 I'm required to remind members that social distancing measures are in place in the chamber and across the Holyrood campus. I ask that members take care to observe these measures, including when entering and exiting the chamber. Please only use the aisles and what we access your seat and when moving around the chamber. The next item of business is a debate on motion 1217 in the name of Annie Wells on the return to normal GP services. I would invite members who wish to speak in this debate to press their request to speak button now, and I call on Annie Wells to speak to and to move the motion. Ms Wells, up to seven minutes please, thank you. Thank you, Presiding Officer. I'm delighted to open this debate for the Scottish Conservatives regarding the motion before us today on the return of normal GP services. We on these benches have called on this debate today on an issue that is causing serious concern in communities across Scotland. Let's be clear that NHS staff, including GPs, have worked flat out every single day to keep our services afloat. Throughout the pandemic, GPs have demonstrated their incredible resilience, whether it be adapting to virtual settings or continuing to see the most vulnerable patients on a face-to-face basis. However, Presiding Officer, it is important to be clear that the NHS continues to be at crisis point, whether it be enormous A&E delays or ambulance service stretched to the limit or waiting times for diagnostic tests through the roof, many services are completely overwhelmed. I'm sure, Presiding Officer, that we were all astounded to hear the health secretary declare just this morning that people should think twice before calling on ambulance. Absolutely. She said that she's astounded in a tweet that was put out by the Scottish Ambulance Service yesterday. She said, and I quote, We're facing an unprecedented period of significant pressure, so please call NHS 24 or 111 or call your GP during the day unless it is an emergency. What I said, so is Annie Wells right or should we believe the ambulance service? Cabinet Secretary, you are the health secretary. You have influence in this country. People listen to you. So what happens if someone takes a medical emergency? Do they think about what you said and say, Oh, maybe I'll think twice about phoning? Thinking twice is not the solution to the crisis in our ambulance service. We also must acknowledge the severe staffing shortages that currently exist across much of Scotland's health system. Only last week, the head of the Macmillan Cancer Support Services in Scotland warned, as the number of people diagnosed with cancer is set to soar in the years ahead, we simply do not have enough specialist cancer nurses to meet demand. And for many battling cancer, having a nurse is a tremendous source of support, comfort and encouragement. Therefore, to hear warnings that we are set to see a perfect storm of a shortage of nurses coupled with growing demands is extremely concerning. However, amidst the array of challenges facing NHS Scotland, we on these benches are today urging the Government to act on the return of normal GP services. I'm sure most of us in this chamber have had concerned constituents getting touched to inform us that they, or someone they know, have faced struggles to access GP services, particularly those who would like a face-to-face appointment. It is no secret that, even before anyone had ever heard of Covid-19, general practice in Scotland wasn't exactly in peak condition, as highlighted by the BMA Scotland only last month. Between 2010 to 2020, there was a gradual decrease in the number of GP practices across Scotland. Meanwhile, the average practice patient list went up. That points to general practice in Scotland. That, in the decade prior to the pandemic, had been under increasing pressure to meet the needs of Scots. As the pandemic has placed untold pressure on NHS services, it is forcing more people on to GPs. I had GP contact me to explain the sheer pressure that they are experiencing because of unprecedented demand, exasperated by staff shortages across primary care. They told me that primary care is broken due to the increased even unsustainable pressure resulting from Scots waiting longer for secondary care. I made this point in the programme for Government debate last week that although more funding for the NHS is welcome, in many ways the NHS recovery plan is limited in tackling the huge issues facing our health service. Not least, a failure to deliver a network of long Covid clinics whereby this awful aspect of the virus has the potential to place further pressure on front-line services if not properly addressed. If we do not do what is necessary to get to hospital, to get hospital clinic and surgery waiting times under control, then GPs will continue to be overwhelmed with patients. With desperate patients also attending A and E to get treatment, as many feel they are left with no other choice, that could severely compound the pressure. People need help today, they need help now. As I am sure my colleague Dr Sandesh Gohani will speak to in his contribution, that is all the components to generate a brittle domino effect across the NHS in Scotland. Many medical conditions will continue to go undiagnosed and untreated, leading to tragic yet entirely avoidable consequences. Considering what health professionals have admitted, the pressures that we are currently seeing on the NHS are akin to the harshest months of winter, the domino effect could soon worsen if warnings are not heedied. Therefore, to reduce pressure on general practice and our front-line staff, the NHS needs a proper recovery plan, one with real substance and teeth to get it back on track. As I have spoken about, GPs are facing overwhelming demand, but what is also true is that video consultations should not become the default for patients who need to be seen face-to-face. Many in the communities across Scotland desire face-to-face GP consultations over appointments via telephone or near me, and that must be respected. I know that I am running out of time, but with that motion in my name today, the Scottish Conservatives are clear that we will support patients who need to get back to seeing their GP in person. If this Government is confident that its NHS recovery plan will help to tackle the backlog and waiting times, it will have no issue in supporting our motion and commit to set a target date for the turn of normal GP services. I move the motion in my name. I now call on Marie Todd to speak to and move amendment 1217.2. The last 18 months have been a time of unprecedented pressure in the NHS, as it has faced the biggest challenge of its 73-year existence. From the cleaners who adopted new cleaning regimes, through receptionists who adapted to a more virtual way of supporting patients, through primary care teams of nurses, physios, optometrists and others who helped to ensure a successful vaccination programme, to the GPs who helped staff Covid assessment centres and, with their teams, led their practices through the pandemic, we owe them all a huge debt of gratitude for stepping up when it really mattered. That is why the Cabinet Secretary for Health and Social Care wrote out to all general practice staff last week to thank them personally for their efforts. In our thanks, we should also recognise the significant contributions of other parts of the primary care system. That includes dentists, optometrists and community pharmacists, who adapted to new and safer ways of working to ensure that patients could access the treatment that they needed. I thank you for taking the intervention. During the pandemic, the other healthcare professionals, the optometrists, the pharmacists and the nurses, all saw patients face to face. Do you not believe that now is the time that GPs start doing the same? Let me be absolutely clear that any suggestion that GPs are not seeing people face to face because they do not want to is false, and I absolutely reject it. As our recovery plan set out, GPs' teams have often been working in constrained circumstances right throughout the pandemic, but they have seen patients face to face where there is a clinical need to. However, as we recover from the worst of the pandemic, I