 The next item of business is a debate on motion 6702 in the name of Gillian Martin on behalf of the Health, Social Care and Sport Committee on inquiry into alternative pathways to primary care. I would invite those members who wish to speak in the debate to please press the request to speak buttons. I call on Gillian Martin to speak to and to move the motion on behalf of the Health, Social Care and Sport Committee. Up to nine minutes, please, Ms Martin. Thank you very much, Presiding Officer. I move the motion in my name, as the convener of the Health and Social Care and Sport Committee. I'm pleased to open today's debate on the committee's inquiry into alternative pathways to primary care. I want to thank everyone who engaged with the inquiry, whether it was through the call for views, the public survey or informal or informal evidence sessions, and being able to engage with so many different people in so many different ways, as we always try to do in the health committee, has been invaluable in helping us to reach our final recommendations. The primary care services are the front door of the NHS, and when a person seeks healthcare, their first point of contact has traditionally been with a general practitioner. Our inquiry, however, focused on the other routes to accessing healthcare in the community, which we, for the purposes of our inquiry, in a report termed alternative pathways. Those various pathways can include seeing a different and often specialist health practitioner located in the GP practice or in the local community—for example, a physiotherapist, urgent care practitioner or a nurse. A patient's route to treatment may be through social prescribing, which aims to improve health and wellbeing through activities such as talking therapy groups, social and physical activity groups, run by the third sector, or even volunteering themselves. There is also the option to use helplines, online services to access additional information or therapy. Of course, there are pathways on our high streets where Government-funded specialist healthcare is offered via pharmacists, podiatry, optometrists and hearing services, for example. Government vision is that people needing care are informed, empowered and able to access the right professional at the right time. The committee supports those primary care reforms and the Scottish Government's vision to widen the primary care pathway. We found through our inquiry that there are a number of obstacles in achieving that vision. Those include limited public understanding of primary care reform and what it means for them. Workforce and capacity issues facing non-GP primary care practitioners. Poor signposting to alternative pathways, including inaccurate information about locally available community services. Digital exclusion of certain people in our society and variable ability of digital health and care services. And patient record systems that do not align with one another with shared data that is easily accessible by multiple healthcare professionals working with shared patients. The evidence submitted to the inquiry suggests that primary care reform and the reasons for it are still not well understood by the public. Many people still expect to be able to see their GP for absolutely every single health issue, no matter how minor. Unlimited public awareness about primary care reform seems to be the main cause of that. Some of them, when they are presented with that idea, can often say that they feel fobbed off when, in fact, they have been directed to the right type of care. One witness told the committee that there has been a failure in getting over to the public that general practice is changing, why it is changing and why it needs to change. What will be put in place to ensure that healthcare needs are fully taken account of? It is imperative that the public understand the reasons behind primary care reform. Rather than preventing them from seeing their GP, it is about making sure that they get quick and easy access to the best person to support their needs. Until that is understood, there will continue to be issues with the public making proper use of the alternative pathways. The Cabinet Secretary for Health and Social Care told us that the Scottish Government has undertaken public information work to inform people about primary care reform. While the committee welcomes that, we believe that more must be done to increase the general public's understanding of the reform and what it means for them. We recommend that the Scottish Government implements a co-ordinated communications plan to look at where that awareness is not there and to address it. That includes targeted national and local elements to be accompanied by a robust methodology for monitoring and evaluation of those communication efforts. The Scottish Government's intention is that the shift to multidisciplinary working will reduce pressures on services and ensure improved outcomes for patients, while freeing up GPs to spend more time with patients with acute conditions or urgent health concerns in need of their expertise. As such, a key aim of our inquiry was to establish to what extent primary healthcare professionals other than GPs have the capacity to take on more patients and accommodate an increase in referrals. Refocusing GPs to take on an expert medical generous role is contingent on the recruitment of a range of practitioners into multidisciplinary teams or MDTs, as I will refer to them from now on. From the start of the Covid-19 pandemic, Audit Scotland reported that health and social care partnerships were having difficulties in recruiting and retaining practitioners within the GP practice MDTs. The inquiry also highlighted the shortage in available capacity in non-GP primary healthcare professions, including pharmacy, audiology and psychiatry. Some bodies, such as Optometry Scotland, claimed that they had untapped capacity and the ability to take on more referrals. Of course, we did not have every single discipline in front of us, so I wonder how many more are out there, such as Optometry Scotland. The committee has concerns in the short term that workforce constraints and recruitment delays will limit the capacity of those non-GP professions to take on those increased referrals. The danger is that, if those referrals are not successful, your patient may not want to use alternative pathways in the future and will revert back to their GP. The committee firmly believes that the better recruitment and retention of professionals is crucial to the access of alternative pathways, notwithstanding the workforce pressures that we all know about. I also want to say that accelerated training and recruitment to increase workforce capacity is essential to this, but also to make these varied career routes known to young people who express an interest in healthcare as early as secondary school. I move on to what we have termed for ease of reference the single electronic patient record. This is long been seen as having the potential to transform multidisciplinary team working, given people consistent access to the best care by allowing seamless transition between services. Throughout this and other inquiries that we have undertaken, the committee has heard that access to data across different health specialities can be difficult, inconsistent and time-consuming, leading to frustration for practitioners and patients. There was broad agreement among many contributing to the inquiry for a need of better integration. The cabinet secretary said that work is already underway to produce a single patient electronic record, but we noticed that it is incumbent on him and the Government to accelerate that work. As the reports have been out there, I have appeared on quite a few round tables on this issue. It might not be a single record, but a single interface, which leads to systems being tied up. Maybe we need to calibrate our language around that. Practitioners should not have to log into multiple systems that do not talk to one another. Patients should expect that a range of clinicians who treat them should be able to see the right information about the patient in front of them. A patient should not have to recount their story over and over to different people. That could be, as I said, a single interface that brings together records. The commitment to do that is most welcome. In conclusion, I welcome the cabinet secretary's response to our report working together to address those challenges. I hope that, even by doing this inquiry, we have put out there a live discussion about the access to alternative pathways and the better use of alternative