 Mae'r next item of business is a debate on motion 12214, in the name of Alex Cole-Hamilton, on improving access to primary care. I'd invite members wishing to take part in the debate, to press the request-to-speak buttons now as soon as possible. I call on Alex Cole-Hamilton to speak to and move the motion up to seven minutes. Mr Cole-Hamilton. Thank you very much indeed, Presiding Officer. Before I begin my remarks, can I welcome the Cabinet Secretary, Neil Gray, to his place? Can I also take the time to recognise and welcome the new member for Highlands and Islands, Tim Eagle, to his place? I met Tim very briefly yesterday. He strikes me as having the makings of a fine parliamentarian. I pay tribute also to his immediate predecessor, Donald Cameron. Donald was a rare voice of calm clarity and consensus in this chamber, and he will be missed, as will his friendship across the chamber. I am pleased to open this debate on behalf of the Scottish Liberal Democrats, and I move the motion in my name. Our health service is in crisis. We all know it. We regularly debate it here in this chamber. The slow and steady erosion of our health service and the years of successive nationalist ministerial disinterest is being suffered by those who work in it and those who rely on it. Nowhere is that pressure felt more acutely than in primary care. For our hard-working GPs, this Government has done a little more than add insult to injury with a litany of broken promises, skewed numbers, missed targets and cut budgets. It was not that long ago that, if you needed your GP, you were able to book an appointment and be seen perhaps even within a few hours, if not days. Across the profession, the alarm is being raised. Dr Andrew Buist, who is the chair of the BMA's Scottish GP committee said of the recent fall in the workforce, that we are often told that GPs are at the bedrock of the NHS, but, on this evidence, that bedrock is crumbling. It is patients seeking access to their GP who will suffer as that becomes more and more difficult. The NHS must aspire to health promotion, the prevention of acute illness, detecting serious issues early and getting the right intervention in place to patients fast. If that does not happen, it piles more pressure on other parts of the health system, from people being forced to attend, already swamped accident and emergency departments, or presenting later with cancer and other diseases due to acuteness of their condition. It is happening, not by a long shot—this is not happening, not by a long shot—in fact, people are waiting weeks just to be seen by their GP and may struggle even to get an appointment over the phone. I have lost count of the number of people who have told me stories of being forced to wait weeks for an appointment with their GP. I know of parents trying to get their sick baby an appointment, only to be told that, unless it is really urgent, there is not a routine appointment for the next two weeks. I am sorry, but new parents do not often know what is severe and what is not, and things can go downhill very fast. If we are not getting right for babies, we are not getting right for anyone. People are being left to wait on their own in a state of crippling anxiety or pain, or both, with no way of knowing whether their symptoms are something innocuous or clinical signs of something potentially far more sinister and even life-threatening. It is no wonder that one in five Scots say that their mental health has been impacted by the delay that they have had to wait for a GP appointment, and 13 per cent say that long waits have adversely affected their physical health as well. The conditions that we know become more acute. Lirking behind many of the issues that we will discuss today is the growing workforce crisis that is impacting primary care 1 that has been exacerbated by the brutal cuts of this administration. The figures on recruitment and retention are really worrying. 42 per cent of practices report at least one GP vacancy. Compared to a decade ago, if you look at working-time equivalent figures, the NHS is in fact down 200 GPs, as it was 10 years ago. I will refer again to Dr Andrew Burris, who said that all the shows that are no longer feasible or plausible to think that we simply go on as we are, believing that we are on course to grow the GP. Workforce is required to care for people in Scotland. In an attempt to pull the wool over people's eyes, the Government would have you believe that that number is over 5,000 and that the number of GPs is over 5,000, which is only the case when you include trainees in that number and a head count rather than the full whole-time equivalent is used as a measurement. How are we going to improve the situation in primary care if this Government is not even going to be straight with the public about the fact that they deploy the smoke and mirrors politics? None of that is the fault of GPs and NHS staff. Let us be absolutely clear about that, and we always will owe them a huge debt of gratitude. We are asking far too much from those working in primary care, many of them are experiencing burnout as a result. The stress and demands mean that more and more GPs are choosing to work part-time or to leave the profession entirely, so the failure to support them properly adds yet more pressure on those who remain behind. The Government has promised to recruit 800 more GPs by 2027, but bodies such as the Royal College of General Practitioners and Audit Scotland agree that they are not on track to meet the target. Part of the answer, of course, is to train, recruit and draw on the wider skills that exist in other disciplines such as mental health, physiotherapy, pharmacy and more. GPs are the first point of contact for many people as they enter the NHS, but particularly at times of mental health. That is why my party works so hard to persuade the Government of the importance of putting mental health care practitioners and talking therapists in every corner and practice in Scotland, but progress has been far too slow. One recent Government-run survey found that 86 per cent of GPs said that they had either insufficient access or no access whatsoever at all to mental health practitioners over a three-year period. GPs were promised new colleagues to help lessen the workload to improve the mental health care that is available on the ground. However, as we know with Humza Yousaf as Health Secretary, the Government actually hit pause on its pledge to train and hire more staff. As recently as May, I will take an intervention from Fergus Ewing. I am very grateful to Alex Cole-Hamilton who mentioned training of doctors of all sorts. Would it be worthwhile considering, in order to prevent the drift of newly qualified doctors to Australia, Canada and the USA after £250,000 on average has been invested by the state in their training? Would it not be worthwhile to introduce a bond system so that, if people do choose just after the state is paid for an expensive education to work in other countries, they are required over time to pay back a proportionate lease or all of the costs of training? I am very grateful to Fergus Ewing for the intervention. The situation is in such a state of extremist that I think that we should explore all options and I will be open to further discussions on that point. To conclude, we need to be open to new and innovative ideas like the one that we have just heard. We also need to look at plans for recruitment and, crucially, the retention of staff. Stop experience doctors from burning out or being pushed out of the profession that they love. Incentivise more people, train and work in the NHS once they qualify. It is time to rewrite the NHS failed recovery plan, get recruitment and retention of GPs and local practice staff back on track and get past the culture of endlessly making plans for more plans. Primary care and the entire NHS need new energy, new ideas and new hope. It needs a new government. Thank you. I now call the cabinet secretary Neil Gray to speak to and move amendment 12214.2 up to six minutes, Mr Gray. Thank you, Presiding Officer. I'm very grateful for the opportunity to speak in today's debate as the new cabinet secretary for health and social care and in doing so I move the amendment in my name. Scotland's NHS is an institution that I am truly proud to lead. While I've only been in post a short number of days, I recognise our health and social