completely understand that some, particularly in our elderly population, want to see a GP face to face, and patient choice in a clinically safe and appropriate way is a critical part of our recovery. Public Health Scotland has recently published guidance on distancing and infection control measures in health settings that change the 2m rule to a 1m rule. Further operational guidance that was published last week 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. I expect those actions to lead to an increase in the number of face to face consultations. Some people will still prefer to have a near me video consultation or, indeed, a telephone consultation, and we will continue to promote choice. I accept that there is a need to rapidly increase the availability of face to face appointments in partnership with the profession. I firmly believe that the steps that we have taken in the NHS recovery plan, the revised physical distancing and IPC guidance, and the whole hearted support of the BMA, our CGP and the wider profession will allow us to do that as quickly as possible, but more importantly, as safely as possible. Of course, it is not just about ensuring access to services, but ensuring that those services are high-quality and inclusive for all of our communities across Scotland. We are working with our expert group to develop practical and innovative ways to improve access and care, including in our most vulnerable communities. We are looking at how we can bring more health care workers to vulnerable communities, helping to address issues around poverty, discrimination and injustice in access and provision of care. She is speaking a lot about communities. She wrote to me earlier this summer saying that the independent view for maternity services at Dr Gray's in Elgin would be with her in a number of weeks. We are still waiting. Has she received that report and when will local people in Murray hear the recommendations? I thank the member for that intervention. I have not received that report yet. As soon as I receive that report, I will organise meetings with Richard Lochhead and other interested local MSPs. Of course, we will relay that information to the community who are rightly very concerned about the services that they receive. Similarly, the health and care needs of our remote and rural communities need to be supported. That is why we are developing a rural centre of excellence to provide expertise and advice on the delivery of care in different rural, island and remote settings in Scotland. People need access to a wide range of services in their community and through general practice, both for their physical and mental health. Our GP contract plans develop jointly with the profession, focusing on recruiting a range of healthcare professionals in the community, such as pharmacists, nurses and physios, all backed by £155 million of funding this year. We are also going to create a network of 1,000 additional link worker staff over this Parliament that can help to grow community mental health and social prescribing. In summary, our pandemic response has driven the agenda on access forward at speed, and, as with any change, it takes time to adjust, adapt and find the right balance. The Government is committed to working with members, the public directly, as well as the British Medical Association and the Royal College of General Practitioners and other professional bodies to recover and strengthen our primary care services. They are the bedrock of our NHS. I move the motion, and Humza Yousaf's name. Thank you. I now call on Jackie Baillie to speak to and move amendment 1217.1, Ms Baillie, up to five minutes. Thank you very much, Presiding Officer. Yesterday we debated the extent of the crisis being experienced by the NHS, with services struggling to meet demand and waiting lists at a record high. Today we talk about GPs. Much of the attention so far is focused on acute care in our hospitals and with emergency services, but the truth is that if we are to resolve some of these problems, then we need to mobilise and resource primary care. We all value our GPs. In fact, we value the entire primary care team, practice nurses, health visitors, dentists, pharmacists and optometrists. All do an extremely important job in preventing and dealing with ill health, but they are often the first and enduring contact in a patient's journey. It is most unfortunate that the messaging from the Government has been so far confused, suggesting that somehow GP surgeries have been closed. In fact, GPs in their teams have been working really hard. I am afraid that you may have got to the right message today, but in your appearances on media beforehand, you have suggested that surgeries have been closed. GP teams have been working really hard. They are the ones at the vaccination centres, helping colleagues in hospitals with Covid patients and all the while dealing with their own patients. Primary care has adapted and evolved, and yes, there may be more telephone or virtual consultations, but if you need to be seen, then you should be given a face-to-face consultation. I recognise that parents want the reassurance of a face-to-face consultation with their GP. Clinically, it is important that some conditions need to be seen to be diagnosed, so virtual consultations should not be the default. GPs are operating to Scottish Government guidance, which wants a model of telephone consultations first. That has not changed, so it is ultimately up to the Government, and transferring blame to GPs is not right nor is it appropriate. I recognise the frustration felt by people over access to a range of services, which is never a reason to be abusive to staff who are doing their very best to help us to keep safe. We all need to acknowledge the failure of Government to support staff in primary care. This is not just a pandemic problem, but a problem that has been building over the past 14 years of the SNP's mismanagement of the health service. The NHS recovery plan fails to address the pressure on staff, and the lack of a coherent workforce plan to build capacity to match demands is more than disappointing, is a dereliction of duty. There was a promise to recruit an additional 800 GPs made in the last Parliament, but there is an urgent need for them now, not just by 2027. Many are retiring early because they feel burnt out, so what progress has been made on that? Multidisciplinary teams and GP practices were also promised, but progress on that has been at best extremely patchy. There is simply not enough physiotherapists and pharmacists in general practice. Again, another promised pre-pandemic that has not been met. Mental health workers are unlikely to be in place until 2026, five years from now. Let me briefly mention pharmacists because they have a contribution to NHS recovery, but the Government appears to be resistant to the opportunity, and I hope that that is not the case. If the Government extended the pharmacy first service, pharmacists could be the first port of call for many people, helping with diagnostic testing to reduce antibiotic use, dealing with blood pressure, type 2 diabetes and cholesterol testing. That would help to alleviate some of the load on GPs. Equally, they could play a key part in helping with the management of those on long-term conditions. I genuinely do not have time, I am in my last minute. Providing pharmaceutical care and creating the capacity for GPs to focus on acute presentations and reduce hospital admissions, more of that needs to be happening so that we use appropriately the entire primary care team. An equally brief mention of dentists, patients are told that they are open for business, but Government guidance means that they are only able to offer appointments to a small number of patients. Again, mixed messaging from the Government that leads to frustration for both dentists and their patients alike, and more and more people. They may be laughing, but that is the truth. More and more people are going private. The Government is effectively privatising the dental service by the back door. We all value the primary care team with GPs at their very heart. I think that primary care is key to the recovery of the NHS, but it needs to be resourced and the SNP