 The next item of business is topical questions, in order to get as many people in as possible short and succinct questions and responses would be welcome. I call Sue Webber. I would like to ask the Scottish Government whether it will provide an update on the use of face-to-face GP appointments. I take this opportunity to thank our hard-working GPs for all that they have done before the pandemic, but, crucially, the good work that they have done during the pandemic. Public Health Scotland is publishing guidance on distancing and infection control measures in health settings. They will be doing that to change the two-metre rule to one meter. That means more potential space for patients in waiting rooms, where, of course, that is appropriate, while continuing to ensure that everyone is kept safe. In light of that, joint NHS and Scottish Government guidance for general practices will be published later today. That is an important step in getting more in-person appointments in primary care. Today's guidance also makes it clear that there is no longer a need to triage every patient, although GPs and clinicians should continue to screen patients for Covid before seeing them face-to-face. It contains resources for practices to help to improve their communication with patients as well as access arrangements. We are facing a postcode lottery with patient experience in terms of trying to access their GP. While patients are permitted to have face-to-face appointments with practice nurses and other health professionals, GP appointments have been limited to phone calls, which in some cases have no specific time to call back. With reports at the weekend of a new contract signed by NHS Scotland to expand those types of consultations, many patients are worried about access. We know that, for many conditions, early diagnosis is crucial, yet so many patients are not able to get access to their GP. Does the cabinet secretary believe that Scottish patients have the right to see their GP face-to-face? Does today's guidance give us a date as to when they can expect that? I agree where that is clinically appropriate. I am disappointed that Ms Webber did not take the opportunity to thank our GPs for the hard work that they have done over the pandemic, because it is not from a lack of hard work. Our GPs are working incredibly hard as they have done over the past 18 months. What I would say to Ms Webber is that because of the appropriate and clinically advisable IPC controls in place, that is why digital solutions such as the near-me video consultation have been used. Yes, I agree with Ms Webber that patient choice is absolutely critical. Therefore, the guidance that is published today will help to increase, I would suspect, and I would hope more face-to-face appointments. However, the near-me video consultation and digital platforms have been well used. We have seen in excess of 1 million appointments held using near-me since the beginning of the pandemic, but I recognise that our recovery plan lays us out in black and white. That face-to-face appointments can help us with some of the acute pressures that we are facing in our hospitals. I suspect that, like everybody else in the chamber, I would like to see more face-to-face appointments. I hope that the guidance that we will be publishing will help in that respect. As I mentioned earlier, accessing healthcare is a problem right now for so many patients. With many unable to access their normal healthcare routes, like going to their GPs, they are simply returning to our A and E services. For the last four weeks in a row, we have seen the number of patients not being seen within four hours at our A and E, hit shocking new highs. With Scotland's largest health board, Greater Glasgow and Clyde, it is now telling people not to turn up unless it is life-threatening. What is being done to tackle these waiting times now, and as we move into the critical period of winter, what planning is under way now to ensure that we do not see a future A and E winter crisis? First of all, I would say to Ms Webber that clearly we are under pressure. Every single health service right across the world, I suspect, but certainly across the UK is under pressure. She is absolutely right. A and E waiting times and target times are not being met. That is, of course, deeply regrettable, but I cannot magic away the effects of the pandemic. Those are effects that are being felt right across the rest of the UK. This is no consolation to anybody who has had to wait more than four hours, but our A and E continues to perform better than any other A and E across the entire UK. We are taking immediate action. £12 million has gone to health boards to help with the immediate pressures. I hope to see some response to the current crisis that we are facing. In terms of the autumn-winter pressure, I can give an absolute assurance to Ms Webber. If any member of the chamber wishes to have more detail of our autumn-winter planning, that planning started months ago. We are very concerned about winter because we suspect that we will see challenges around flu, we have already seen challenges around RSV, and of course autumn-winter generally sees more trips, slips and falls too. We are concerned, but we are already investing to make sure that our workforce continues to be not just at record high levels but the best-paid in the entire UK. I would like to take the opportunity to thank our GPs and acknowledge the importance placed on high-quality care and general practice where GPs have time to nurture and maintain relationships of trust with patients. According to a recent