pathways and continue to make reforms to make this process seamless for patients. I hope that that will enable us to give the better health outcomes that we all want primary care reform to deliver for the Scottish public. I remind all those members who are wishing to speak in the debate to please check that they have pressed the request to speak buttons. I now call on minister Marie Todd at around eight minutes, please minister. As the public health minister, I really welcome the chance to open this debate on alternative pathways to primary care. I also want to commend the committee for undertaking its timely inquiry into a topic of such high importance and thank the many stakeholders and members of the public whose views informed the committee's final report. My portfolio means that I am all too aware of the health challenges that Scotland faces. As the front door of the NHS, primary care in the heart of our communities is at the forefront of our efforts to tackle those challenges. Primary care has significantly changed in the past few years because since 2018 we have committed over half a billion pounds to employ many more healthcare professionals to work in multidisciplinary teams. This has been a major culture shift from a model of care where the doctor is often the first point of contact to one where patients will benefit from access to a whole team of health professionals. In general practice, that means that an increasing number of patients receive the care that they need from pharmacists, advanced practitioner nurses, mental health workers, physiotherapists and community link workers. Through our reforms, we have now recruited 3,220 of those professionals to work in primary care multidisciplinary teams since 2018. In the wider primary care system, more patients access the care and advice that they need from community pharmacists. At the same time, we remain committed to increasing the number of GPs in Scotland by 800 by the end of 2027. We envisage a person-centred primary care system where GPs occupy the role of expert medical generalist supported by a multidisciplinary team providing holistic care to patients. It's important to recognise the commitment from our skilled workforce that has made this culture change possible and I really welcome the committee's recognition of the hard work that that's involved. That fits into our wider reform agenda within primary care, with the aim of transforming the system to ensure that people are seeing the right professional at the right time. Reforms to improve patient experience are underway across Scotland from the new GP contract and its expansion of multidisciplinary teams in general practice, including new or reimagined roles such as community link workers or care navigators. At the centre of all this work is a commitment to ensure that patients and their experience of primary care come first. Are we aware of how many whole-time equivalent GPs are currently delivering at NHS primary care and are we aware of how many whole-time equivalent community link workers are currently working across Scotland? I can certainly get you that data. I'm sure that the cabinet secretary will include it in his summing up. It's certainly possible. I know that we have increased the number of GPs working in Scotland and that we have, as we've said many times, more health professionals of all kinds per head of population working in Scotland than other parts of the UK. One of the most important innovations that we've seen in primary care and one that I'm especially interested in is a move away from a purely medical model of care. We know that many of the forces that shape a person's health and wellbeing issues are their social and economic circumstances. That's where community link workers in general practice and other social prescribing professionals in other community settings have played such a key role. Having specialist staff who can work with an individual to get to the heart of their experiences and then identify and help them to access the community support, financial help or practical guidance through the system that they need not only benefits that individual but it helps to ensure that clinical staff are free to focus on those cases that need a clinical approach. Their introduction was timely and they played a truly invaluable role within their communities during the pandemic and demonstrated an admirable ability to adapt to a rapidly developing situation. I was also pleased to see the acknowledgement of their work not just from the committee but also several independent research and evaluation studies. We're extremely grateful for the efforts of our community link workers during a challenging time and will continue to support their work, which forms a key part of our recovery from the pandemic. We've developed other roles within primary care to help to guide patients through that complex system. Our care navigators are absolutely key in this regard. As front-of-house staff, they're often a patient's first encounter with primary care and in recognition of the importance of this role, we're working to both upskill our care navigators and ensure that these changes are communicated to the public through the receptionist campaign, which was launched earlier this year. As well as developing a more varied workforce that are now more diverse pathways and methods for people to be able to access care and support, telephone consultations have long been part of general practice, but the pandemic has certainly increased their use. Other changes arose from digital innovations, which were often accelerated by the pandemic. We're working to ensure that patients have as many user-friendly options to access support as possible. The services and funding have allowed NHS 24 to move from a predominantly out-of-hours service to one that operates 24-7. People can access telephone support through a number of pathways, including the mental health hub, the Police Scotland pathway for those in mental health distress, the wellbeing helpline and urgent care pathway. An increasing number of digital pathways are available to patients, and we're continuing to roll out gp.scot, a user-friendly website that provides practices with consistent NHS websites for patients to access up-to-date health information and which will support online prescription ordering. NHS Inform, which was established in collaboration with Public Health Scotland, has seen monthly usage of up to 12 million site visits a month to access the up-to-date self-health advice and guidance on offer. That's a phenomenal resource. The experience of the pandemic increased many people's familiarity with those digital pathways, and we are working to fill any gaps in digital literacy to prevent any inequality of access. I'm mindful of the fact that not everyone will benefit equally from those changes. What for one person is a positive ability to choose the care they feel they need. It might just feel like a confusing array of options to another person, which might create anxiety or dissuade them from seeking the help that they need, and we're very aware of the need to avoid change, which might unintentionally widen health inequalities. Of course, new pathways to care in an expanded workforce have needed considerable investment, and the key enabler for multidisciplinary teams has been the Scottish Government's primary care improvement fund. The fund has continuously grown since its introduction in 2018, and to embed the progress that's been made and to expand upon it, we've increased its funding to a new record level of 170 million for the year 2022-23. This will form a minimum budgeted position, ensuring continuity of funding going forward. The committee's report highlighted areas where our reform agenda has delivered improvement for patients, as well as areas where we need to continue our collective efforts. I think that all of us in the chamber today are realistic that this winter will bring unprecedented challenges across the whole health and care system, but these tests should not lessen our commitment to ensure that we are doing all that we can with the resources at our disposal to improve health outcomes and offering patients alternative routes to care that they need. I welcome today's debate as an opportunity for us to reaffirm our commitment to ensuring that patients and their experience sit at the heart of primary care and that primary care sits at the heart of our health system. Thank you. Primary care is the backbone of the NHS, and it is at breaking point. Increased demands, limited capacity, it's a perpetual extreme winter. The expectations being placed on GPs