has so far failed to do so adequately. Yes, we need to remobilise. Yes, patients want more face-to-face consultations, but the Government needs to be honest and manage expectations, and above all, they need to resource GPs in primary care so that they can play their full part in the recovery of the NHS. As the BMA said, we are open for business, but it is not business as usual. I move amendment in my name. Thank you. I call Alex Cole-Hamilton up to four minutes. I thank you very much, Presiding Officer. Like my colleagues across the chamber, I would like to start by taking this opportunity to pray tribute to the work done by not just our GPs but their practice managers, nurses and everyone who supports them. Also, in particular, for the role during the pandemic, many GPs that I know personally volunteered in the red zones of the Covid hubs. They were instrumental in the foothills of the vaccine roll-out. They are often the first stage on a patient journey when receiving a diagnosis for mental, physical and chronic health conditions. Like every other sector in our health services, the challenges that they have faced throughout the pandemic have been unprecedented. The pressure and skills required to be able to make a diagnosis and prescribe a course of action largely over the phone or through video consultation cannot be overstated. Whilst that was necessary during the pandemic, it is absurd that we cannot at least set a date for pre-pandemic activities in practices to take place. If you can go to a nightclub, an optician or a massage therapist, logic would suggest that it is safe enough for you to have an in-person consultation with your GP. I know many GPs who want to get back to that as well. The Scottish Liberal Democrats welcome the motion put forward by the Conservative Party this afternoon because it highlights a problem that the Lib Dems are becoming increasingly concerned with. Last week, my colleague Willie Rennie asked the health secretary if he would look again at the physical distancing requirements in primary care settings, and he was assured that the Government would do just that. Today, the Government's amendment is typical of their approach to our health service. Plenty of warm words but an absence of action. Where is the evidence of that commitment? I am cautious. I will give way to the health secretary. On two points, one Public Health Scotland published guidance last week, which reduced the physical distancing measures. When he said that we are not going to give an arbitrary date for face-to-face consultation, one will recognise GP's arcing patients face-to-face. Secondly, the BMA says that it would be absolutely wrong to set an arbitrary date. Who should we believe, him or the BMA? I absolutely welcome the intervention of the BMA on this point. It is the interruption in flow that the lack of face-to-face consultations that are causing a backlog and perhaps missed clinical signs that could lead to far more acute conditions going forward that the GP workforce is so keen to get back to work is normal. I recognise that people are being seen but they have not been seen in non-emergency situations. I am as cautious about Covid as any minister in the Government is, but I am deeply worried about the long-term and deep-seated problems that continue to exist in the NHS. The BMA has described GP's as being under huge and unrelenting pressure and of workforce having a real sense of feeling of demoralisation. That is not just because of the pandemic but of the long history that this Government has of poor workforce planning. It is all well and good for the Government to promise the introduction of more GP's to alleviate the strain, but they cannot be magicked out of thin air. It takes the best part of a decade to train an individual GP and the seeds of the workforce crisis were sown upstream by this Government a long time ago. We all know that this Government likes to create the impression that all of these problems are new, but the problems in primary care were well in place before the pandemic started. A recognition of the long-term problems would not go amiss from the health secretary. Yes, the Government must set a date for returning face-to-face services for GP practices, but it must also seek to improve the state of services that were offered pre-pandemic. Long-weights and a high-stress work environment might be normal in public sector stewarded by this Administration, but it does not mean that it is good enough. Increasing the workforce is part of the answer, but reducing the downward pressure on GP surgeries is key, particularly around mental health. The Scottish Government needs to increase the number of trained GPs in Scotland and embed more nurses, dieticians, physiotherapists and crucially mental health practitioners with GPs so that people can get a wider range of diagnosis, treatment and follow-up care in their community. That is how to reduce the burden on current staff and crucially, and to offer the level of care that everyone across Scotland deserves. Our NHS is in crisis. It is not simply under extreme pressure, as the First Minister and the Cabinet Secretary for Health and Sport say. The NHS in Scotland is overrun. It is crumbling from historic systemic failures of government to plan, resource, manage risk, listen and act. The writing on the wall was clear before the pandemic. Let us be frank. We need to accept the extent of the crisis. We should deploy strategies from learning from the failures, and we need a plan. I do not mean a headline number or some of cash, but a detailed plan that is underpinned by credible clinical pathways. I appreciate that this is no easy task, and I will illustrate why. Behind the stats of A&E waiting times and patients trying to get through to their GP, beyond the unedifying comments from the Cabinet Secretary of Health advising sick patients to think twice before calling for an ambulance, endangering life, your words matter in medicine. This is what is happening. This week, in my GP practice, the phones, as usual, were ringing off the hook. We have calls from patients who need to be seen in the pain clinic or get an operation, but with no appointment date in sight, they are quite rightly ringing up, desperate, pleading for help. However, there are also new patients who have developed a lump or bleeding, and they are trying to call us as well. It is demand on top of demand. Let us be clear, GPs are working hard. GPs are seeing patients. GPs up and down this country are pulling out all the stops, but GPs are overrun because the system is failing them. We need the capacity to be able to see more patients face to face. We never stop seeing patients face to face, but we want to see more. GPs see patients whose management would change from being seen, but there are patients we would love to bring in, such as an elderly patient who just wants to come in and be seen. However, the system is failing us, and we are being overwhelmed. Beyond my own practice, the picture around the NHS is absolutely shocking. Over 600,000 patients are waiting on hospitals. These are the same folks who are calling, wanting to know if the family doctor can do more—something—anything to help. I am afraid that sometimes there isn't, and so they go on suffering. That has a knock-on effect on accident and emergency, who face huge demand, such as a patient with persistent abdominal pain who just wants needs to be seen by a specialist. All the wild Covid cases are soaring, piling even more pressure on to our fragile system and its exhausted staff in wards and intensive care departments. Let's be frank. This is not a system that is simply under extreme pressure. It is an NHS in deep crisis. Two years ago, before the pandemic, morale was low, healthcare workers struggled through the winters, but things got a bit better in the summer, and we just coped. Now the pandemic has exacerbated the problems and brought them into sharp focus. There is a perpetual state of winter crisis. The conveyor belt is jammed, and let me explain. The NHS is a conveyor belt. I, as a GP, see a patient, and I either treat them or I put them on the conveyor belt to be seen in secondary care by the hospitals, and they are then treated, and they drop off the conveyor