care system is far more than just a series of individual services. It is a vibrant living system that supports every life in Scotland, and those who have dedicated their lives to working in the services across that system help to ensure that all of us can live longer, healthier and more fulfilling lives. I want to set out at the outset how grateful I am to those who work in our health services, in this case, in primary care. Before moving on, I also want to take a moment to acknowledge and thank my predecessor, Michael Matheson, who I know gave his all to the role of health secretary. Michael's commitment to NHS staff and efforts to work constructively with unions have ensured that Scotland is thus far the only nation in the UK that has not lost a single day to strike action. That is not a situation that I take for granted, and I want to continue to pursue a working relationship that Michael established that was fostered on trust with our trade union colleagues. Our health and social care service is going through its most challenging period in history. The collective impact of the pandemic, Brexit and the cost of living crisis are some of the biggest systemic shocks that this country and the NHS has faced. All of that is against the backdrop of 14 years of UK Government austerity that has left our public services with very little resilience. I am clear that in order to move forward and recover from those collective challenges, we need to see reform and innovation right across the health service. I will set out my vision for that reform in the coming weeks, but key to that vision will be listening to the voices of people who use, work in a health and social care service. However, let me take this time to restate that the fundamentals of Scotland's NHS will not change. Will you remain committed to free access to healthcare at the point of need? I will give way briefly to Alex Cole-Hamilton. I am grateful for the intervention. The cabinet secretary talks about listening to the voice and lived experience of those at the front line. Would he agree with Liberal Democrat calls for a health and social care staff assembly so that we could put the voice of that experience at the heart of the solution to this crisis? The reform process that I will be embarking on alongside my colleagues will be informed by those with lived experience, those who work in our NHS, the experts, academics and service users, as well as trade unions, to ensure that we get a reform package coming forward that is informed by those who use and work in our health services going forward. I genuinely welcome this debate, and I would like to thank Alex Cole-Hamilton for bringing it to the chamber. I saw first-hand this morning in Birloch practice in Edinburgh how primary care services involving a wide range of skilled professionals can have a huge impact on health outcomes and are greatly valued by the communities that they serve. I am proud of the record investment in primary and community care services over £2.1 billion in the draft December budget. That represents our continued commitment to ensuring that primary care services are better focused on people meeting their needs in a joined-up way. General practice must be at the heart of our healthcare system. It is unparalleled in managing such a wide range of care needs in the community from long-term condition management through to urgent unplanned care, with more than 1.5 million GP encounters a month and more than 1 million for other clinicians in practice. Of course, there are demand issues, but we are dedicated to ensuring the sustainability of the GP and wider multidisciplinary team workforce. On workforce in 2017, we committed to adding 800 GPs to the workforce by the end of 2027. At the last count in December, 271 additional GPs had been recorded and record expansion in our GP speciality training has resulted in over 1,200 training GPs currently in Scotland. That is the beginning of our efforts bearing fruit. We are also working with the GP profession on developing a series of recommendations to ensure that we are retaining our current GPs. We are also reforming the way general practice works through the 4,700 wider multidisciplinary team members in post, including pharmacists, physiotherapists, community-linked workers and mental health practitioners, to name but a few elements. That additional capacity allows teams to work together to support people in the community and free up the GPs to spend more time with patients in specific need of their expertise. I will do very briefly for a final time. I wonder if the cabinet secretary would obtain us what data he can about the number of GPs and newly qualified doctors in general who leave this country for other countries preparatory to considering the proposal of a bond that I put to Mr Cole-Hamilton. Yes, I'd be happy to take that consideration forward. I think that the retention of those that go through training in Scotland is critically important, as is the continued attraction of people working in our NHS from other countries as well. We know that health inequalities exist and have been exacerbated by Covid. That is why we are taking further targeted action through the inclusion, health action and general practice support project, with £1.3 million funding dedicated so far and stabilising our highly valued community-linked worker capacity in Glasgow with £3.6 million funding already confirmed for three years. The needs of rural communities are also at the forefront of our policymaking. Our new national centre for remote and rural healthcare is now in its delivery phase and will initially have an intense focus on primary care. It is clear that our health and social care system needs of which primary and community care is at its centre will require reform to remain sustainable and meet growing demand. I will continue to work with our professional bodies and the people of Scotland to deliver on our ambition for a thriving, sustainable primary care service, focused on both mental and physical health to be at the heart of the healthcare system. Just to advise the chamber, there is no time in hand for this or the subsequent debate, so members will have to stick to their speaking time allocations. Sandesh Gullhane will speak to a move amendment 12214.3 up to five minutes. Dr Gullhane. I wish to refer members to my register of interests as a practising NHS GP, living the pressures that we are debating here right now. I would like to start by welcoming the new cabinet secretary to his role and also to my new colleague, Tim Eagle, who is giving his maiden speech today. Successive SNP Governments have watched, as if caught in the headlights, as general practice struggles under sustained pressure on multiple fronts. The SNP, now supported by the Scottish Greens, are responsible for failing to develop and implement credible medium to long-term strategic plans. The last attempt, three health secretaries ago, flopped before the ink was dry. Whom's use of so-called NHS recovery plan could well go down as one of the most underwhelming and poorly thought-through pamphlets in NHS history, but right now it's important that we truly understand the issues that need to be tackled. And we owe it to our amazing frontline staff in primary care to come up with real workable solutions. So allow me to first run through some stats. There are a quarter of a million more patients registered with Scotland's GP practices now than in 2012, but if we look back over the past 12 years, the number of GP surgeries have actually decreased by 9%. Importantly, over the same period, the number of patients aged over 65 has increased 20%. So now we're actually seeing increasing numbers of GP practices being forced to close their patient list because they do not have sufficient resources to meet patient needs. The Royal College of General Practitioners Scotland say that GPs face such unmanagable workloads that over half of members cite poor morale or declining mental wellbeing. As for SNP government's flagship policy to recruit this additional 800 GPs by 2027, well Audit Scotland says they are not on track. Presiding Officer, primary care is the front door to a successful health service. A thriving general practice brings both direct benefits to patients and protects the entire NHS from overload. We need to have a serious rethink now about how we deliver healthcare and greatly improve access to