, I worry that some of those steps have simply come too late. I was concerned to see that the Scottish Government's health and social care workforce plans haven't yet comprehensively addressed general practice. I welcome recent action that the Government has taken to improve access to careers in medicines, but there is much more to do. I am not sure that steps taken such as the new GP training bursary have really seen a significant impact on recruitment yet. I am particularly concerned about the impact that the GP recruitment and retention crisis will have on patients living and GPs working in our most deprived areas. Analysis already shows that GPs practising in the most deprived areas of Scotland typically manage larger lists, and they have more patients with multiple health conditions, including mental health needs. However, last year, it seemed that GP practices in the most deprived areas of Scotland received £1.34 less per patient than practices in the least deprived areas. The shortage of GPs has terrible knock-on effects for the rest of our NHS services in terms of unscheduled hospital admissions and deepening health inequalities. I firmly believe that we still do not place enough real emphasis on preventative health, and anticipatory care begins in general practice. Just last month, I was able to visit the Edinburgh access practice to learn more about the fantastic outreach work that they do to treat hepatitis C. The ability to lead outreach work and tackle unmet need if we do not protect and enhance funding for general practice will be sorely diminished. I have called for fairer funding for GPs in deprived areas. I fully agree that GPs across the country are stretched and stressed. The demands of working with elderly populations are very high. Working in remote and rural areas is challenging, too. However, our young people in the most deprived areas of Scotland must not lose out, as a result of long-term consequences. Ensuring that GP funding reflects the need to tackle health inequalities and ring fencing some of that funding for practice development would go a long way to redressing this historical imbalance. Initiatives such as the Governship project show what can be achieved with a little additional support and funding to give patients with complex needs longer appointment times. I believe that the way of working might have cross-party support. We must work smartly to make our GP workloads sustainable. We must do all that we can to attract, retain and recruit GPs. Scotland badly needs them. Thank you very much. I call Colin Smyth. We are followed by Tavish Scott, Mr Smyth. Thank you to Jamie Greenefri's motion, which has provided the opportunity to debate the GP crisis in Asia, but also across Scotland. GP practices are not only at the heart of our NHS, but at the heart of our local communities. As many as 90 per cent of patient interactions are with primary care, and for many GPs are that vital first point of contact in our healthcare system, but a decade of cuts to the share of NHS spending being made for GP services and to training places by the Scottish Government has left that point of contact at breaking point in far too many of our communities. It is estimated that there are currently 171 GP vacancies in Scotland, 73 per cent of which have been open for more than six months. Right now, a practice has been forced to close almost every month, and a total of 14 practices have closed since 2016. In many communities, the situation is stark. Jamie Greenefri rightly highlighted the particular problems that are facing North Ayrshire and NHS Lothian. In my own home region of Dumfries and Galloway, the number of GPs has fallen from 134 in 2012 to 118 in 2016. Villages such as Warnlockhead have lost their outreach surgery because of a shortage of GPs in the Moffitt area that provided that service. Admissions to Thornhill hospital were closed because the local GP practice that provides the cover at the hospital could not fill vacancies in their practice. It is not alone. Forty-two per cent of practices in the region have a vacancy, 16 posts largely unfilled for six months. NHS Dumfries and Galloway has already had to take over the running of two GP practices with that number set to rise. The reality is that the problem is set to get worse. 26 GPs in Dumfries and Galloway were aged over 55 and therefore are likely to retire within the next five years. As a result of Brexit, the number of applications for health posts in the region from the EU has all but dried up. It is frankly a ticking time bomb, a crisis that is happening on the watch of this Government, but a crisis that the Government should have seen coming. In 2008, Audit Scotland called on the Scottish Government to collect comprehensive data on GP and GP practice staff numbers to support proper workforce planning. In 2014, the Royal College of GPs warned that the underfunded of GPs was putting patients at risk, yet by 2015-16, the proportion of NHS spending allocated to GP services was at an all-time low. After 10 years of ineffective action and countless ignored warnings, tackling the GP crisis in the short term will not be easy, not least because the current shortage is adding to the workload of those GPs that remain impacting further on recruitment, but it is also impacting on patient care. A recent BMA survey revealed that 91 