and their practices are causing burnout, demoralisation and ultimately forcing doctors to leave a profession. This is a typical Monday in GP surgery. I'm in for about eight to start with paperwork and believe me there's a lot to plow through. In the background I hear the volume of phones ringing and our fantastic surgery staff handling call after call who also deal with an awful lot of abuse. They are really under the cosh. By about 8.30 I've started seeing patients, some will be struggling in pain on a long waiting list for surgery, others have chronic conditions like COPD or diabetes. There might be a happy mum to be, but there might also be patients who need to be seen by a specialist in hospital immediately. As a GP you can't afford to miss a sign that someone is going into crisis. By lunch I've had about 30 patient contacts and after stretching my legs at a house call and catching some fresh air it's back to the surgery and over the afternoon I'll usually have about another 20 patient contacts. During the course of the day I'll be checking blood results from the lab, overseeing other clinical staff including advanced nurse practitioners, allied health professionals and paramedics. There'll be questions from pharmacists and what about repeat prescriptions? In Scotland all practices have an online request system or the vast majority do. Unfortunately each and every prescription must be wet signed. We must sign it with a pen. I do about 300 of these a day. This day is typical for GPs across our country. Alternative pathways to patient care provide a vital way of alleviating the burden on overstretched GPs and other healthcare professionals. I appreciate today we're focused on primary care pathways but we should be mindful of the wider NHS that GPs practices are part of. Primary care cannot and does not function in isolation. BMA Scotland has been clear that NHS is struggling under workload pressures and workforce issues. Pressures that doctors were used to dealing with in the winter are now affecting the NHS all year round and staff feel they're working in a perpetual winter. In terms of general staff welfare consider the surveys by the medical and dental defence union of Scotland. 78% of junior doctors in Scotland have experienced burnout. 42% say a lack of access to nutritious food at work was a contributing factor. 66% report they fear patient safety is at risk when hungry and tired. This is really worrying. It's symptomatic of a management culture that does not prioritise frontline healthcare workers. Dr Andrew Buse chair of BMA Scottish GP committee says failure to support general practice now could have dire consequences for patient care across the country this winter. He goes on to explain that the Scottish government pledged a £30 million sustainability support package for general practice to be paid in two instalments. The trouble is last month the BMA were informed that the second £15 million was being cut to £10 million. That announcement came shortly after more than 50 million intended to support development of health board teams across GP practices, pharmacists, nurses, physios, mental health specialists was withdrawn. Turning to alternative pathways to primary care we need to be frank and ask the question are we doing enough to both provide and communicate alternatives to the GP as the first port of call. Let's consider high street optometrists who are well equipped with highly specialised equipment to monitor and treat eye issues. Yet a lack of funding is a barrier for these high street specialists to act as an alternative pathway. According to Optometry Scotland with additional funding the sector would be able to often enhance range of services and we will be able to do so which will ease pressure on not only general practice but also our secondary care. On social prescribing Alison Leitch of Scottish social prescribing network said a lack of leadership in Scotland is holding social prescribing back. She said no one sadly is taking charge of social prescribing. That is where Scotland falls down. In England there is a head of social prescribing in the NHS and Wales that is dealt with through public health. The Scottish government is aware of this problem. Dentistry, the cabinet secretary, by cutting the funding multiplier to dentists, is presiding over the death of NHS dentistry in Scotland. In Scotland the BBC reported in August that 82% of NHS dental practices are now not accepting any new adult patients and 79% are now not accepting new child patients. Now let's turn to communication. The Scottish government talks about promoting alternative pathways like going direct to opticians, physios, podiatrists, pharmacists for support and even treatment but the public are largely in the dark about this. According to the Royal Pharmaceutical Society there is a lack of public awareness for patients using alternative pathways. There has been no meaningful national publicity around changes to the GP practice team and the roles of different professionals within the team. People only become aware of this when they are directed to the pharmacist for example as part of routine contact. The Scottish Conservatives want to work constructively on alternative pathways and get these flowing. We would invest 11% of the overall NHS budget into general practice by the end of this Parliament. We would also increase the number of training places to deliver 800 more GPs as promised by 2027 and ensuring that all GPs are supported by a multidisciplinary team. Some of what you are saying is actually really interesting and some of it is in the report but it seems like what you are proposing is not what the report was about. I am just really interested in some clarity about what part of the report you are referring to. I am referring to the professionals that we speak to on a daily basis. I am referring to the professionals that I am in contact with on a daily basis. This is about alternative pathways. This is not purely about the report that was produced. If we did this by having this increased budget to GPs, that would enable GPs to offer longer appointments to those who needed them. We want to see alternative pathways rolled out to ease the pressure on GPs and we would train more independent prescribers to enable pharmacists to treat a wider range of common conditions. We want to see social prescribing embedded in primary care, including rolling out community link workers and links to advice services more widely, such as the Students Advice Bureau, which makes a huge difference when embedded in primary care. I want to draw members to my register of interest as a practicing NHS GP. I am pleased to open for Scottish Labour. My party fully supports the report and the Scottish Labour looks forward to seeing its recommendations come to fruition. There is a lot here that the Government must act upon. If they fail to do so, they are lighting down many people who would benefit from this great reform. I am confident with the right approach and I am confident that we will be able to do that. I am confident that we will be able to do that. I am confident that we will be able to do that. I am confident that we will be able to do that. I am confident that we will be able to do that. I am confident that we will be able to do that. I am confident that we will be able to do that. I am confident that we will be able to do that. I am confident that we will be able to do that. I am confident that we will be able to do that. I am confident that we will be able to do that. I am confident that we will be able to do that. I am confident that we will be able to do that. I am confident that we will be able to do that. I am confident that we will be able to do that. I am confident that we will be able to do that. I am confident that we will be able to do that. I am confident that we will be able to do that. O'r cyfrifysgau rhaid o'n meddwl i gyrnyddio i ddim yn grithio'r cyffredinol, a fyddwch i ddefnyddio sights ar gyfer y cyfrifysgau a chydigol iaith i ddarfodraethu angen am agor i'r fagin, a hyn nid os ymgynnerion i ddim yn gyda'r cyfrifysgau a byddwch i gydigol iaith i ddau'r cyfrifysgau i dduaf i'r gyfrifysgau i ddau i ddau, ar gyfer y gyrnod am gilyddiaeth gysgau ar gyfer y cyfrifysgau, oedd oedd y blwyddyn arfer reforms to primary care is simply not true. That is backed up in the report. Very few patients fully understand the self-referral process, and that is in large part due to a failure of properly informing the public of those changes and ways that they can access and make sense of this, and we must do better on those points. Whether I am in Dumfries or Thurslow, the