primary care. On the news that emerged last week, that NHS borders is facing a mountain deficit and will have to cut its budget by 10% next year. Does he share my concern that this SNP Government has failed to properly fund rural healthcare? I couldn't agree any more with my colleague. Over the past two years, I've had candid discussions with patient groups, clinicians, health economists, academics, technologists, third sector organisations and NHS executives with the goal to develop a vision for our NHS that we can bring to a national conversation. It's clear that Scotland needs an NHS that is modern, efficient, local, accessible to all. To achieve that, our country will need to truly embrace innovation and change. Plus, in order to maintain universal healthcare, as we know it, we need to reduce strain from our health service and its staff, and that will require all of us to take greater responsibility for our own health and our NHS to identify issues before they become big problems. I'm grateful to Sandish Gilhoney for giving me away. What impact and what greater strain does he expect following Tory spending plans, which is to see a further £0.5 billion reduced from our health service if we had followed his budgetary advice? Perhaps the cabinet secretary will reflect on the fact that, if he had passed on all health consequentials since they took power, we would have £17 billion more to spend in our health service. Shame on you for your pet projects. A modern NHS would embrace innovation and introduce its latest medical equipment in rural and remote areas. That would include mobile screening services, and we would take diagnostics to the community, such as lung screening, instead of expecting patients to travel long distances. We need to provide credible backing for community pharmacists, optometrists, audiology services, physio and link workers to have expertise within the community. To achieve that, we need to reprioritise resources. In plain speak, we need to fund the necessary changes and ensure that we reduce inefficiencies. Sound healthcare economics is vital. Scotland's NHS must be geared to deliver, at the local level, to get a stronger primary care. It's really important that we focus on the fact that central belt solutions for primary care won't work for all of Scotland, which is not what the SNP understands. We are ready to contribute to a national conversation on the future of our NHS, which healthcare professionals are calling for. I move the motion in my name. I would also like to welcome Mr Eagle to his place and look forward to listening to his maiden speech later this afternoon. He certainly will have big shoes to fill in replacing Mr Cameron as a representative for Highlands and Islands. I can also thank the Liberal Democrats for tabling their Opposition Day motion on primary care for debate this afternoon. Those benches will support the motion later today. Over the course of this Parliament, we have considered the issue of long waiting times on many occasions, and rightly so, one in seven Scots are on an NHS waiting list. The reason we keep coming back to the issue is because it is not going away. In fact, it is getting worse under this current Government. If primary care had the support that it needed, we would be able to build capacity and give people the timely help that they need in their community to reduce pressure on our acute hospitals. Unfortunately, primary care does not have that support. The Scottish Government is not on track to deliver on its commitment to recruit an extra 800gps by 2027, and the earlier commitment of 1,000 new community mental health workers has been abandoned. Patients in primary care teams deserve better than constant broken promises made by the Government, and Labour supports this motion's call for the NHS recovery plan to be rewritten. I welcome the references to mental health in this afternoon's motion, too, and I am sure that members will agree with me that it is an issue that is raised with us frequently by constituents. Unfortunately, it is clear why. As of September last year, 27 per cent of children and young people referred to CAMHS were rejected, an average of 26 children a day. Some patients have been waiting in excess of 1,000 days to start psychological therapies, and NHS 24 mental health hub calls regarding psychotic symptoms increased by 101 per cent between 2021 and 2023. This is an extremely serious demonstration of unmet need. We know that support from mild to moderate mental health issues in the community has a positive impact on outcomes for patients as well as reducing the demand for onward care, but this is something that the Scottish Government has failed to deliver on. Indeed, the Government's previous commitment to funding mental health and wellbeing services in primary care, before pulling the funding entirely after the health and social care partnerships had spent almost a year planning for delivery, has been a catastrophic failure. As this afternoon's motion states, the mental health budget has been frozen and then cut in year for two years running. This kind of incoherence is unsustainable. Those are not the decisions of a Government that takes mental health seriously. Labour are clear that primary care teams need to be supported to be afforded to headroom to innovate and establish the services that are required to meet the needs of their practice population. My amendment to the motion notes that these benches are serious concerns that the health professionals are not being meaningfully involved when the Scottish Government is taking decisions on service delivery, patient safety and workforce planning. There is no service delivery, no patient delivery and no workforce without our dedicated NHS staff. Those workers and our patients deserve better, which is why our amendment calls for a national clinical council on a statutory footing to empower clinical experts and make better a reality for patients and professionals. I move the amendment in my name. Thank you, Mr Sweeney. We now move to the open debate. I call first Beatrice Wishart to be followed by Ivan McKee up to four minutes. Ms Wishart. Thank you, Presiding Officer. I also welcome Neil Gray to his new post and extend a welcome across the chamber to Tim Eagle. I know what it's like to join a new class halfway through terms, so I wish him well. Before I begin, I'd like to pay tribute to all the hardworking NHS staff, those on the front lines, those supporting behind the scenes and everyone who worked through the pandemic. You all deserve our great thanks. This afternoon's debate is a good opportunity to discuss our constituents' experiences of primary care services. I think that everyone recognises the pressures that the NHS faces during the Covid-19 pandemic and the challenge of recovery. Years before the pandemic, issues were building in the health service. Recruitment and retention of NHS staff from primary care through all parts of the health service has been an issue for years. The problems didn't start yesterday and nor did they the sole consequence of the pandemic. The pandemic did present us with something new, however, long Covid. Constituents of mine have raised the lack of dedicated care for those living with it. I quote from one parent who said, Our son is very unwell again and it's utterly devastating to see the lack of support for children with long Covid and their families in Scotland is a national disgrace. Post-pandemic staff are feeling overworked and undervalued and we are seeing GP numbers reduce. Cuts to nursery and Midwifery University places in 2011 by the then SNP health secretary, Nicola Sturgeon, are now coming home to roost. My party colleague, Alison MacKinnis, asked at that time and I quote, If we aren't training enough nurses and midwives today, who's going to look after our ageing population in the years to come? In my constituency, at the end of last week, NHS Shetland was looking for a salaried GP announced and another in Lerwick, as well as a psychiatric nurse team leader. The surgery in Hillswick has been advertising a GP post for well over a year. Within the last year, the community of Fetlers struggled to fill nurse cover for the island. Those adverts are for primary care posts. Overall, NHS Shetland was advertising for 14 posts to fill, ranging from GPs to support services. As islanders, those in the communities mentioned, are fully aware of the unique