per cent of responding GPs said that they felt that the quality of care that their patients receive has been negatively affected as a result of their growing workload. Urgent action is needed. Professional bodies across the primary care sector support a move towards a multidisciplinary approach in GP practices to take the pressure off GPs, providing that the crucial key role of GP is protected. Such moves are simply not happening quick enough. Audit Scotland has rightly called on the Scottish Government to provide strong leadership by providing a clear framework to guide local development. There are also clear examples of successful models such as the Governship project mentioned by Alison Johnstone that show that if general practice is properly funded, major benefits can be achieved for patients, GP workload, recruitment and retention. Funding is the key, whether that is a proper high-profile recruitment campaign that reaches beyond the EU or increasing the share of funding for general practice, which has fallen from 9.27 per cent in 2006-07 to just 7.2 per cent in 2015-16. It would therefore be helpful if the minister can tell members when to sum it up whether the Government intends to ensure that 11 per cent of the total NHS budget will go to general practice and deliver the improvements and services for patients, reduce strain on our GPs and help make the profession an attractive choice of career for medical students once again. Without fairer funding, there is no doubt that the GP crisis that we face will continue. Jamie Greene is right in his opening remarks that this is not just a situation in West Kilbride but right across Scotland. Crisis is a much-used word in politics, but Colin Smyth's figures and many other members across the chamber do illustrate why that is indeed exactly that. Learned bodies who represent GPs, organisations that represent carers and anyone who looks at the NHS budget and the consequences of the squeeze that is now taking place know that that crisis is hitting constituents, the lends and breadth of Scotland. Colin Smyth was right to point out to that 2008 report. I remember reading that at that time as well. It made very clear recommendations to the Government and it would pose some good parliamentary questions as to what happened to those recommendations and why they have not been followed, because discernibly they have not. The biggest change has been the move that has been published in the papers today on the last couple of days away from independent practices to salaried practices. That is now the reality for an awful lot of the delivery of primary care right across Scotland. Do not believe that salaried practices always work. In Lerwick this morning, like too many mornings at the moment, under the salaried practices that is now the Lerwick health centre, people queued at 8.30 am to get an appointment. Now, there is nothing good about that. There is nothing working about that model and yet that is the reality in too many parts of Scotland, as Alison Johnstone clearly indicated here in the capital city as well. So the Government do have some big questions to answer and here is why, because the health boards are a creature of the Government. The idea that they are an independent part of the process is complete nonsense. Health boards chairs and health board chief executives are told to jump by the minister of the day. It happened under the Government that I was in as well. I see Alex Neil, former health secretary there. He knows how the system works. I am not making a political point about the current Government. I am just saying that that is the system that we have had since devolution and demonstrably it is not working. If ever there was a system that needed change and reform, it is the system of health boards. Jamie Greene rightly mentioned locums. Shuttle health board is spending £1.3 million on locums in the current financial year. Eight out of our 10 practices are now salaried. Eight out of 10, in eight of those practices, we are one GP short or more. That is the reality of the problems that exist in one part of Scotland. I will finish this point and no doubt much more so in different parts as well. I am happy to give way. I thank the member for taking intervention. I think that what strikes me from the debate today is just the sheer geographic scale of this. Far from local scaremongry, we do not agree that this is a crisis throughout Scotland and is absolutely aside from party politics. That is the case. I hope that, in that sense, the Government will treat it with all the seriousness that it should, given the range across Parliament of parliamentary views on this. I have a number of questions as well. I would like to pose to the minister. I hope that she will deal with in the wind-up. Is the Government's policy still to support single GP practices? In Shetland, our health board has just issued a letter to patients saying that it is the NHS Scotland's policy not to support single GP practices. I hope that the minister will set that out very clearly in her wind-up. I would also like her to deal with dispensing practices, because many GP practices across Scotland benefited from being dispensing as well. Most health boards have taken that away. Indeed, in Shetland, when Walser, Yale and Unts ceased to be an independent practice and became salaried, the health