BMA survey, one-third of GPs are considering taking early retirement. In relation to the Government's remobilisation plan, Dr Lewis Morrison, the chair of the BMA in Scotland, has said that the plan has worrying gaps, including the crucial omission of any plan to retain current NHS staff. The plan states that we have 800 new GPs by 2026 or 2028, depending on which paragraph you read, so will the cabinet secretary clarify that target and outline what action will be taken in this current crisis to retain GPs and ensure sufficient capacity for people to see their doctor? Mr O'Kane raises some really important points. Many of them, which I agree with, retention is clearly going to be a key strategy and is a key strategy that is part of our NHS recovery plan. In terms of the current workforce, the current GP workforce is at record levels, 5,134 GPs, and we remain on track to meet our target of 800 additional GPs by 2027. The minister creates the impression that all those problems are new, but the problems within primary care were deep-seated well before the pandemic started, so a bit of recognition of the long-term problems would not go am this. I am concerned about the continued physical distancing of 1 metre. It is welcome that it has moved from 2 to 1, but it restricts the options for GPs to see some patients in person, even though that might be the best thing for them. We do not look again at the physical distancing rules in primary care and justify why he thinks that it is appropriate to continue, because it is not all about Covid anymore. There are other issues. I am as cautious as any minister in the Government about Covid, but I am deeply worried about the long-term and deep-seated problems that continue to exist within the NHS. Many of the actions that we have taken were pre-pandemic in terms of the increase in the level of GPs, the record staffing level that we have invested in and funded, so we have taken action pre-pandemic. Equally, I would say to the member—I know that he knows this, of course—but it is worth reiterating that the pandemic has been the biggest shock that our NHS has ever suffered. It is going to take investment but also time, and that is why our NHS recovery plan is, of course, ambitious but also realistic in its time frames. Yes, I will look again at the physical distancing, but what I would say to Willie Rennie and I know that he understands this is that we take advice from public health experts and clinicians. Yes, we challenge them robustly, but ultimately it is important that we take that clinical advice but also take soundings from patients, absolutely, but also stakeholders such as the BMA and the Royal College of GPs. He has asked me to look at that again. I promise him that I will do that. Clearly, restoring more face-to-face GP consultations as quickly and safely as possible is absolutely vital, but there are many people who have welcomed the opportunity to use e-health and telehealth solutions like near me to contact their GP. Can the health secretary confirm that these new avenues will be maintained after the pandemic for those who choose to use them? Cabinet secretary, thank you. Yes, absolutely. I think that it is a really important point by Gillian Martin. A number of surveys that have been carried out have shown that a significant majority, in fact, in some of those surveys, of people prefer to have a telephone appointment or indeed a video consultation. I myself, a couple of weeks ago, I mentioned this at committee this morning, I was able to phone my GP to get, when I had an eczema flare up, to get the appointment that I needed. It was all done without having to disrupt my work. I could do it in between calls and made life easier for me. That is not the case for everybody. Clearly, many people, in particular demographics, would like a face-to-face appointment. Having that mix of both near me, having the video consultations, telephone consultations as well as face-to-face appointment, having that hybrid mix of options, is certainly something that I am keen to maintain. To ask the Scottish Government what its response is to the on-going industrial disputes with ScotRail. First, I want to reiterate the Government's recognition and appreciation of the contribution that all our rail workers made during the pandemic to keep rail services operating. There is actually only one dispute currently impacting ScotRail services on a Sunday. As part of agreed working conditions, all rail staff who work on a Sunday receive an enhanced payment. The current dispute concerns enhanced payments for working rest days. That arrangement made between the RMT and ScotRail provided an additional time-limited enhancement for ticket examiners and conductors, largely in acknowledgement of the extra work that existing staff were undertaking while ScotRail recruited and trained additional staff to minimise the requirement to work rest days. Now that there are 140 additional ticket examiners and conductors, the issue of excessive rest day working has been resolved. I understand why the unions and workers might want to make that additional allowance permanent, but it simply is not sustainable in the long term. I know that one group of RMT members has now voted in support of extended the current industrial action, but I would encourage settlement of this dispute. Any cancellations as a result of industrial action not only have the potential to undermine the recovery of our rail services, but also to impact on vital revenue streams from ticket sales. Industrial relations on Scotland's railways are at an all-time low. That is a damning