circumstances they find themselves in. Every community, every individual is entitled to healthcare, and where that cover is missing, it's of greater and disproportionate impact on small communities who have already done everything to extend, supplement and retain existing provision. Like urban areas, island and rural areas face significant challenges to healthcare provision, such as ageing populations, depopulation and geography. In turn, the reasons behind depopulation and ageing populations are keeping healthcare posts from being filled. Where will the new GP or nurse live when there is a shortage of housing to rent or buy? What attracts a healthcare professional to an island community when ferries don't run and are unreliable in providing lifeline services? That is just one way where travel concerns significantly impact patients in rural and island areas. Beatrice Wishart describes the shortages of medical personnel in Shetland, and I am sure that that is the case in many rural parts of Scotland. A bond system could be combined with the requirement that young medical qualified doctors could be required to work in such remote areas. I believe that that system of ensuring that rural provision is met and personnel available is applicable in other countries. Might it be worth emulating it here? Travel expenses are paid to patients travelling distances beyond 30 miles by road or five miles by sea to get to their hospital or health centre for treatment. The Scottish Government needs to look again at how best to ensure that patients are not financially burdened when undergoing treatment. The anomaly that residents in Bresa face has still not been addressed. Their ferry journey does not qualify, but it is the only means to cross Lerwick Harbour to reach the ageing hospital, which I have long called for to be replaced with a modern facility. Am I running out of time, Presiding Officer? You are indeed, Ms Wishart. In fact, you have run out of time. I have run out of time. I have plenty more to say, but I have concluded there. I know that to be true. I now call Ivan McKee to be followed by Tim Eagle up to four minutes. Thank you, Presiding Officer. I am delighted to speak in this debate. First of all, I want to pay tribute to the staff that work in our NHS and social care services and the tremendous shift they put in day in and day out. It is important to recognise the challenges that we all know that the service faces with waiting lists where they are and particularly the challenges around GP appointments. I also recognise the fact that Covid has had a significant impact on that. That is something that is common right across the UK and beyond. The longer-term trends in demographics and health inflation are pressing down on the service. However, it is also hugely important to recognise, as the cabinet secretary has done, the Scottish Government's commitment to the principles of the NHS free access at the point of need in Scotland, unlike elsewhere in the rest of the UK. The importance of primary care as the gateway to that service is absolutely critical. The most cost-effective way of providing that preventative service up front that helps the whole health and social care system to operate more effectively, so we should not under stress its importance to the whole system. It is important to recognise the Scottish Government and the NHS and Scotland's performance in that regard, with GP numbers in Scotland, the highest in the UK 81 per 100,000 population, compared with 62 in Tory run England and 65 in Labour run Wales. To recognise the steps that the Scottish Government has taken to address the challenges that we undoubtedly do face with regard to GP provision, with GP training places now at 1,200 and increasing 35 more this year, and an additional 35 next year, the multi-discipline teams 4,700 in place, as the cabinet secretary has identified absolutely critical to providing that more efficient and effective service at a local level. The community links worker programme, I am delighted that his predecessor continued that programme and I am sure that he will do as well. I see that very much week in, week out in my constituency of Glasgow Provin and the GP practices that are supported by community links workers, and of course GP numbers up by 270 since 2017, so clearly more work to be done there, but much going in the right direction. I also want to take the opportunity to mention in the rural context the importance of particular challenges faced by rural and island communities. As you will know, that is an area of investigation by the health and sport committee that I sit on, but it is also worth recognising the ScotGem programme, which is a graduate entry to medicine programme unique to Scotland across the UK, with St Andrews and Dundee universities already participating in that with a focus to recruit and train GP specifically for rural and island communities. I very much welcome the cabinet secretary's comments on bringing forward plans for reform and innovation across the service, and hopefully that will happen sooner rather than later. There is much to go at there, but I believe that there is certainly much opportunity and scope for innovation both in technology and in process innovation to deliver service improvements, particularly if best practice is rolled out at scale across all 14 territorial health boards and right across the service. Just to put it in conclusion, I want to recognise the importance of recruitment of GPs and, of course, other skills, but to recognise, as the cabinet secretary has also done, the impact that Brexit has had on the potential for that recruitment, then placing the brakes very much on the opportunity for Scottish NHS to recruit from the rest of Europe. It brings in to stark highlights, frankly, the Lib Dem's position and bringing forward this motion, recognising the problem with recruitment, but the elephant in the room, the Lib Dem's, vote faster about turn on their position on Brexit, which is to talk to their inability to maintain consistency in these matters. The National Party, the only party in Scotland, committed to Scotland rejoining. Thank you, Mr McKee. You do need to conclude. I now call Tim Eagle to be followed by Alec Rowley for members who haven't been paying attention. You will wish to be aware that this is Tim Eagle's first speech in the Parliament. Mr Eagle. Thank you, Presiding Officer. I'm honoured to give my maiden speech today as a new representative for the Highlands and Islands region, and I'd like to declare an interest in that my wife is actually a practicing GP. Before I talk about health though, can I first offer my thanks to the parliamentary staff who have supported me this week, and also my thanks to Donald Cameron as he begins work as a parliamentary undersecretary of state for Scotland. It speaks to the character of Donald that politicians from all parties praised his contribution to this Parliament over the last eight years. I didn't quite realise how big his shoes were, so I'll have to get some big shoes from somewhere. He is a well-known and respected, and the UK government's gain is our loss. Like my colleague here, Douglas Ross, I live in Murray with my family, and I share Douglas's infectious passion for the region. No two communities are the same, and residents across the Highlands and Islands face distinct and unique challenges. Whether that is the need to get a ferry, paying for more deliveries, recruitment difficulties, or the need to travel hundreds of miles for healthcare. Indeed, the news on Monday that there will be a significant delay to the delivery of an MRI scanner and a refurbishment of the mental health ward at Dr Gray's hospital in Elgin is yet another serious blow for Murray and its wider communities. But while these challenges are many and varied, our region and its people have very much to offer. As I mentioned earlier, my wife is a practicing GP, so I know and live with the daily challenges that those on the front line deliver in primary care. But it's not just the GPs, the advanced practitioners, the physios, the front line staff at the desk, the administrators, the practice managers, the pharmacists and more. People in these professions and many other professions don't just switch off at the end of the day. Their job is a part of their lives, and they do an amazing job despite the difficulties they face. There are many great things this