board removed the dispensing functions. When Alex Neil was health secretary, I raised this as many members raised it across the chamber, including his own party, about that requirement. The health boards are the ones that appear to me to be removing those dispensing abilities, and that has a significant financial impact on the practices. Two final questions, Presiding Officer. First, I hope that in terms of GP referrals, Maureen Watt, who represents the north-east, will tell us what is going on in Grampian when people in my constituency are now being referred to Newcastle for cardiology, when that service used to be able to obviously be available at the Aberdeen royal infirmary. Lastly, the BMA ran a sensible programme this summer to encourage all of us to visit GP practices in our areas. I certainly did that at home. Those are incredibly valued staff, not just the GPs themselves but the practice nurses and others who work in those practices. It is time that the Government recognises the pressure that those people are under to put the money into support them and to answer some fundamental questions about what model of primary care the Government wants for the future. I thank Jamie Greene for bringing this debate to the chamber. Members across the chamber have highlighted the scale of the crisis throughout Scotland. I want to focus in the next few moments on something that Tavish Scott mentioned, which is the issue of locum GPs. When we have a GP crisis, the cost of locums goes up, and that is certainly what has been happening throughout the country. In my area, Lanarkshire, I have been passed letters written by two GP practices. I just want to read out passages from those letters. One actually calls itself a cry for help from GP practices. It says that we are rapidly reaching a crisis point with trying to provide adequate GP locum cover. Trying to find locum GP cover for existing GPs already in place in general practice is becoming a major issue. It seems, according to this letter, that locums have discovered their rarity to be a valid reason to try and hold GP practices to ransom. It goes on to say that most of us would usually pay between £230 to £260 per three-hour session for a GP locum cover and up to £500 for a full day. That has recently increased to up to £800 a day, quite a rise. Along with that is the demand that locums will not do extra duties, i.e. home visits, signing prescriptions, et cetera. You really wouldn't believe it, would you? It says that it is incredibly time-consuming and frustrating. It goes on to relate a couple of instances of what locums have asked for—£650 per day to see no more than 30 patients with no additional duties. Another one charges £764 per day to see no more than 24 patients with the cost of return flight from their home in the Isle of Man to be paid and to be picked up and returned from the airport. Quite unbelievable, is it not? Another practice, a different practice, talks about the crisis in locum recruitment, calls it a source of stress and frustration, talks about the spiralling financial demands of locums, of refusing to undertake duties, other than seeing the requisite number of patients in the clinic, therefore no house calls, no routine script signing, no emergencies, no results commenting, no handling of any correspondence. If that's not a crisis, I don't know what is. It calls this situation unjust and morally unfair, and it goes on to say that the situation is now intolerable and unsustainable, with many practices having to reduce their patient-facing time to avoid prejudicing the quality of the consultation. I think that that situation is completely unacceptable. If the minister cannot answer and cannot say what she and her Government are going to do about that, then that is a disgrace. I thank you. I call Alec Neill last week in the open debate. Thank you very much indeed, Deputy Presiding Officer. I can speak for hours on this having been a health secretary. I welcome this debate. I think that it's good to have an open debate about this, but rather than trying to cover every single point, I want to emphasise two or three issues that have not really so far been highlighted in this debate. I think that inevitably we all recognise the challenges that there are, not just in terms of the shortage of GPs, which is a worldwide shortage of doctors. One of the consequences of Obamacare, for example, is that the United States of America has had to recruit nearly 20,000 additional doctors to cater for the additional demand that is created by Obamacare. Sometimes that has a knock-on impact in the destinations of medical graduates from the United Kingdom, so there is a whole range of issues that have influenced that matter. However, there are two strategic issues in particular that I want to raise by way of looking forward to trying to find a solution to the problem rather than just continually reiterate the nature of the problem. Those two issues, I do not think, have been given enough attention either in this debate or more generally. The first one is that we are just simply not admitting enough young people to medical school in Scotland. In fact, in some of our universities—and Milbriggs referred to this briefly—less than half of the medical students are actually from Scotland. That is not a nationalist point. It is a medical health policy point because