belt. What is happening now is that I am putting patients on the conveyor belt and they are going nowhere. They are still suffering, so quite rightly come back to me again and again. They are not getting the help they need. We need hospitals to start running capacity again. No, we need them in fact to run at more than capacity to catch up. We need more staff. As NHS professionals, myself included, we have no choice but to carry on because our patient lives depend on us. However, as a parliamentarian, I am calling on the Scottish Government to start producing details on how it plans to save the NHS under its watch. The system is failing our GPs, and we need help. A declaration of interest—I am a practising doctor and I refer members to my register of interests. I call Stuart McMillan to be followed by Carol Mawkin. Thank you very much. The Conservative motion in front of us is very short and simple, and I will read it to that status. The Parliament recognises that patients have a right to treatment by GPs and calls on the Scottish Government to set a target date for a return to normal activity in practices, including face-to-face consultations. That sounds very much what Douglas Ross said in the chamber on 1 September, and I quote, people cannot see their general practitioner in person. That statement, in fact, is inaccurate, as we have already heard the Sarther Noon, and certainly heard beforehand as well. Someone suggested a complete fabrication even, and it did surprise me that, on the very same day, Dr Gullhane MSP, someone whom I greatly respect, accused the health secretary of attacking general practitioners and causing his colleagues a lot of distress. He then suggested that his colleagues do not leave their posts, which would be an unmitigated disaster. Dr Gullhane, I agree with you, it would be a disaster of GPs left. I therefore suggest that the Scottish Tories, including their leader, stop spreading the truth about patients not being able to see their GPs. I thank the member for taking the intervention. I am sure that he will join me in giving her heartfelt thanks to her GPs right across the country. In Dumfries and Galloway, GPs are seeing more patients face-to-face than they did pre-Covid, but general practice is the front line of our NHS service. However, does the member agree that Nicola Sturgeon has failed to adequately resource general practice, given that she was warned about GP shortages as far back as 2008? Stuart McMillan. I certainly disagree with Mr Carson. I am sure that he is probably not going to be surprised with that. Dr Gullhane, on his comments yesterday, indicated that we are seeing patients in his practice on Monday. I welcome the fact that Dr Gullhane is doing such a thing. The GPs have been working tirelessly throughout the pandemic. They have been seeing patients face-to-face. To suggest otherwise is unfair to GPs and to their staff. GPs are not happy with the characterisation. I will do that a short extract from a GP in my area, after I wrote to him on behalf of some constituents. I quote, My complaint is that I feel that you and your colleagues are engaging in lazy politics. You know that we are working in a pandemic and you must be aware of the demands, yet, regularly, we receive emails from GPs and, I know from other practices, they have the same issue going over the same issues, i.e., when will you see patients face-to-face? We do see patients face-to-face and have always been doing so. Sorry, I have already taken one, I cannot. That goes back to the comments from Sue Weber earlier on and also from Douglas Ross on 1 September. The email conversation continued, certainly for a couple of emails, and then it ended. Presiding Officer, the email from this GP is clearly the one of frustration with MSPs spreading with truths, and there is no-one any favours to perpetuate that myth. Seeing the Tories in this chamber today once again making these claims highlights yet again the lack of regard that they have for GPs. Seeing the same amount of patients face-to-face is a different argument from how the debate should be framed, which is what I think the Tories should be attempting to argue. I know that the current situation does not suit everyone, and there is a demand to return to GPs face-to-face on a more regular basis. However, I also know from some constituents that they have appreciated the telehealth and e-health that has certainly been offered, and some of them actually do like it, but it does not suit everyone, and I accept that. It is clear that face-to-face appointments will be better for many patients, but the NHS near me video consultations will also be better for others. It was not that long ago that we are all clapping for the NHS. Sadly, the Tories certainly have already moved on to badmouthing the NHS and our GPs. I have been inundated with requests from constituents to return to face-to-face GPs consultations. For the most part, people simply want a feeling of assurance from a friendly face. After all, so many of our constituents, particularly older people, receive a great deal of social as well as medical support from their local GP practice, and it is understandable that losing that has been a real drain on so many lives. As such, I believe that, within the sensible confines of Covid regulations, we should be returning to face-to-face appointments. We do not expect that immediately. The public are simply asking for clarity around when that might be, and at the moment I have little I can tell them just to calm their concerns. At the same time, I equally understand why, with Covid cases rising and fears about the approaching winter, many still have concerns about returning to some form of normality. I agree then that we must be led by the science and a disciplined focus on utilising the proven methods that have limited the spread of cases in the past, but, in doing so, we have to be clear with the public about what that means. Thousands of people have been patient and stayed away from the NHS unless it is urgent. Doing so will undoubtedly mean that serious illness and disease have gone undetected. We have to let people know when they can get back to their doctors sooner rather than later. I want to work with the Government on that. As I am sure everyone here does, we will get that message out, but there has to be some direction from the top. In chorus with other colleagues, I would like to stress the amount of pressure and uncertainty GPs and practice staff have been under since March 2020. The public criticism of them is due perhaps to unclear communications, and that has made it worse. No one should be under any illusion that care is not being provided after all GPs and practice staff in the wider primary care team are supporting colleagues in acute care and also administering thousands of vaccines. In most cases, GPs and practice staff are working more than ever before, and with us comes burnout, fatigue and serious stress. We know that the BMA Scotland's recent survey of GPs revealed that two-thirds say that their current workload is unmanagable, and more than half say that it has got worse since the Covid-19 pandemic. In what sense does that suggest that the problem is under control? We seem to have stressed staff, patients worried that they will not be receiving the care that they need, and ministers seem to be unresponsive to the plight. This is a problem not just for the period of Covid, but one that could be damaging the NHS for years to come if we do not deal with it now. Let us be honest, the reality of staffing levels in local practices was a concern long before Covid had become a normal part of everyday life. This is just one chapter in the 14 years of the SNP mismanagement of the NHS. It is one that many staff raise concerns about in the years leading up to the pandemic. Had we listened, perhaps we might have a much easier road to recovery now. The member is closing. There should be a lesson about proactivity over reactivity. Let us not wait until something becomes a media scandal before we tackle it. I am not sure that Scotland can take this for much longer. We need to deal with this now. It could be a crisis that turns into a catastrophe if we do not deal with it at the moment. As well as all the other