Parliament can and will do, but it is a fundamental essential that we get the most basic needs of the Scottish people right, and access to healthcare that delivers quality, timely care to patients from staff who are valued as one of them. GPs are the beating heart of primary services, yet Public Health Scotland's website today shows a drop of 40 GPs in the last year alone. SNP's promise to deliver 800 more GPs by 2027 is frankly looking increasingly hollow. It leaves me asking big questions, where are they getting these GPs from and are they truly listening to patients and GPs at present? To add to this pressure, the number of registered patients is increasing. Reform is clearly needed to deliver modern, efficient and local health services, and in the case of my constituents, it is vital that the trend of rural depopulation is tackled. Although I enter Parliament at the latest stage of this session, I bring with me many lessons learned from serving the community of Bucky during my time on Murray Council. It is a community I am deeply proud to be a part of, and it is one with immense spirit, so prominently displayed when a large part of the town travelled to Glasgow to support Bucky Thistle against Celtic in the Scottish Cup recently. As a councillor, I firmly believed that I was only truly capable of serving my community if I listened to those who I served, because ultimately it is their lives that are made better or worse by the decisions that we take here. While I will challenge this Government when it is necessary, I want to work with all politicians because that is what our constituents expect of us. I look forward to delivering for the Highlands and Islands, but I end with perhaps one of the most urgent requests to this Government. That primary care is calling out to you from the shadows. It needs more help from this Government to bring it back into the light in which it can shine. I now call Alex Rowley to be followed by Gillian Mackay up to four minutes, Mr Rowley. Thank you, Presiding Officer. I begin by congratulating Timmy Gill on his maiden speech today. I would also welcome the statement by the Cabinet Secretary where he says that he will be listening to the voices of health users and those in the workforce. I do hope that that also means those on the front line of our health services, because when I spend time speaking to workers on the front line of health and social care, they often feel like nobody listens to them, whether that is those further up the tree in the management sectors of the NHS and the IGBs or politicians. We should start. Alex Cole-Hamilton talked about NHS health and social care being in crisis. Those on the front line face that crisis every day. It is right that we should unite in this Parliament to thank those who are delivering health services and social care services, because they are under such immense pressure. However, if you speak to anyone who uses those services and certainly my own experience, they are full of praise for the dedication, commitment and care that they take and deliver on their jobs every day, despite sometimes the real difficulties upon which they work. The value of social care work is a key issue. I have raised in this Parliament over a number of years. What value do we put on social care? I suggest to you that the poor pay of social care workers does not match what is needed in terms of the job that they deliver. If you then look at those in social care who are delivering in the private sector, it is the poor pay, which is even poorer, and it is the poor terms and conditions upon which they have. It baffles me that we have not addressed that. We have spent millions coming up with the new social care services that we talk about. I think that there is a bill coming forward in the number of weeks. However, why have we not addressed what, for me, is the core issue? If you do not treat care workers with respect, if you do not value the service that they deliver and do that by decent terms, decent pay and decent conditions, then it is no surprise that people are not only being recruited into those services, people are leaving those services, so I would make that appeal. On the workforce planning, I think that I raised a month or two ago with NHS Fife about the concern that constituents have raised with me that many GPs are at the point where they are due to retire. There is real worry in many communities about what is going to happen when those GPs go. The chief executive of NHS Fife told me that they do not hold any data or any information and have not carried out any surveys in terms of looking at that workforce that is out there in terms of GPs across our health centres because they are private businesses. No other business or public service would run in that way where it is clueless as to what the requirements are going to be for staff in the future. Again, we have to address that issue. I will finish in the brief time I have got. I praised this Government many years ago when the Christy report came forward and was focusing on prevention. We should not forget that many of those people who are going to use primary care services are doing so because of other poor services. If they are living in damp wet housing, if they are unable to get the skills and the opportunities to get the job or the education, that will all result in poorer health. The statistics show that, so we need to take a holistic approach that recognises those factors. I want to start as others have by thanking GPs and their primary care teams for their efforts for their patients every single day. The briefing from the Royal College of GPs rightly calls them the front door of the NHS. They are the service in most contact with the public and the best possible position to help us to achieve some of the public health goals that we are rightly proud to have. I welcome the commitment from the cabinet secretary to speak to those on the front line as well as patients as to what they want to see from front line health services. We need to tackle the issues and challenges that GP services are facing. The pandemic has played a large part in the frailty, deconditioning and complexity of patients that GPs are dealing with. This is no fault of patients or GPs but is a reality facing many. Those pressures and added complexity simply have not gone away and will be with us for some time to come. We also have new conditions for GPs to treat such as long Covid, as well as advances in how we treat other conditions. I strongly believe that we need to ensure that GPs have sufficient time to update their knowledge and deepen understanding of complex conditions that they are having to manage. Data is a huge issue across the sector, and I will once again call for a single patient record. There are particular pressures in particular places, however, I want to touch on some of the interesting work that the Health and Social Care Committee has been doing on remote and rural healthcare. Unsurprisingly, workforce and the ability to recruit people to rural communities is difficult. A range of issues have been highlighted by clinicians to us about the difficulties. Housing came up as a major issue, both the cost but also the availability. Some highlighted that the cost of housing is prohibitive in certain places to allow them to move to a new community in the first place, but some of the biggest barriers were the types of available housing, if in fact there was any housing available at all. Cost was highlighted as more of an issue for other members of the multidisciplinary team. In many rural villages, GP practices may only have one GP, which comes with challenges in terms of recruitment. Many GPs want to be part of larger teams for support and for collaboration. There are very good wider networks for rural GPs, but on a day-to-day basis some noted that it can be quite isolating. Added to that the issues of an ageing population and the number of older people being a higher overall proportion of the population in some rural areas. Many people choose to retire to rural locations exacerbating the issue, and some thought needs to be put into how we best equip GPs in those areas for the likelihood that the number of older people in their practice areas will increase. How we deliver those services is hugely important across the country, but particularly how we can innovate in GP services in rural areas so that people do not have to travel