way to which I might self-refer very significantly from location to location and from category to category, and we need to help people to understand the processes in their areas so that they can seek the services that they need. For instance, while the option to self-refer to pharmacists, opticians and dentistry is reasonably well understood in many areas, there is far less public awareness of the option to self-refer to other services such as audiology or mental health services. Interestingly, given that mental health backlog is growing day by day, it strikes me that changes in that area could have a great benefit to so many people who are struggling across Scotland, and it would not be particularly costly to the public purse to help people to navigate that system for mental health and wellbeing support. Key to all of these blockages is, of course, the complete lack of a single electronic patient record, and we heard that time and time again and was referred to by the convener of the committee. Having that would streamline the process by which people are referred to and self-refer to the alternative pathways to primary care. It is probably the single most consistent recommendation that we heard during the creation of the report. Although it has serious logistical barriers, it can be overcome and we must do better in that area. Until that issue is resolved, wider understanding and use of those pathways will be limited, which begs the question, why is it not the top priority of the Government? It has to be, and I ask the minister to perhaps respond directly to that in his closing remarks. Commitments were made about workforce numbers and increasing the capacity surrounding primary care by the Government. Time and time again, they have not been met in any serious way, so it is perfectly understandable that services that deal with referrals and advice are often overwhelmed and understanding leads to an unfair perception to the public of the services. We did hear that as we collected our evidence about the way in which the public interacted with people providing the services, particularly in those new pathways. We cannot expect a first-class health service when staff are overworked, overtired and the patients and service users coming through are not fully aware of how the service works. I have no doubt that the prevailing economic climate makes life difficult for all aspects of our NHS, not least surrounding staffing, but the cuts that were announced last week are justified. The £400 million was slashed from key health and social care budgets. The direct impact of that will be incredibly harmful for some of the most vulnerable people in need of care and make the work of this report all the more difficult. It seems remarkable to me that, on the same day that the Scottish Government launched an awareness campaign encouraging people to get the right care in the right place, the SNP ministers cut the primary care budget by £65 million and the mental health by £38 million. The actual reality of those cuts to ordinary people is devastating and makes it very difficult to do their job of building sustainable first-class services. I thank Karen Watkins for taking intervention during what I think is a really helpful speech, but what I would say to Karen Watkins is that if we have to mitigate £650 million worth of inflationary pressure, plus we have to give a fair pay deal to NHS workers, if we do not re-profile that money from somewhere, where else do we take that money from in this financial year? I thank the cabinet secretary for the intervention. I think that he will know that I absolutely agree that one of the biggest challenges that we face in Scotland is the current climate of austerity from the Tories, the Tory UK Government, but I also think that we have to have more honesty in this Parliament about some of the inaction of the SNP and some of the inability to really have a vision of how we can make changes happen. I think that it is really important that the health team looks at what can be done, as opposed to constantly talking about what happens because of Westminster and the Tories, so I want them to have a vision and to talk about the things that they can do. There are inflationary pressures and I understand that. One of the biggest things that we could do, of course, is when we get the chance is to make sure that we do get a Labour Government and I would ask those benches to help with that if they get the chance at all. As I have said, Scottish Labour is committed to getting primary care right for both patients and staff. In closing, I would ask that the Government considers that they look again at the cuts and that they look again to make sure that we can make way with the report, as it is highlighted, and the excellent outcomes that we could have from it in Scotland. I will come to this pretty impressive committee report, but the context we simply cannot ignore. I have never seen primary care in the state that it is now. Patients calling repeatedly to get an appointment day after day after day. Doctors under incredible strain often burnt out. Many leave in the profession of going part-time, practices closing down, all of which puts more strain on those who remain. Even pharmacies are closing down. The ramifications on the rest of the NHS are evident, too. Ambulances queued up outside hospitals, long waits at ANE, long waits for treatment, even longer waits for mental health treatment and social care. Thousands of people without a care package stuck at home or stuck in hospital, which also compounds the problem of the NHS. Now the nurses are on the verge of a strike. They never go on strike, and that is how bad it has become. The situation is incredibly dark. The BMA talks off breaking point, burnout, demoralisation and departure. Yes, the pandemic had an impact. I will agree with the health secretary on that, but the Government's negligence and complacency over many, many years are far bigger factors. The former NHS Scotland chief executive Paul Gray says that those problems have been building for years, well before the pandemic. Let's remind us what he said. The current system was going to be overwhelmed regardless of Covid. The virus has simply brought the date of that event forward. The reasons after 15 years of this Government include inadequate reforms, poor workforce planning for the multidisciplinary team, refusing to recruit enough GPs for years, cutting the number of nurse training places and failing to eradicate the delayed discharge that they promised in 2016—you should listen to this list, this is an important list—undervaluin the social care year after year after year, delaying the mental health strategy and the spending associated with it. Action 15 of the mental health strategy committed £35 million for additional mental health workers in A&E, police custody suites and GP practices, but ministers now cannot even tell us whether that target has been met. The explanation in a parliamentary answer is that the Government does not hold the data. I will take an intervention from the minister. When listening to the litany of failures from the SNP Government, whether the member reflects at all on his party's role in bringing us austerity when they went into government with the Tories in 2010, brought us austerity, which, as we all know, academics have prosman, has shortened the lives of people living in Scotland. At some point, we must pray that this Government will accept responsibility for its own powers, decisions over the past 15 years, including what we heard today about people who have died in hospital because of the Government's inadequate performance over the past 15 years. From my discussions with the police and GPs, there is very little evidence that mental health workers in various places have been delivered. To compound the problem in primary care, we have heard the issue of the cuts. The cuts are £5 million to the sustainability support package, just at the time that primary care is absolutely on its needs. The £50 million intended to support the development of health board teams with GP practices, including pharmacists, nurses, physiotherapists and mental health specialists— Mr Rennie, please resume and seek the point of order, Julie Martin. As the convener of the committee that produced the report, sometimes it is very frustrating when members come into a committee debate that we have secured time for and do not speak to the motion or the report. Can I seek your advice on whether they should? I thank Ms Martin for her point of order. The debate is indeed focusing on the inquiry into alternative pathways to primary