Opposition Bench speeches here today, it seems that the SNP has no idea what is going on out there with its constituents. Rural constituencies such as mine have been let down badly. Over the years by the SNP Government, there has been a lack of urgency in responding to a GP and health recruitment crisis on top of the pandemic, which has affected face-to-face consultations. Could I just finish my first paragraph? Thank you. It is no wonder that I am contacted regularly by constituents, particularly old and vulnerable people, with real anxiety over their worsening health conditions. I will give way. I thank the member very much for giving way. I was going to make the same point with the earlier speaker. Recruitment, retention and support for GPs has been an ongoing issue for some time, not just in Scotland but across the UK and indeed internationally. I wonder what specific suggestions the member has to take action in relation to that as our collegiate approach to supporting the NHS. If that is all Bob Doris has, this is a really desperate situation. We know that GPs have done a tremendous job throughout the pandemic, and I want to thank them like others have done today for their wonderful work. However, there is an inescapable problem. The problem is not you. Even before the pandemic, the SNP was failing general practice with underfunding and a lack of workforce planning. On workforce planning, I will give way to the cabinet secretary to give him the opportunity to tell the chamber today how his Government is progressing with GP recruitment. I am happy to have a target of 800 additional GPs by 2027. I am pleased to say that we are on track to meet that. I am delighted about our record investment in the NHS, which, of course, is £400 more million than the Tories pledged in their manifesto. Richard Hamilton Well, Presiding Officer, on track, I can tell you that it is 237, 800 by 2027, on track with 237. Interesting. There are also substantial issues with higher-than-usual A&E presentations, because the patient's condition is worsening. GPs are telling me that they are getting phone calls from patients who are just fed up because they cannot be seen by the hospital. It concerned greatly the sheer volume of correspondence that I am receiving from constituents. It is vital that we give our constituents the opportunity to return to person-to-person consultations. One of my constituents said, for me, that it is wholly unacceptable that representatives of medical practices can tell me that a medical practitioner will call me back at some time during the day without telling me when. Hanging around waiting for that call, which may not come until later in the day, is preposterous. That is just one of many who have shared with me their frustration the lack of access to appointments. It is having an impact and deteriorating their health. For the last 18 months, of course, we have seen GPs not being able to eyeball their patients. Whilst not proven, I believe that the lack of early intervention must be contributing to increased presentations at A&E. It is not just the lack of face-to-face appointments. It is also the constant threat on rural GP practice closures as a result of this Government's failure to properly conduct workforce planning and its obsession with centralisation. Just two weeks ago, Caldingham practice, which is at the east of my constituency, was branded not fit for purpose with challenges around recruitment, retention of staff, health and safety and, as a result, also loan working. For the benefit of the members in the chamber, with their fingers in their ears, in 2008, the BMA warned Nicola Sturgeon that Scotland was facing severe shortages of GPs. That was 13 years ago, Presiding Officer. It is absolutely a disgrace that it has not happened. In conclusion, I have taken a number of interventions. It is going to be a long winter. We all know that. Scotland's people want a pragmatic solution to this health crisis. Is it too much to ask the health secretary to set a date for return to normal activity and, furthermore, make a pledge to ensure that GP services will be protected and that recruitment targets will be met? Presiding Officer, I am pleased to be able to speak in this debate today on behalf of my constituents, very few of whom have contacted me on this issue. I listened to some of our colleagues today who have appeared to have this belief that, yes, Covid-19 is undoubtedly a disaster of unprecedented proportions, yet somehow it should not really have an impact on services. What a weird position and how alienated from both reality and to some extent honesty it is. It is also extremely disappointing to hear assertion after assertion based on extremely flimsy evidence and then not take a ministerial intervention and response. The Covid-19 pandemic changed the way in which it was considered safest for GPs to operate. The surgeries that are placed were potentially old people congregating waiting rooms. It makes perfect sense in the early stages of the pandemic to switch to more remote and telephone appointments if possible. This was an implementation of telehealth technology that had been a long time coming. As in so many other walks of life, the gains from that should not now be cast aside and the rush to return to what was once considered normal. I have used that method on far too many occasions during the last two years, one of the benefits of ageing, I suppose, and found that nothing but reassuring e-date and efficient at a time where I feared the exact opposite because of the unavoidable pressures being placed on our NHS, including our GPs, during the pandemic. However, I have also been seen face-to-face on more than one occasion, as despite what some of us believe, doctors can and will see you if they have the slightest concern about your condition. The Cabinet Secretary for Health and Sport set out the NHS recovery plan last month, and I draw the attention of members to that. It is an ambitious document backed by real investment in their health service to the tune of £1 billion over the next five years. An important part of that will be the recruitment of over 1,000 new mental health link workers in our communities to take some of the pressures off the front-line GP practices. I am glad that mental health continues to get the focus and resources needed in order to provide better help to the people in local communities across Scotland, and I welcome that step forward. I also welcome the assurances in the document that are returned to face-to-face GP services where possible will be happening as soon as it is practical and safe to do so. I have been contacted by some, just a few, who have been having difficulty getting these appointments. Although innovative telehealth solutions such as NHS near me video consultations are welcome, they do not always reach all the people in areas of higher deprivation, where access to the internet and internet-enabled devices may be harder for some people to come by. It is clear that there are still parts of the population who will not be able to access telehealth as yet, and I welcome assurances that priority face-to-face GP appointments will be given to people who are unable to access other means of obtaining GP assistance. The BMA believes that demand for GP services has been pushed to record levels during the pandemic, so I am pleased to welcome the additional investment by the Scottish Government of £155 million to provide general practices and their patients with support from a range of healthcare professionals and community, such as community pharmacists, so that people can have the prescriptions filled faster. That has been a time of tremendous pressure on GP practices across the country, and I think that we all owe them a huge debt of gratitude for the work that they have done and thank them for the contribution, helping to stay in Scotland through the pandemic. GP surgeries in Scotland have done remarkably well coping with the upsurge in demand for their services, while having to adopt a new way of working to ensure the safety and wellbeing of staff and patients during this unprecedented and difficult time, and I think that they deserve more than being criticised by somebody or position and used as a political