long distances. Those are just some of the issues that have been raised with the committee as part of the inquiry that is still on-going. The potential solutions to some of those issues lie in other portfolios within Government, and I hope that the new cabinet secretary will explore those with colleagues. There is a lot to cover in this debate, but one other issue that I wanted to briefly touch on is out-of-hours GPs. They add a huge amount of support and breadth to the urgent care landscape. They are a hugely dedicated team doing this work over and above their normal clinical load. They help to divert people away from A&E but ensure that, for those patients with particular concerns, they are seen, given help, support and treatment that are needed. They are an enormously important piece of the GP workforce that we often forget about, but they are hugely valuable. Our primary care teams are the front door of the NHS, and we need to ensure that they get the support and investment that they need. Thank you, Mr Mackay. We now come to the final speaker in the open debate. Keith Brown, up to four minutes, please. First of all, I welcome Neil Gray to his position as Cabinet Secretary for Health, one of the strongest members of Government, and one of the most difficult posts of the best of luck to Neil. Can I also welcome Tim Eagle? I hope that I have the same convivial relationship with him that I do with his colleagues. If he could pass on my best regards to Donald Cameron, we left very suddenly, but we worked together on the culture committee, and I was finding it to be a very courteous and considered individual. The discussion that we heard earlier on from Alec Cole-Hamilton obviously raises some very real issues, but of course the contribution, in my view, is entirely fatuous, because it seeks to ignore some of the big determinants of what we are discussing. First of all, the comparison with the other parts of the UK—we get groans from the other parts of the chamber when the comparison is made with the UK, unless it is a comparison that they want to make, of course. Of course, the amount of resources that come to Scotland are determined by spending decisions in London, and they take those decisions quite rightly in view of what they believe the need to be, but Scotland just falls into place, as does Wales. To try and ignore the extent to which that, including the capital cut to the NHS budget, derives from Westminster means that it is not a real debate in that sense. The other things that are disregarded and ignored in this debate are, of course, the fact that Covid has seemed to be, as it was this week in the House of Commons, a justifiable reason to give for some of the issues in the NHS in England. It seems to be a justifiable reason to give in Wales, but it is not justifiable here in Scotland. I will not give you four minutes, and you have not been here during the whole of my discussion anyway. I would also say that the other thing that is unreal is the failure to acknowledge, in particular for Alex Rowley, the fact that, in Scotland, we have higher paid NHS staff. We have more NHS staff, as Ivan McKee pointed out at the same time. We have had no strikes in the NHS, so if there is a genuine discussion about the condition of primary care services, presumably there will be some mention of that fact as well. The fourth thing, which is not mentioned by other members, was mentioned by Ivan McKee, is the impact on the NHS of Brexit. Even the more recent announcement, further restricting the ability of care workers to come to Scotland. No mention has made it so how genuine can this discussion be, if those things are completely ignored. The other thing that I would say is that much of what comes out of the chamber from the other parties is derogatory towards the NHS and its staff, usually dressed up by saying that it is the SNP NHS. For my own experience, whether primary care or otherwise, including cancer care, even in the last couple of weeks, somebody who has had cancer was seen within three days, had a mammogram, had an ultrasound, saw the consultant twice and was dealt with in three days. I am not saying that everyone gets that, I am not trying to pretend that there are not issues, that there are not waiting lists, although there are waiting lists that are substantially shorter than in many other parts of the UK. Surely the more important discussion that we should be having is how they spend on NHS services, including primary care in Scotland compares with other countries, because that would give us a true comparison. Or what are they doing that is different that we could learn from? There is no question that I think that the NHS has done an absolutely fantastic job. The experience that I just recounted about the last couple of weeks was even better during the midst of Covid. One instance that I will just quickly recall was a consultant seeing somebody I knew who had to have their gall bladder removed, an emergency admittance to hospital to afternoon, and said that, since he was on that night, he would do it that night anyway, the same night as being diagnosed. I am seeing how crammed that hospital was at the time, this was Glasgow Royal Infirmary, and I think that he had done an absolutely fantastic job. I just wish that we had heard more about that, the work that has been done in the NHS, and I just wish that we could have a realistic debate where the constraints operate in Scotland as they do in Wales, as they do in Northern Ireland, because of the way the UK is structured, we are at least acknowledged by the other parties, and I will be supporting the emotion in the name of Neil Gray, the amendment in the name of Neil Gray, when we come to decision time. Thank you, Mr Brown. We now move to the closing speeches. I call first Karen Mocchan, up to four minutes. I am pleased to close today's debate on behalf of Scottish Labour, and thank the Liberal Democrats for bringing the debate forward during their time. In reflection on the speech before me by the member, Keith Brown, I think that that is a key point that we do have short time when it is always the Opposition parties that require to bring forward, so I would welcome, Keith Brown, really putting some pressure on the front branches to have some Government time, real Government time to talk about these issues, because I agree, we should be talking about these issues. Members know that I appreciate the concerning impacts of Brexit and the Tory Governments that we have had, and I have said this many times in the chamber, so I do not pull away from doing that. However, it is fair for us to come to the chamber as Opposition and say that patients and staff are getting fed up with the SNP deflecting, blame, but probably more deflecting any responsibility that they have on how poorly things are going in the NHS for staff and for patients. If I am honest, I think that it is a key responsibility of back benchers to put some pressure on the front benches to try and talk about and take responsibility for things. The direction of travel that we find ourselves in regarding access to primary care is undoubtedly the wrong one, and it is piling pressure on parts of the health service that could do without it, as was mentioned by the mover of the motion, Alex Cole-Hamilton. Let us be clear, it is honest to say that targets to deliver 800 new GPs is not being met, and the evidence was brought forward by Sandesh Galhany in his opening speech. Waiting lists are dangerously high with many waiting in pain, and in primary care sometimes you cannot even get to speak to a GP. It is fair for the Opposition parties to bring that to the chamber. Mental health appointments are still extremely hard to come by for both children and adolescents, in particular. My colleague Paul Sweeney outlined that more or less the promise on this has been abandoned, so we must bring those points to the chamber. I agree with that. I see nothing wrong at all in the concerns that have been brought to the chamber. That was not my point. I am just saying that if we have a rounded debate, let us acknowledge why some of those things are happening, what the root cause of them. It is just a more rounded debate. I am not challenging your right to come to the chamber and raise those issues. I thank the member for the intervention. I think that we come at it from different directions. I think that I have been fair in my assessment