care. Obviously, that is quite a wide subject area, and it really is not for the chair to, in effect, police the contributions from members to the extent that they have relevance to the broad subject at hand. I am sure that Mr Rennie has heard the concern from the convener and would wish to specifically address perhaps some issues in the committee's report, which is the subject of the debate today. I can understand why SNP members do not want to talk about that stuff. I can understand that, because their failure over the last 15 years has been lamentable. It has been a disgrace, and, of course, it has a direct impact on the delivery alternative pathways to primary care. If you do not have the core service working properly, then, of course, you are not going to be able to change the service in the way that the committee quite rightly identifies the necessary. That is something that I have passionately believed in for a long time. I have done a lot of work on social prescribing, on making sure that we have mental health professionals alongside GPs in GP practices. I have done a lot of work on all those areas, but I have to say that the context is deeply damaging. For this Government and its SNP-backed benchars, I do not want to talk about it. I can understand it, but that is one thing that I am certainly going to do, because I have a responsibility to make sure that people understand the failings of this Government. I am going to give the health secretary a bit of credit. The health secretary responded positively to the calls from the BMA to make sure that the pension contributions with a new REC scheme made sure that they were not deterred from working extra hours, because they were effectively paying for the privilege to work for the NHS. And now, thankfully, the minister has agreed to that change, and it means that we will be able to free up extra capacity for doctors to help the NHS. It is a positive change. I have also got some other positive suggestions that the minister could adopt as well in terms of resolving the pay dispute with the nurses would be good, retain and recruit the promised 800 GPs by 2027, sort out the social care problem so fundamental to the operation of our national care service, deliver the mental health strategy and the 800 additional workers promise, lead a programme to help inform patients how to access primary care with alternative pathways, convener, to make sure that that system works to improve the easy access and knowledge and provision of alternative services, including through social prescribing. I hope that the minister does all of those things. I do support the committee's recommendations on self-referral, on Alice, on the role of the receptionist, on the single patient records, on the digital improvements. I am an enthusiastic person about those things. I am an enthusiastic advocate for those areas. However, health professionals are too, but they have very little time to breathe at the present time, and that is why all of those other issues need to be resolved. I want to conclude with a letter that I received from the Oster Mwchty Health Centre in my constituency. They talk of the system being fragile, bigger list sizes but fewer staff and astonishment at the cuts to fund. Finally, they say, in future, when your constituents complain to you about the lack of GP appointments and services at Oster Mwchty health centre, we hope that you will be honest with them about the limitations of general practice in Scotland and who is responsible for the policy decisions that have led to and exacerbated the crisis. I hope that I have done so today. I thank Gillian Martin and our committee colleagues for bringing forward the support and to the clerks for their help. I want to focus on the role of social prescribing in the time that I have today. I have met the Public Health Minister, Marie Todd, on a number of occasions, as well as hosting a parliamentary reception with the Scottish social prescribing network. I attended my many organisations from the sector and I thank the minister for our meeting. As part of the inquiry, the committee was interested to understand the levels of awareness of social prescribing amongst both patients and health practitioners and to what extent effective use is currently being made of social prescribing. Social prescribing is described as a means of enabling health professionals to refer people to a range of local non-clinical services. In its national clinical strategy for Scotland in 2016, the Scottish Government noted that the multiple long-term health conditions can result in complex needs, many of which would be best addressed by social rather than medical interventions. To deliver that vision, that people are led to live more year in good health and that we reduce inequalities and health expectancy, the Scottish Government argues that our efforts need to shift towards even greater prevention and alien intervention to local community-based support across Scotland. In 2019, the session 5 health and support committee published its inquiry report, a social prescribing, physical activity as an investment, not a cost. The report explored opportunities and challenges for social prescribing in Scotland. Its support concluded that social prescribing has clear benefits for the Scottish population and for health services. Social prescribing and primary prevention approaches can help in preventing long-term conditions and dependence on pharmaceutical prescriptions. They also have the potential to ease the pressure on existing health and social care services, as well as reducing waiting times, unplanned admissions to hospital and delayed discharges. The report also noted that there were costs involved that they should be considered as an investment. What is the potential for social prescribing? Many of the witnesses are contributing to that. I do not think that the card is in. In many instances, social prescribing will focus on sport and leisure. Does he share my concern about the real-terms cuts to council budgets over the last decade, which has impeded council's ability to deliver those services that can be used in a social prescribing context? I think that it is delivered in many ways. It is important that men are involved in football for 15-20 years in a professional manner and other issues. It is not only councils, it is also the third sector, and I will come on to that a little bit later on. I want to come back to many of the witnesses who are contributing to the inquiry, who have identified significant potential for social prescribing to patients, particularly for those problems that are rooted in non-medical issues. For clients, for example, decreased social isolation at isolation, improved new housing, financial and benefits issues being addressed, and increased confidence, awareness and empowerment. By using local resources, people can become more connected to their community and increases the sense of belonging. For GPs, reduced patient contact with medical services, providing more options for patients, raising awareness of non-clinical services, and increased GP productivity. Further evidence that Claire Cooke from Spring Social Prescribing and the Scottish Social Prescribing Network argued that there should be not be a one-size-fits-all approach to social prescribing. Programs must be able to be responsive to local needs. We have heard already about Alison Leitch from the Edinburgh community link worker programme, arguing that we need a clear overall lead on social prescribing in efforts to try and promote that. The committee heard the evidence that mapping work currently being undertaken by both the social prescribing network and the Scottish community link worker networks would provide a clearer overview of a social prescribing provision across the country. Current mapping shows that most local authorities have social prescribing programmes in existence. The cabinet secretary himself mentioned that he is a real believer in the ability of social prescribing to have a positive impact on people. He also expects to hope that there would be more people at access to social prescribing, the more we will see its value and promote its benefit to others. What are the barriers to greater uptake? Evidence to the inquiry suggests that at least some of the barriers to greater abuse of social prescribing still remain. The committee heard that social prescribing is described as the biggest cultural shift in healthcare and medicine that we have had at the same time. It acknowledged that these services are not universally available throughout the country, and that is a barrier to mounting them