weapon today. We'll thank you very much for that. It wasn't possible to intervene on Mr Dawn when he was speaking, but it's surely unparliamentary to cast the charge of dishonesty upon those opponents in the chamber. While members are responsible for the content of their own contributions, I urge members to remember that the code of conduct requires members to consider one another with courtesy and respect at all times. I now call Gillian Mackay to be followed by Claire Adamson. I, too, would like to pay tribute to Scotland's incredible GPs who have worked in an extremely pressurised and fast-changing conditions during the pandemic. The contribution of all practice staff has been immeasurable and they deserve our sincere thanks. What they don't deserve is any suggestion that general practice has been closed during the pandemic or that GPs have not been offering face-to-face appointments. I am seriously concerned about the tone of the conservative motion in that light. GPs have continued to deliver a 24-7 service, including out-of-hours, and have always offered face-to-face appointments when clinically necessary. As the Government amendment notes, GPs were asked to change the way that they worked due to Covid and they rose to the challenge. They rapidly adapted their ways of working, while also stepping in to help with the vaccine roll-out and staffing Covid assessment centres. There were GP workforce shortages prior to the pandemic, and, as we know, demand for GP services has risen considerably in recent months. People are now coming forward with conditions that emerged during lockdown and GPs are caring for patients who are on long waiting lists for secondary care. Contrary to what some may think, remote working does not reduce workload. Practice staff are tired, overstretched and demoralised, and I am seriously concerned about the impact of this debate on their morale. We cannot afford to undermine GP recruitment and retention, but the conservative motion has the potential to do just that. Instead of demanding that GPs return to doing something that they have been doing throughout the pandemic, we should be talking about how we can recruit more GPs and other members of the primary care team and how we can best support practice teams' mental and physical wellbeing to continue to deliver excellent patient care in very difficult circumstances. Thank you, Gillian Mackay, for taking that intervention. Would Gillian Mackay not really agree that the ScotGem programme is one unique way that the Scottish Government is taking forward GP recruitment and training in Scotland? Gillian Mackay? No, I would absolutely accept that and thank the member for the intervention. Of course patients should be able to get a GP appointment when they need to, and of course this appointment should be face-to-face if it is clinically appropriate. No one is denying that. Remote consultations are not appropriate in all circumstances, and that is also recognised for GPs, but for many patients they offer more flexibility and reduce the need to travel. According to the BMA, before the pandemic, approximately 20 per cent of GP appointments were by telephone or video, and the presumption that a return to normal equates to a return to all appointments being face-to-face does not reflect the reality of general practice before Covid. There should not be a one-size-fits-all approach, and the Royal College of General Practitioners Scotland is clear that a mix of telephone, face-to-face and virtual appointments is the future of general practice. We must also acknowledge that, due to on-going Covid protections, the physical capacity within GP practices is limited. If we rapidly increase face-to-face appointments, patients could face longer waits for appointments due to reduced numbers being able to enter the building. Patient safety is a serious consideration. For example, Asthma UK and the British Lung Foundation Scotland do not support setting a target date for a return to majority face-to-face appointments due to the on-going risk to people living with lung conditions from Covid-19. They have said that that could force people to miss out on treatment if they are worried about mixing with others in waiting rooms. I would like to end with a quote from a GP provided by the BMA, as I think it sums up why I have such serious concerns about the motion. They said that, and I quote, we have had a barrage of negativity from policy makers and smears from the media. General practice has been open all throughout the pandemic, and yes, we are seeing patients face-to-face every day—examining, investigating, immunising and treating. GP's deserve better and so do patients. They need us to be honest about the pressure general practices under and why services are being delivered the way they are, and I hope that members will reflect on that at decision time. Thank you. I call Claire Adamson, the last speaker in the open debate. Thank you very much, Presiding Officer. The pandemic has been with us for 18 months now, but for some people in this chamber, it seems to only matter to them when it is politically convenient. Colleagues on the Tory benches are blithly switching between the health service being in crisis and at the same time furiously opposing public health measures that the Scottish Government enacts to help that same health service at this time. They cannot sit both ways on that. Yesterday, in his speech, I said that we cannot get back to normal, we have to get back to better, and that is what we should be doing. However, the motion epitomises an attempt to make political capital out of a deeply complex and precarious situation. As legislatures and policy makers, we need to allow for nuance, we need to consider consequences and we need to seek expert opinion and listen to advice. We need to set a target date. It might sound out for a sound bite, but I am sure that the Covid virus is not working to a Google calendar. Does the member agree that the BMA Scotland's comments on not having enough GPs before the pandemic, do you agree with that statement? I do, and that is why we have set recruitment targets. However, as Mr Doris pointed out earlier on, this is not a problem just in Scotland, it is throughout the UK and globally a crisis for recruitment in GPs. The BMA has said that, but they have also said that this is a clinical problem of on-going need to protect vulnerable patients and staff from the risk of Covid-19. Current workload pressures within GPs mean that GPs, like the rest of the NHS, have to prioritise the time and meet the most urgent need. The BMA Scotland does not welcome an arbitrary target set by the Scottish Government. The Royal College of GPs has also said that it refutes as strongly as possible terms any suggestion that the general practice has not been delivering face-to-face consultations throughout the pandemic. It has been said many times, but since some of the interventions were to indicate that people have not read those briefings, I feel that I have to repeat them. Face-to-face consultations have been provided to patients where they are deemed clinical in excessly, usually following a telephone or video consultation. That has ensured that general practice can continue to provide care to patients to help to protect the most vulnerable patients. We would not welcome an arbitrary target set by the Scottish Government to reach such a position. That is a BMA and the Royal College of GPs. As someone whose sister is at a tiered GP, I felt that the Royal College is still examining them. When I was invited to take part in some projects with my local training GP practice, I was delighted to do so. For a number of years, I have been working with my local practice. That includes bringing GP trainees into this Parliament when it was possible to see the health committee, to come for a cup of coffee or perhaps go for lunch and to have a conversation about how the work that we do here influences what their work will be in the future and to show them the opening welcoming interaction that we want to have with our colleagues in the health service. During the pandemic, I was involved in a video call with the local practice and other training practices, as Dr Logan, who is involved in this, is the