of where we have come to, but we have to have a Government here in Scotland with a massive budget for the NHS and lots of staff to manage and support. The Government has to take some responsibility for that. I think that the member Beatrice Wishall put it very well when she said that this did not start yesterday. I think that the member gave a fair reflection of what has happened over many years before Brexit, before Covid. We need to be honest about those things. I can tell my time is running out in my own region because the cabinet secretary mentioned it about the concept of recruitment and retention. The reality is that he spoke about physiotherapists. In my area, we require physiotherapists, but our inability to recruit on to the original physiotherapy course to gain more physiotherapists far into the future lies at the door of the Government. The physiotherapy organisation has been trying to speak to you about how we recruit and retain more physiotherapists. Scottish Labour has an amendment and we are supporting the motion tonight and we would hope that people will support our amendment as well. I remind all the members that are participating in the debate that they should be here for open and closing speeches. There have been members who have drifted out of the chamber both during the opening speeches and now during the closing speeches, which are not acceptable. I will now call Tess White up to four minutes. Neil Gray has inherited an overflowing entree from disgraced Michael Matheson, who missed no less than 72 NHS-related targets set by his own Government while he was in charge of the health service. As we have heard this afternoon, the SNP Government looks likely to miss another of its flagship target of recruiting 800 GPs. In fact, the British Medical Association believes that not only is Scotland not on track to meet this commitment, we are going backwards. This matters because primary care is the backbone of the NHS. The majority of patient contact occurs in primary care. These services are being expected to take the pressure off of the parts of the NHS, which simply do not have the capacity to treat patients. GP practices are pivotal to the survival of the NHS, but under this SNP Government, patient numbers are up and GP numbers are down. Scotland has lost 10% of its GP surgeries between 2012 and 2022. General practice is chronically underfunded and underresourced, as we have heard today. Rural communities have been hit particularly hard because it is increasingly difficult to recruit and retain GPs. The GP practices are under an increased pressure for closure. It is little surprise that one of Scotland's top doctors has warned that general practice is dying a slow and lingering death. As the new health secretary gets up to speed with his brief, Neil Gray would do well to read the Scottish Conservative health paper. We have committed to raising the amount of NHS spending to GP services by 12%, and we would recruit an additional 1,000 GPs. Dr Sandesh Gulhane shed light on the flopped plans of the last three health secretaries against a backdrop of GPs with low morale due to an unmanageable workload. Sadly today we saw more deflection from the latest Cabinet Secretary, who, if according to Keith Brown is one of the strongest members of the SNP, let's see him start to put in place workable solutions to this crisis, rather than continue to lay the blame elsewhere as his colleagues do. Dr Sandesh Gulhane challenged the Cabinet Secretary and his colleagues for not passing on the £17 billion consequentials on the NHS and spending and wasting it on SNP green pet projects. Drs Gulhane is not precious about our policies, so the Cabinet Secretary could swallow the pride that he talks about and look at our workable solutions to give him a head start. The Cabinet Secretary looks frowns at me in this, obviously not looked at it. I would actually say we'll send you a copy. That would be a refreshing change rather than the deflection and cracked record and the smoke and mirrors that Alex Cole-Hamilton talked about in his opening speech. Tim Eagle in his maiden speech asked the Cabinet Secretary to listen to those who you serve and please do something now, listen and show you mean what you say to make general practice the heart of the healthcare system, and I quote your words to you. Presiding Officer, the Scottish Conservatives do have a clear plan to deliver a modern, efficient and local NHS. The SNP cannot preside over the permanent crisis in our NHS any longer. Thank you, Ms White. Just a reminder that remarks should be made through the chair. I call Marie Todd to wind up up to five minutes, minister. Thank you, Presiding Officer. Now, I only have a brief time to close for the Government, so I'm going to try to respond to as many of the points that have been raised as I can. As a mental health pharmacist, who spent 20 years working for NHS Highland Far from experiencing nationalist ministerial disinterest, as described by Alex Cole-Hamilton, I'm so inspired by the leadership of our health and social care system in Scotland by SNP ministers that I became one. Mr Sweeney raised the issue of the challenging financial pressures that we face and the impact on our mental health budget, an issue very close to my heart. Those pressures that we are facing are recognised as being some of the most challenging since devolution. Welsh Labour colleagues recognise that situation. I only wish that Scottish Labour colleagues would also recognise that situation. Of course, there is a lingering impact of Covid and Brexit, but so is there an enormously painful impact of Liz Truss's premiership. It might only have lasted a few weeks, but the impact of it will be felt for many years. No one here is charging the Government with not having to deal with a difficult financial position, but it is the clarity with which they are approaching those points that we have issued with. For example, community link workers, we know that they have a positive effect in avoiding unnecessary admissions to acute hospitals, yet they were about to be cut in Glasgow and we had to fight a defensive campaign. It's just one symptom of wider issue where the Government has found wanting on acting intelligently with the resources that they have. We absolutely recognise the value of community link workers. That's why we have invested in them. They have a record budget this year. The mental health directorate budget has more than programme budget, has more than doubled from 2021 to over £260 million. In fact, the investment by our NHS boards in mental health has also increased despite the difficult situation that we face. I welcome Tim Eagle and make his first speech a new representative for the Highlands and Islands region. I have had the privilege myself of representing the region and I wish him all the best in his work. Mr Ewing raised the issue of whether a bond can be applied particularly to rural practices. I would have to say that a form of this already happens for the successful ScotGem initiative that was introduced in 2018-19. Bursaries are available with conditions attached that can trigger repayment. Mr Rowley, I absolutely agree that we need to value social care staff. That's why I am very proud to serve in a Government in Scotland that has ensured that our social care staff are the highest paid in the UK. Not only that, thanks to our progressive tax reform, they pay the lowest level of taxation in the UK. I share his wish to go further and faster, but I am pleased that we are on a path to improvement. I am certain that Mr Rowley would join me in opposing the appalling treatment of care workers that is being proposed by the UK Government. Those people who come to this country to care for our most vulnerable people who are being singled out and denied family life—absolutely brutal, disgraceful and should shame each and every one of us. This Government sees primary care as the foundation of our health and social care system. The cabinet secretary has covered the work under way to increase and to retain our GP workforce in Scotland. We are also committed to reform the way in which general practice works through expanding that wider multidisciplinary team in general practice, including pharmacists, physiotherapists, community link workers and mental health practitioners, to name but a few elements. That additional capacity is also in turn allowing GPs to move into