at a national level. The committee also noted that there is no national lead on social prescribing, given that the responsibility is shared between two Scottish Government ministerial portfolios. The committee commends the work that has been undertaken by social prescribing networks to map the availability of social prescribing passways across the country. What is next for social prescribing? The potential for social prescribing is endless, but it must be embedded fully in health and social care to achieve that potential. We must have robust evaluation processes to measure the impact of our own individual lives and on communities. We need to work in partnership with the third sector to provide most of the community services that social prescribing can only be as good as the service is able to refer to. We need primary care in the third sector to work closer together to meet the challenges facing society. We need to work with social prescribing medical students to embed social prescribing into the medical degree so that the GPs of future can see early on that they have a toolbox of multidisciplinary professions available in order to achieve the best outcomes for patients. The Scottish Government has recently carried out an ambitious consultation on framework for social prescribing in England, and no on island already have a framework in place. In conclusion, the social prescribing movement in Scotland is being recognised as a part of a global social prescribing alliance to the existing networks. The important part here is an overring structure designed for Scotland by Scotland and for the people of Scotland. Ownership is essential to ensuring that the momentum is built upon. I am speaking today as somebody who was a member of the Health, Social Care and Sport Committee when this inquiry started. I want to acknowledge and thank all those who gave evidence, my fellow committee members and for what was a very eye-opening and informative time that I spent there in both the informal and the informal sessions, most of the informal sessions that I found to be even more relevant and revealing. Thank you to everyone for making that so impactful. However, as the British Medical Association has said, primary care is the backbone to the NHS and it is, at breaking point, with increasing demands and limited capacity. The expectations being placed on GPs and their practices are causing burnout, demoralisation and, ultimately, forcing doctors to leave the profession. It is very important that we had and took part in this inquiry into alternative pathways to primary care, which, after all, is for patients to access a diagnosis and or treatment. Pressures that doctors are used to dealing with in winter are now affecting them all year round. Staff feel like they are working in perpetual winter, as Dr Gohani said earlier, and have been for the past 18 months. The SNP Government is not doing enough to provide those alternative pathways right now for that primary care workforce. That makes the report that we are debating and discussing today even more timely and even more relevant. That is why all of the recommendations must be implemented. One of my constituents wrote to me about his struggles to get an appointment to get that key diagnosis. He did get to see his GP, but what came after was a path of confusion and challenging timelines for him. He was initially referred to the Royal Infirmary of Edinburgh by his GP, as I said, who he was able to access. However, he received a letter saying that he had been triaged by a professor as general. When he inquired what that meant, he found out that it might mean a six-month wait to see a cardiologist. I am just curious—and forgive me for being maybe a bit too controversial—that I am concerned that some of those pathways are being used as a stalling tactic to prevent people from accessing acute care. Understandably, my constituent was concerned, so he sought an appointment at the Spire hospital and sought a cardiologist within a week, but that came at high cost. After an extensive echocardiogram and ECG, he was diagnosed with a stenosed heart valve and heart failure, which can be very serious. Thankfully, after an adjustment to his medication, he is feeling a lot better and his cardiologist has agreed to see him again at his NHS clinic at St John's hospital at the beginning of March. My constituent is in a rare cohort, because he does understand self-referos and how the process of the NHS, acute and primary care, works. He is also very aware of the challenges that all those healthcare professionals are facing, but he knew that he needed a diagnosis. People should not have to seek this route to access healthcare and get the treatments and the diagnosis that are needed to save their lives. My constituent was luckily able to do this, but so many people are not. The consequences are that Scotland's healthcare is turning into an unfair two-tier system, depending on what you can afford. That is not the alternative pathway that we are here to discuss today, but that is the reality of what we have. The NHS staffing crisis is all around us, and there is one branch of the service that we could do much more to alleviate the pressure on hospitals, and that is our primary care practitioners, the backbone and gateway to the system, as the minister stated in her remarks. It is in every bit of crisis as the care system. GPs, allied health professionals, nurses and podiatrists, the list is extremely extensive. The number of qualified medical staff cannot keep pace with the growing demand, both from an ageing population and the expansion of housing estates, with the number of GPs virtually unchanged at 3,600 full-time equivalents, while the population has risen to 5.47 million and expected to grow another 10,000 in the next six years. Housing developers happily commit to building new GP surgeries in their sprawling new estates without any idea where the qualified medicals will be found and why should they? As 5,000 homes go up around Winshborough, it is not the responsibility of Cala or Taylor Wimpey to source doctors and nurses. Scotland's GP workforce has shrunk in six years leading up to the pandemic, and in 2017, the Scottish National Party Government pledged to increase the number of GPs in Scotland by 800 by 2027, but they are not on track to achieve that. We want to see an increase in training places to deliver more than 800 GPs promised by 2027 and ensure that all GPs are supported by that wider and invaluable multidisciplinary team. That would enable GPs to offer longer appointments to see those who need them. We would train more independent prescribers to enable pharmacists to treat a wider range of common conditions, and we do want to see social prescribing embedded in primary care, included by rolling out the community link workers and links to advice services more widely available. Alternative pathways to primary care provide a vital way to alleviate the burden on our overstretched GPs and other healthcare professionals. The pandemic may not have been the genesis for all those issues, but its shockwaves have exacerbated them on the state of urgency and crisis that we are facing now. We need more work to see the alternative pathways rolled out to ease the pressure on GPs and to take cognisance of all the recommendations in the report. They are all welcome and we support them today. I was very pleased to be involved in the alternative pathways to primary care inquiry, and thank you to everyone who engaged with the committee on this work. Whilst recent research by the Nuffield Trust shows that Scotland has record numbers of GPs, and the highest number per head of population in the UK was 76 GPs per 100,000 people, compared to a UK average of 60, there is no doubt that they are under pressure. Alternative pathways to primary care are freeing up resources. For example, local pharmacies can now treat minor conditions that would have required a GP appointment through the pharmacy first service. In autumn 2022, pharmacy teams have already carried out over 3 million consultations for minor illnesses, while referring under 5 per cent to other healthcare services. I can use my local health board to demonstrate the benefits of alternative pathways. The population is growing and the number of residents aged over 65 is increasing even more rapidly. However, already NHS Forth Valley has been able to extend GP appointments from 10 to 15 minutes through, for example, piloting the use of physiotherapists and mental health nurses in local GP practices. Children are also being vaccinated in the community by dedicated immunisation teams. There