there is clear evidence that those medical students who come from a particular country such as Scotland, when they graduate, most of them decide to practice in Scotland. Indeed, it goes further. There is clear evidence. If you take more students in from rural and island areas, they may not return to their own rural and island area, but they will return to a rural or island area. One of the things that Mike Russell and I did for Mike was that the education secretary increased the number deliberately—the number of medical students gaining entry from rural and island areas. That does not pay off for five to 10 years until those people complete their education. As well as dealing with some of the immediate issues, we need to look at the strategic issues. One of the strategic challenges is to substantially increase the intake of medical students. The BMA has resisted that in the past on the grounds that they do not want to see any unemployed doctor. Given the exponential increase in the need for doctors, not just GPs but all kinds of doctors, the chances of any good doctor being unemployed are practically zilch. That is not a good enough reason to resist the substantial increase in the intake of medical students. The other strategic point that I would make is this, Deputy Presiding Officer, and I do not think that people realise the impact that this has had. Up until 2010, many other people in the economy were entitled to build up a private pension pot that was tax-free of £1.8 million. George Osborne reduced that to £1.5 million, then £1.25 million, and more recently to £1 million. Most people would think that a tax-free pension pot of £1 million is a very substantial amount of money. However, for senior doctors and GPs, £1 million pot is the equivalent. If you build that up, if you put the maximum contribution allowed in, that builds up to more than 25 years. Within 25 years of your working life, you reach the top of the million-pound pot. However, it was £1.8 million that you had to work 38 years at the maximum contribution in order to do that. If you speak to doctors, they will tell you two things. Number one, the reason why so many are retiring in their 50s, which is a major contributing factor to the situation that we find ourselves in, is because the pension policy now acts as a disincentive to continue to work full-time until anything near the normal pension age. Secondly—I will finish on that, Presiding Officer—there is also a specific effect. I remember when that was introduced, there was almost immediately a 40 per cent reduction in Glasgow alone of GPs prepared to do out-of-hours, because the more out-of-hours they did, the earlier they would have to retire in order to gain the maximum benefit from their pension. No, there you must conclude. Fascinating and invaluable it is. We have to address that issue, Presiding Officer. Thank you very much. Part of the problem. I close on Maureen Watt to close with the Government Minister. Seven minutes, please. I welcome the opportunity today to respond to this important subject raised by Jamie Greene. I thank all members who participated and for the issues raised. MSPs of every party, as with the general public, recognise the great work that is done by our health professionals across NHS Scotland. I welcome that and we share it. Colin Smyth said that GP practices are at the heart of our communities and they are at the heart of our NHS. That is why, in March, the cabinet secretary announced that funding in direct support of general practice will increase by £250 million by the end of this Parliament as part of our commitment to increase primary and community care funding by £500 million. This game-changing investment in primary care will deliver multidisciplinary teams offering patient access to the right professional at the right time and it will support GPs to do their job, but we are far from complacent. Even with the increases in the numbers of GPs under this Government, at 6.9 per cent, at 315 since 2006, we recognise that healthcare must adapt to meet the changing needs of the people in Scotland. We are fully aware of the challenges of recruitment and retention for GPs in some areas and we are taking action on multiple fronts to address them. Our long-term national workforce plan is helping to identify and address the key issues for every part of the workforce. Alison Johnstone wanted to know about primary care in that regard and that is in part 3 of our plan and that will be published following the conclusion of GP contract negotiations. We have heard about the specific situation with the West Kilbride practice. I know that, during this period of uncertainty, Ayrshire and Arran health board have enhanced the level of pharmacy input into the practice thanks to the investment in the multidisciplinary team from the Scottish Government. Kenny Gibson was right to all his residents in West Kilbride to reassure them of the commitment of Ayrshire, not only Ayrshire and Arran health board but also the Government. With regard to NHS Lothian list restrictions, the board has indicated that that is only a temporary measure. I am confident that patient safety is always the top priority. We will continue to work with all boards to ensure that our investment delivers better care, better services and better value. Kenny Gibson is right to highlight all the