NHS lead clinical tutor primary care. I learned that in 2019 of the 300 medical students in Glasgow, only 19 were choosing an elective in GP. That is 6 per cent of them. That is an incredibly difficult situation, and to just make political capital with it in this place this afternoon is lazy politics, and it does no good to our health service from the folks at the NHS. We now move to closing speeches. I call on Paul O'Cain up to four minutes, please. Thank you, Presiding Officer. In closing for Scottish Labour, I want to echo the comments of other colleagues across the chamber and pay tribute to the GPs working in our NHS across Scotland, recognising particularly their dedication throughout the pandemic, supporting colleagues in acute care and helping to administer the vaccination programme, most notably to the oldest and most vulnerable in our communities. We should also take a moment to pay tribute to all those who support GP practices, the practice managers, the practice nurses, healthcare assistants and admin staff. Those teams working together, knowing their communities makes a real difference in the health and wellbeing of us all. I think that what we have heard in this debate this afternoon have been some of the frustrations and worries that have been experienced by patients, particularly where they have been unable to or have felt unable to access face-to-face appointments. We heard reference made by Jackie Baillie in her opening remarks to the confusion often in communication about whether or not GPs are indeed open. Carol Mawkin referred to constituents of her own feeling that they should stay away from their GP and stay away from the NHS. We have also heard from Sandesh Gohani about the capacity that is required in order to support GP practices and the pressures that exist at all parts of the system. We have to recognise that for many elderly patients, for patients who have a learning disability or perhaps due to communication or language barriers, digital justice is not accessible or always appropriate. Virtual GP appointments should not be the default. Patients and clinicians must have the option to have face-to-face appointments and always when it is safe to do so. Of course, we would acknowledge that technology has its role to play, but we need to consider, along with clinicians, the appropriateness of when digital appointments are offered. I note Gillian Mackay's contribution when she spoke about the British Lung Foundation. It has also pointed out the importance of ensuring that things such as diagnostic appointments and where patients have lung condition symptoms, that those people are seen as soon as possible in person with their GP so that that holistic view can be taken of what is going on in their life. We call on the Government to make clear what more can be done to support GPs to see more patients face-to-face. I again highlight the areas that were raised by Alex Cole-Hamilton and have previously been raised by Willie Rennie around physical distancing, particularly in smaller and more rural practices where space and waiting rooms is a concern and there is a need for perhaps, for example, improved ventilation. He will know that Public Health Scotland published guidance last week on reducing physical distancing. Is he suggesting that we should not be listening to the experts? Does he suggest that we should be reducing it and eliminating physical distancing altogether? That would be the concern. The point that was previously made by other speakers is that we need to look at that package of measures that can be put in place. For example, in smaller practice, where are people waiting? Where is it acceptable to wait? What are those spaces? What ventilation is put in place as well? We need to look at how we can increase capacity by doing a variety of things. It is clear that GPs and their teams are stressed and undervalued, and we have to recognise that. We have heard reference already to the survey from the Royal College of GPs reporting that 57 per cent of GPs working during Covid-19 have said that that has negatively impacted their mental health, and 58 per cent of respondents to their annual tracking survey have reported that they are so stressed that they cannot cope at least once a month. Many are leaving front-line practice altogether, leaving a job that they love because they just cannot do it anymore. However, we know that, as with other crises in our NHS, those challenges have existed before the pandemic and have been exacerbated by it. Indeed, the Royal College of GPs, the BMA and others have pointed out that the ongoing crisis in GP recruitment has been around for some time, and we have heard that reference today by colleagues. Indeed, Rachael Hamilton and Jackie Baillie certainly made the point that the promise to recruit 1,800 new GPs is nothing new and has not yet been delivered. In concluding, we would again point to the Government's sin recovery plan and ask where the detail is to support retention and increased capacity to ensure a sustainable future for primary care in Scotland, with the ill-being of patients and staff at the heart. I have listened closely to the debate today, and it is clear to me and a point of consensus and agreement that we all place a high value on access to our GP teams and those across primary care and indeed those that work within GP clinics up and down the country. Primary care teams have responded magnificently to the pandemic, ensuring that care is provided to those who need it and when they need it. I add my voice to the tributes that are rightly being paid to our GPs and our other primary care staff. Let me also unequivocally say that any abuse aimed towards our primary care staff is utterly, utterly unacceptable. I understand the frustrations that a number of colleagues across the chamber have spoken about their inboxes and the emails that they have received from constituents. I too have received those emails too, and I can completely sympathise and empathise with the frustrations that some patients may be feeling and not being able to see their GP face-to-face. Patient choice is crucial in accessing GP services, but that must, of course, be informed by the best and latest clinical guidance. We have to be mindful that we are still in the midst of a global pandemic. We are still contending with a highly transmissible variant of the virus, and that fact seems once again to be ignored by a number—not every, but by a number—of contributors. In fact, the Tory motion itself speaks of, and I quote, a return to normal activity. On the day that we have registered a further 30 Covid deaths, such talk is reckless as it is premature. Where I agree with colleagues across the chamber is that we also share their desire to increase the number of face-to-face consultations. There has been some significant disinformation during this debate about the scale of the Scottish Government investment and our primary care workforce, so let me correct some of those inaccuracies. It is the SNP who promised and are delivering record funding for our NHS. It is the SNP-led Scottish Government who have committed to primary care and GP services receiving a greater share of NHS front-line investment over this Parliament, an increase of 25 per cent. It is this Government that has increased that spending to £250 million. On that note, I am happy to give way to Finlay Carson. We have focused a lot on recruitment, but does the cabinet secretary recognise the comments from the BMA that the NHS recovery plan contained worrying gaps, including the crucial omission of any plan, to retain current NHS staff? It is a good conversation with the BMA, and I thank Finlay Carson for raising what was an important point. I had a good conversation with the BMA about retention, and we have decided to continue to work together to see how we can retain the workforce, because Finlay Carson makes a good point. Recruitment is important, but retention is important. We are, of course, increasing our workforce. We are increasing the number of GPs, the number of paramedics, the number of mental health workers, community link workers, paramedics, all of that backed by Scottish Government investment. Our GP workforce is at record levels. We have more GPs per 