is an innovative website supporting social prescribing for both patients and healthcare staff, providing details of a range of alternative resources. As part of the 2018 GP contract, over 3,000 whole-time equivalent multidisciplinary teams have been recruited, including pharmacists, mental health workers and physios. That is great potential to ease the pressure on GPs and promote greater use of alternative pathways through the creation of MDTs carrying out primary care functions in a patient-centred manner. However, I will not at this present point, but maybe soon. However, key elements of the contract have been delayed due to the Covid-19 pandemic. As the convener noted, the committee saw evidence from the public through a survey that highlighted a lack of awareness of services to be a problem. GP services have been the clear first point of call for healthcare for a long time, and the study revealed high awareness of opportunities to self-referral for some services, such as dentists and optometrists, but much lower for others such as audiology and mental health. It is clear that many people highly value GP services and felt dismissed when sent on an alternative path. The right care, right place campaign, which included radio and television broadcasts, as well as a booklet sent to all households across Scotland in January 2021, has not fully addressed public understanding or acceptance of, for example, the enhanced role of GP receptionists and options for self-referral. Perhaps a similar campaign needs to be rerun learning the lessons highlighted to support this significant cultural shift. I am encouraged by the cabinet secretary's response and openness to continue dialogue with the committee on this matter. I am pleased that the Scottish Government is also exploring the potential of standardising training for administration staff working in primary care in order to improve relationships between admin staff and patients. It is also good to see that, after such a challenging few years, £8 million is being invested by the Scottish Government to support the physical, mental and emotional needs of the workforce. Thanks to the reckless and self-serving decisions of the Westminster Conservative Government, the Scottish health budget has now worth around £650 million less than it was in December 2021. In addition, austerity has had a terrible effect on the lives and shortened the lives of Scottish people. Our committee knows this because we took evidence on it. The Scottish Government's promotion of alternative pathways to primary care cannot make up for Westminster's incompetence and austerity, but it can. I didn't know that that was in the committee report. I'm not clear what that is. I'm just questioning the relevance of Westminster and the UK Government. It has no bearing on the committee report. Thank you, Ms White, for your point of order. As I said in response to Ms Martin on her point of order, I, as the chair, am not here to police the contributions of members to the extent that they bear relevance in broad brush to the subject at hand. That is what I said in response to Ms Martin's concerns about a previous speaker's contribution, and that is the answer that I would give to Ms White. I will just resume that last point. The Scottish Government's promotion of alternative pathways to primary care cannot make up for Westminster's incompetence and austerity, but it can help to better distribute resources and capacity in healthcare to ensure that everyone gets the care that they need from the most appropriate practitioner. Thank you, Ms Tweed. I now call Sarah Boyack to be followed by Stephanie Callaghan around six minutes. I want to thank the committee for their report, because it's vital work. I thought the speeches by Carol Mawkin and Willie Rennie were powerful in highlighting the pressures that primary care faces today. In my contribution, I want to make the links between the ambition of identifying alternative pathways to care and delivering in communities across Scotland. I also want to take the opportunity to join in the discussions that we have had in our Constitutional, External Affairs and Culture Committee work on the evidence that we have received and the work that I have been doing with the culture sector, where social prescribing comes up time and time again as crucial for support for people's health and wellbeing. On one level, it is inspiring to see the work in our communities. On another level, it has been incredibly frustrating to see the fact that it's now over a decade since the Christie commission's recommendation on investing in prevention were made. We've not seen fast enough progress, so I very much support the committee's recommendation to map availability across Scotland. I think that that's important. When we question the cabinet sector for health at our CHIAC evidence session in March, its timetable for action social prescribing was to ensure that by 2026 every GP practice would have access to a mental health and wellbeing service with the aim of helping to grow community mental health resilience and direct social prescribing at a grassroots level. While I welcome the ambition, it's years late, and my frustration is that the cultural sector that we have in Scotland is already providing fantastic wellbeing activities, targeted support people and to help their wellbeing, even as the sector faces the perfect storm. However, what we don't have is the connecting delivery strategy to make the links between health and culture that we really need now. We know from research that social prescribing works, so we just need to get on with mainstreaming it and making it available to those who need it. I very much welcome the recommendations from the committee that we are debating today, in particular their acknowledgement that cost is a key barrier for people on low incomes. There was a 2020 Glasgow University report that examined the impact of links worker programme, a social prescribing initiative in areas of high deprivation in Glasgow, and it was designed to address health inequalities. It conducted interviews with community organisations representatives and community links practitioners. The empirical evidence on the positive impact in areas of deprivation is really important to highlight. Social prescribing allowed people to be engaged who would otherwise not have benefited from services outside formal primary healthcare. A powerful quote from the research was, the challenge is reaching the people who are hardest to reach. The people that don't realise that, although they might be aware of us, they don't realise that we could actually help them. The study also reported the increase in the need of services happening at the same time that we had funding cuts, with organisations left with a massively reduced resource. Projectism is what we call it in the CHIAC committee from the evidence that we have had, and it is how culture organisations have described the challenge that they face. With rising demand, organisations are focused on getting through the crisis after crisis, but they are not able to do the long-term work building relationships with those who need it. We know from other research published last year that the challenges that social prescribing coordinators are facing following the shift towards delivering services digitally, so there is an awful lot that needs to be addressed now. The thing that I really want to bring out is that social prescribing links our health and cultural sectors, and it is absolutely crucial for post-Covid recovery to support people through the pressures and anxiety that are now coming through the cost of living crisis. It really would be a practical way to promote health and wellbeing now, and to support people and to avoid them getting further and further into the health process when actually there's a way to enable them to be supported now. There's practical work being done now. Over the last 12 months, I've been able to hear from different organisations about the benefits they're delivering with joined-up approaches. I had the pleasure of sponsoring the exhibition reception to celebrate the incredible work that art and healthcare is doing to improve health and wellbeing by using visual art and healthcare settings and humanising our medical environments to support staff and patients. Inbury University's prescribed culture pilot is aimed at increasing access and their take-30 brochures available and free to download. At our recent cross-party group and culture, we heard from those involved in the archive services at the University of Dundee about the huge benefits that have had to them