factors and, as did Alex Neil, leading to the current situation, many of which are out with our control, such as the pension that Alex Neil was right to highlight. He first encountered it when he was working in the health. For the Opposition Tory bench to dismiss Brexit, it is absolutely disgraceful. We know that people will have a direct effect on the Scottish workforce. People from the EU who choose to live here, including doctors, nurses and others, providing healthcare, are welcome in Scotland as the First Minister has made clear. It would be disastrous if the uncertainty—well, already we know that the uncertainty is making people decide not to come and live and work in Scotland and also to leave. That is a real problem. However, we are addressing, Presiding Officer, the day-to-day challenges that GPs tell us that they face. Two years ago, we were the first country in the UK to remove the bureaucratic tick box quality and outcomes framework. Instead, our GPs are working together to make services better. We are working hard with the BMA at the moment to deliver a new GP contract, which will see our GPs focusing more on the challenging work that they have trained to do, supported by a bigger multidisciplinary team. The minister specifically asked during my contribution if the Government were quick to deliver 11 per cent of the NHS budget to GPs. It was Dr Philippa Whiteford that told Pulse magazine on 24 May 2017 that the GP contract is currently under negotiation, but the Scottish Government has committed to reversing the decline in the share of the health budget that general practice has had and bringing it up to 11 per cent by the end of Parliament. Is that the case? We are committed to bringing the proportion of the NHS budget up to 11 per cent, and the GP contract, as a member knows, is currently under negotiation. It would be wrong to go into any detail with regard to that. However, we are working hard with the BMA at the moment to deliver a new GP contract, which will see our GPs focusing more on the challenging work that they have trained for, as I said, with the bigger multidisciplinary team. We have increased funding fivefold for the GP recruitment and retention this year to £5 million. That is part of the overall £71.6 million package of investment this year in direct support to general practice. Tabby Scott. The First Minister has talked about multidisciplinary medical teams a number of times in her speech. How do those fit into single-GP practices in rural areas? The member asked me about single-GP practices. The member mentioned health boards, and it is up to health boards to take Government policy, as he knows, and deliver it according to the needs of their local populations. Across the country, we are seeing GP practices and multidisciplinary teams working together to give patients access to the right person at the right time. However, I will make sure that the particular question about single-GP practices is replied to by the member. The member will also know that, in relation to his query about dispensing practices, that was a trend that took place long before the Government took office. Not only are we working with the BMA in terms of the new contract, but we are also increasing the numbers that Alex Neil mentioned about young GPs coming through the pipeline. To increase supply and widen access, we are investing £23 million into a medical education package. It includes an increase of 50 medical undergraduate places from 2016-17, a pre-medical entry programme to commencing academic year 2017-18, and the establishment of Scotland's first graduate entry medical programme, ScotGen, commencing in 2018-19. Those programmes, particularly the pre-medical entry programme, specifically address the point that Alex Neil made about getting people from more disadvantaged backgrounds and rural areas into medicine. Those are the people that are more likely to stay and return to rural areas. We have also heard today about concerns about board-run practices. As of 1 July 2017, out of the 959 practices throughout Scotland, there were only 57 practices directly run by NHS boards rather than independent businesses. Sometimes that is the best solution for a local area. Sometimes the practices will return to independent contracting. The point is that patients will always be able to see a GP, regardless of whether it is an independent business or whether it is run under the 2C practice. It is the safety of patients, which is always the highest priority. In conclusion, we are committed to primary care and to GPs who do a difficult job but do it well. As the needs of our population change, so too will our primary care services as we shift the balance of care towards the community. We are investing a huge £71.6 million in direct support of general practice this year, and it will be £250 million by the end of the Parliament. We know that we have more to do. We work on the GP contract and our investment in GP recruitment and retention, and that is on-going, supported by our primary care investment. We want everyone involved in primary care to get behind our vision for the future of primary care, to help to make it a reality, and I trust that all MSPs from all parties want that to happen too. Thank you, Presiding Officer. Thank you minister. That concludes the debate, and I close this meeting of Parliament.