indictment of abeilio's treatment of key workers, who kept Scotland moving and a damning indictment of this Government too. They are leading Scotland into COP26, with growing unrest on the railways, and the prospect of strikes bringing Glasgow to a halt. It is a national humiliation and a failure of leadership from this Government. The minister must get a grip and get a grip now. Why is he not intervened to ensure a satisfactory resolution to six months of RMT action and overtime bans? Will he intervene to ensure that ScotRail disputes with engineers who have voted overwhelmingly for strike action last week is resolved? Why does the transport minister believe that industrial relations knows dived in the final months of the abeilio contract on his watch? In regard to negotiations, those are a matter between the transport operator and the trade unions. However, I have had a number of discussions with both the abeilio and the trade unions, and I have encouraged every constructive effort to be made to try to resolve the situation. However, we cannot continue the situation with the funding that is going into rail at the moment. To make the chamber aware, pre-pandemic Scotland was spending circa £1.1 billion a year on its railway. That covers all aspects, including investment. Currently, because of the money that we have put in because of the pandemic, that has risen to around £1.5 billion. That is simply not sustainable. However, what we have done is encouraged the unions and management to come together in a constructive way to identify efficiencies from both sides that could be used to fund reasonable pay increases. I reiterate that point today. It is a matter for the operators and the trade unions, but it is also a matter for the transport minister and the Scottish Government. The Scottish Government and taxpayers are paying ScotRail for a seven-day-a-week service and getting six days at the moment, because ScotRail does not have the workforce to cope with an overtime ban. Workers' terms and conditions are under attack. Jobs and services are being cut. ScotRail will not rule out compulsory redundancies. Key workers are not getting the fair deal that they deserve, and neither are passengers who cannot even get replacement bus services on a Sunday. Abeilio is making a mockery of the Government's commitment to fair work. As are five SNP MSPs who have done nothing to resolve that dispute and who shamefully blame disruption on Scottish workers for exercising their rights instead of ScotRail's intransigence. Who is the Government on? The workers defending their jobs, conditions and services for passengers or unreasonable bosses who, in the advent of COP26, are wrecking our railways? The Government is on the side of delivering a sustainable rail service for the future and protecting the jobs of the employees. However, that is a time for everyone to act responsibly, a time for recognising the challenges that we face on the rail and finding a way to build back from the pandemic in a manner that delivers a more sustainable and efficient service that is ready to meet future demand. Everyone includes Labour. No politician can expect to be regarded as credible if they are arguing as Labour appeared to be and have been over the last week, that at a time when public finances all around face extremely significant challenges, we continue to subsidise the pre-pandemic pattern of rail service, regardless of affordability and usage, and we meet the cost of pay claims without seeking to achieve that by delivering efficiencies. Presiding Officer, we all aspire to have an efficient and sustainable rail service, and we all have a responsibility to help the delivery of that. Cuts to services, a dispute that has now passed 130 days, 90 per cent of Sunday services cancelled, engineers now threatening strike action and the looming threat of this continuing when world leaders visit rat-infested SNP-run Glasgow in November. All this happening on the transport minister's watch, when is he going to take control and get this sorted? Presiding Officer, a typically pejorative contribution from Mr Simpson. Let me share with the chamber that behind all of the rhetoric that is going on around this dispute, and I agree that the unacceptable nature of no Sunday service for passengers, but behind the rhetoric, there are moves behind the scenes to try and resolve some of these disputes. There is a meeting taking place today with one trade union in the Beilio, and I know that there is another one planned for later in this week, so every effort is being made within the constraints that I have highlighted to bring this to a conclusion. Mark Ruskell. It does appear that we are now in a perfect stone with COP26 disputes, timetable changes that are rocking the confidence of workers and the travelling public, but next year ScotRail will pass into public sector ownership. What kind of best practice from the public sector in terms of industrial relations, fair work, patient negotiation and consultation can be brought to the new franchise? Mark Ruskell makes a very fair and reasonable point, and that is where we aspire to get to. I hear groans for the Conservative benches, but it is the most constructive contribution that we have heard this afternoon. The model that we want to deliver is one that protects the jobs of workers, delivers fair wages and has negotiating protocols in place, which allow them rightly to seek a reasonable pay increase for their members. All that can be achieved with a reasonable and proportionate approach from all sides, and that is what we want to deliver going forward.