the expert medical generalist role, focusing on more complex care in the community, as intended through the 2018 GP contract changes. We are taking forward the work to develop multidisciplinary teams through the establishment of a phased investment programme over the next 18 months, with four demonstrator sites across Scotland showing us what the next phase of multidisciplinary team delivery would look like. Turning to mental health in particular, we have exceeded our commitment to fund over 800 additional mental health workers, many of whom are working in primary care and community settings, to develop a culture of mental wellbeing and prevention in local communities. We have invested £51 million in our community's mental health and wellbeing funds for adults since 2021. We have ensured access to counselling services in every secondary school and continued to support local authorities with funding for that. Following our record-breaking investment in CAMHS, 13 out of 14 CAMHS services in NHS boards in Scotland have effectively eliminated their long waits. That is to be celebrated. I know that we need to further enhance the support available in the community, both for mental and physical health. Primary and community-based care are priorities for this Government, and we are committed to continuing partnership working with our professional bodies to ensure reform, and our committed investment in the draft budget is configured for the needs of our communities. I hope that members can see that this Government is delivering on its ambition for a thriving, sustainable primary care, focused on both mental and physical health at the heart of our healthcare system. I thank everyone for taking part in the debate this afternoon, especially Tim Eagle, for a fine contribution. I thought that it was excellent, and he showed his passion, certainly, for Murray. He has a good grasp of the issues that are at play. The one bit of advice would not be to follow the leader of Sandish Gohani in failing to turn up for the summing up in the debate, but otherwise it was an excellent first start. One of the issues that he did specifically mention was about the long distances to get access to some care, especially around the maternity services and Dr Gray's. That was the bit of Beatrice Wishart's contribution that she was not able to squeeze in because she was far too generous to Fergus Ewing. That was about Jamie Stone's point in the far north, the maternity services from Caithness, women having to travel for hundreds of miles to get treatment. That strain must be incredible. Alex Rowley was right. I think that everybody in this chamber recognises the value of NHS staff. We have seen it at first hand over the past year, with far too many family members who have spent a long time in hospital. I have seen at close quarters the pressure that they are under. I think that there is no doubt that everybody here would thank them for the work that they are doing. That morning call to the GP is incredibly stressful. Repeated calls sometimes engage if they do not have the right telephone system, but repeated calls sometimes fail day after day to get an appointment. That adds to the pressure, the strain and the anxiety that people already feel because they believe that they have an important illness that needs to be addressed. Those long waits are adding to the problem, let alone the fact that something might be really urgent and they do not know it. That might prevent us from dealing with the early intervention that GPs often provide. Ivan McKee was bang on when he was talking about GPs being the gateway, the preventative service, the old-style family doctor. It was really important as part of the community. I know that it has changed and I am sure that everybody recognises that now the additional health professionals that are part of that multidisciplinary team that the minister has just talked about. We should encourage our constituents to try and accept the advice from the receptionist to go to another health professional and not just insist on seeing their GP because that helps alongside going to your pharmacy that often provides more direct support as well. Ivan McKee was right on that. I think that he was a wee bit wrong in blaming the Lib Dems for everything that they do with primary care, but I will accept that he is allowed to make some political points within that. The cabinet secretary did acknowledge some of the issues, and I accept the issues around Brexit. We were opposed to that, still opposed to it. The pandemic, we know that that has added to the pressure, we know the budgetary pressures that have applied to them. However, there was a bit too much, I have to say, of blaming everybody else and not accepting the responsibility for the inordinate pressures that are faced by primary care, yes, or taken into account. In the work that I am seeking to take forward in the reform that is needed across the NHS and social care services, I absolutely accept responsibility that we need reform in that service. I give Willie Rennie that assurance that the context is important around what we are operating within, but that I take very seriously my responsibilities to ensure that we have reform, to ensure that we increase capacity and productivity in our service. The problem that the minister faces is that we have had 17 years of this Government and promises of endless reform. I have to say that we are not really that much further forward. We have still got those long waits that I talked about trying to get access to GP in the morning. I talked about the waits for mental health treatment, and I know the minister saying that the very, very longest waits have almost been eliminated. However, there are still thousands of people that are waiting a hell of a long time to get access to mental health services, and that is adding to the problem. The thing that the minister did not refer to, and I think that we do need to get to grips with, and that feeds into what Fergus Ewing was talking about, is that GPs, firstly, retiring early and hardly any GPs, go their full term now. We need to make sure that we try to keep them for longer, but secondly, an awful lot of GPs are going part-time. That is a symptom of the pressure that they feel in their practices. We are into a vicious cycle. The GPs and all the staff feel the pressure, the demand increases, they go part-time, the demand increases more because of the pressure on the staff that are left. We have long-term problems with that, and I hope that the minister will try to address the issues around GP. The pension changes at the UK level will help a bit, but far too many have gone already. Paul Gray, the man who used to be in charge of the NHS in Scotland, gave the Government a warning some time ago that, irrespective of the pandemic, there were already deep-seated problems in the NHS, and I am afraid that the response from the Government has been wholly inadequate. It is not on track, according to the RCGP, on the recruitment of GPs. It is just not. In the past two years, there has been a decline. In mental health staff, we are not, according to Audit Scotland, on track to meet that, either. They say that the plan is at risk. The multidisciplinary teams have raised that before, but the minister said that there are pockets of the country where we are not able to recruit members of the multidisciplinary team. There has been a cut in-year budget on mental health, but that does not help either. We need action in terms of recruitment and retention. We need to explore the issues around the bond—a preferred carrot rather than stick—but we need to look at whether the bond is something that we should look at. Fundamentally, we need to look at the long-term problem that, although primary care deals with the bulk of the work in the NHS, it deals with most people, they get a fraction of the budget. We have not really shifted that dial enough. We need to increase the proportion now. It is not easy, especially if you have significant pressures elsewhere in the system. If we do not get into that bit that I have made— If you could conclude, please, Mr Reiny. Certainly, about the gateway, the early intervention and the prevention work, we are just going to add to the problems in the rest of the health service. Thank you. That concludes the debate on proving access to primary care, and it is time to move on to the next item of business.