100,000 than any other part of the UK, and it is quite stark. We have 94 GPs per 100,000—England 76, Wales 75 and Northern Ireland 72—so we are continuing to invest in our GPs and in our workforce. I have also personally met, as I have already referenced, the BMA and the Royal College of General Practitioners. The cabinet secretary agreed that the SNP's GP contract that was put into place not only harmed rural practices and reduced the help that it got and made patients travel extraordinary distances but has not been delivered in areas around the country and has made things worse. I do not agree with that characterisation at all. Again, Dr Gohani forgets the fact that we are in the midst of a global pandemic. Some of those issues around the GP contract have undoubtedly been affected by the global pandemic. Let me come to Dr Gohani. I ask the members to try to listen if they can, as opposed to shout from a sedentary position. I have personally met the BMA and the Royal College of General Practitioners. From his register of interests, Dr Gohani is a member of both. Of those professional bodies, he has been conspicuously silent about what they have said about the Tory motion in front of us. They have said unequivocally that the Tory demands to send arbitrary date for increasing face-to-face appointments is wrong. So who does Dr Gohani side with when it comes to decision time tonight? The professional body that he is a member with or does he tow the party line? In fact, he himself said that we have phones, videos and can be sent pictures. That means that if you are a working person and I am quoting him, you do not need to waste your morning coming in to see me, we can be in touch remotely and I can give you the help remotely. When talking about that technology, he said that because it happened so quickly, this has led to consternation and people asking, why can't I see my GP this week? Well, you can. So Dr Gohani, do we believe the August edition of Dr Gohani or the September edition of Dr Gohani? You cannot have it both ways. Cabinet Secretary. I will end by this winter while I undoubtedly bring its share of new challenges, but I am confident that collectively we can meet those. I thank all of our NHS staff, our primary care staff, for their incredible efforts during the pandemic. I am pleased to move the motion in my name. I call on Craig Hall to wind up the debate up to six minutes, please. Thank you, Presiding Officer. Today's debate has shone a stark light on the problems facing Scotland's hard-working and dedicated GP surgeries. Too many patients, though, cannot contact the local surgery, let alone get an appointment with their GP. When they do get an appointment, too often that appointment is virtual, even when the patient would like a face-to-face consultation. Years of chronic underfunding and the Government's total disregard for workforce planning have led to a systemic failure, which has now come back to bite SNP ministers. Yes, Covid has given the SNP a cloak to hide behind, but as many patients and front-line practitioners are only too well aware, the problems facing Scotland's GP provision predate the pandemic. Years of SNP cuts have eroded morale among general practitioners, and their staff. The on-going failure to train and recruit GPs into the service—I have just started, so I won't. The on-going failure to train and recruit GPs into the service has created the perfect storm that we see today. Pressure has now grown to the point where many GPs want to leave the system entirely, sometimes only a few years into their new careers. And yet today, there is no hint of an apology from this Government. An army of over 50 spin doctors, funded by the public purse and more ministers than ever before, and not one, not one of them, has the word sorry in their vocabulary. Today, we have heard some valuable and insightful contributions. My colleague Sandesh Gulhane, himself a GP, told this Parliament that the Government's mismanagement of primary care is shocking. Jackie Baillie said that we urgently need to remobilise and resource primary care services. Annie Wells warned that the Government must now do whatever is necessary to get hospital clinic and surgery waiting times under control. Otherwise, GPs will continue to be overwhelmed. Alex Cole-Hamilton noted that many GPs wanted to get back to routinely seeing the patients. I really appreciate you giving away Mr Hoy. I am just wondering if the cabinet secretary talked about Mr Gulhane saying that we have phones and videos and we can be sent pictures. I am just wondering if Craig Hoy agrees with Annie Wells' motion that we need to get back to the normality of face-to-face. Or, if he agrees with Dr Gulhane, in a mixed model, is what we need to do going forward. Craig Hoy, forgive me, I thought that she might be getting up to apologise on behalf of the cabinet secretary, but clearly not. The solution is a hybrid system, and that is what we are arguing for. Let me talk directly to GPs. Will Craig Hoy agree with me that we need to have telephone videos and face-to-face appointments? Will he also agree with me that we GPs would love to see more people? Will he also agree with me that the GP contract was in place in 2018, way before the pandemic started? Craig Hoy. Thank you, Dr Gulhane. Let me speak directly to GPs. We are not blaming GPs for the fact that not enough patients are being seen face-to-face. We are blaming the SNP Government for the fact that SNPs do not have enough capacity to see their patients face-to-face. However, that is not just a capacity issue. GPs have been given no clear guidance on how and in what circumstances face-to-face appointments can routinely resume. GPs and their patients up and down the country urgently want to know when something resembling normality will resume. Asked of patients have the right to see their GP face-to-face, the cabinet secretary for health said only when it was clinically appropriate. Perhaps the cabinet secretary can tell the elderly man, worried about his wife, who is writhing in pain, what clinical appropriateness actually is. When will ministers realise that their job is to give leadership and confidence to patients and practitioners as we emerge from the Covid pandemic? Prior to the pandemic, around 1,200 video consultations took place each week on the near me platform. It is now running at 12,000 per week. Tele and video conferencing suits many patients and practitioners of that we should be in no doubt. However, while the system is called near me for too many vulnerable or elderly people— Mr Hoy, can I just ask you to pause for one moment? I am aware of conversations taking place around the chamber and I would ask members to remain in their seats while the debate continues, Mr Hoy. No problem. However, while the system is called near me for too many vulnerable and elderly people, the model of healthcare is simply too impersonal and too far beyond its reach. At the height of the pandemic, people were rightly anxious about the prospect of inpatient appointments. As other services shut their door to patients, GPs worked on and demands on their surgeries and staff reached record highs. However, many patients dropped out of the system. They were unable to get an appointment or reluctant to e-consult. Now they are representing, with significantly more serious health conditions, only a matter of months later. The Government's feeble and flimsy NHS recovery plan fails to get to the heart of the problems that are facing our NHS today. The Government is in denial about the problems that it has created, and they are in denial about the critical recruitment and retention crisis across our NHS. Our NHS needs a bold, wide-ranging, ambitious and urgent recovery plan, not the back of an envelope effort that we have seen from ministers. Our health service needs significant investment and greater understanding of workforce challenges, but, after 14 years of SNP neglect, we will not get that from those ministers, nor will we get that from this failing SNP Government. That is why I urge Parliament tonight to support the motion in the name of Annie Wells. That concludes the debate on the return to normal GP services, and it is now time to move on to the next item of business.