personally in terms of their mental health, and then there was the excellent work of the Tayside healthcare arts trust. I also want to highlight the fantastic work of National Museum Scotland and their museum socials. For seven years now, they have been having learning and programmes that look at community engagement team to host museum socials for people living with dementia. It's an informal learning experience. It gives participants access to a range of opportunities to engage both with national collections and with wider social activities, and it also supports their family members. I think that the report that Museum Scotland has done about health and wellbeing is absolutely superb. It's definitely well worth reading, and then you've got the work of National Gallery Scotland on access to mindfulness, dementia-friendly access and a commitment to autism and sensory-friendly access, but it needs to be supported on an on-going basis, and we need similar projects right across the country so that every local community can access them. Although it's not just a question of funding, multi-year and predictable funding is essential, and that's the constant message that we get from the cultural sector. Then it's the making links with the health sector, and I very strongly support the committee's call for action to support voluntary sector providers and to support them to address long-term financial viability, because we are in a perfect storm and we need to see the Scottish Government address the issue now. Physical activity prescribing is becoming more common and it's delivering benefits for people now and our health service, but we need to see culture prescribing become legitimate with clear political leadership ministers as recommended by the committee, and their suggestion of work to deliver a targeted communication strategy to raise awareness of the positive impact of social prescribing is really important, and I hope that ministers will take that up. I want to start today by thanking primary care staff and all those who provided evidence to our committee, including patients who told us their own personal stories, as well as the other members of the committee, especially our chair, Gillian Martin. As others have said, primary care really is the absolute backbone of our health service, and one of the things that came up for me was about what primary care is, and when you ask most people they'll tell you it's about their GP, but as we've heard today it's about so much more than that. It's the community nurses, it's the physiotherapists, the occupational therapists, it's dentists, end of life care, health visitors, and many many others, and that as well is not forgetting the invisible support staff who back them all up too. As the first point of contact for healthcare for most people, strong primary care is really really central to an effective and sustainable health service. In general practice too are GP's, they're busier than they've ever been. The GP's and their teams are striving to meet spiral and patient demand along with establishing Cree primary care networks, and in Lanarkshire I know there's been between 40% and 50% increase in the demand for patient appointments, so there's much around the challenges of Brexit, the pandemic, and 12 years of austerity, which have all hit really hard, and now we're also facing current levels of inflation as another threat there too. So the need to reform general practice and deliver these alternative pathways has never been suppressed as it is today, but it's a challenging area for reform too, both here in Scotland and internationally as well. Our access to primary care is deeply affected by many factors including resources, staffing and planning as well. So there's a lot going on in primary care and services are working really hard to adapt to a time when resources are already stretched to the limits, that's something that we heard repeatedly throughout the committee, and it's compounding the barriers to sustainable and effective change, but that doesn't mean that we need to slow down, we need to work even harder to make sure that we're meeting these challenges head on. And we also need to be mindful that the public are being asked to adapt to at a time when they've never been more anxious or confused about access to care. And I think many of the public think, you know, this is just a process that is started because of Covid, and we need to get that recognition out there as well that it's something that's started before, then it's not just about a response to that, it's about it being the right thing to do. So, Presiding Officer, transformation is really needed and the success of our NHS will, to some extent, depend on our ability to increase access and awareness of alternative pathways to primary care. So, those alternative pathways can include receiving advice or treatment from allied health professionals, using social prescribing initiatives, accessing websites or using telephone services, and doing that instead of going directly to your GP every time. And the name alternative pathways itself is maybe kind of slightly confusing, as what we're really saying is more about effective pathways to receiving better care, and maybe that's something that we really need to communicate a bit more coherently. During this inquiry, a majority of people didn't really quite understand why we were reforming general practice, and again, that's a message that we need to really, really be talking about, because a general practice is a community asset that should act as the go that connects all of their other services and professionals within healthcare, rather than being the single focal point for the patients dependent on a particular GP. So, I want to just touch on three wee bits of the report, it's got so much more in it and you've heard so much about it today already, but I'm going to speak about community social prescribing, digital opportunities and recruitment challenges a little bit. So, first of all in social prescribing, in some cases there was an increase in uptake during the pandemic, and the positive comments we got from patients were really good, they noted quicker and better health outcomes. However, the evidence also suggested that some people have still reverted back to their GP practice, and we need to take that on board and recognise that behaviours are going to take a time to change. Among constituency in Lanarkshire, the community link workers programme offers full coverage across all the practices, and during this year more than half of Lanarkshire's GP services referred into the GP community link workers programme, that was just under 300 referrals. The most common reasons were related to mental health issues, but we know that social prescribing can be effective for physical health and fitness too, and that can have a huge impact going forward. I really would welcome an update on any plans that the Scottish Government has to develop social prescribing further to build on that success, particularly around perhaps having a national lead to help improve delivery. Moving on to digital opportunities, our committee report highlighted that digital progress will be key to transforming healthcare for patients and for health professionals too, and I read the recent Scottish Government report titled Care in the Digital Age, which sets out the delivery plan as we move through into 2023 and the rest of this year. Easy to use patient apps that provide really nice easy access to appointments and test results are a huge thing that we all really, really want to see, and a single electronic patient record is another huge thing as well, something that can be accessed by health and care professionals right across the NHS, right across social care, will make a really, really huge difference not just to them but to our patients too. However, the reality in the ground is that a lot of time and money is being invested, but a lot of that too is going into IT systems just now. It's about strengthening cyber security, it's about training up staff, and while I recognise those complexities and the level of background work in this area, I do still hope that the cabinet secretary can offer a bit of reassurance that developing digital apps and records will be an absolute priority going forward, and I know it's challenging, but it's something that's just so vital and so important. Last but not least, I'll briefly mention recruitment, and this is a really challenging area, as others have mentioned there. However, to touch on some positives, I really welcome the Scottish Government's winter plan that commits to recruiting an additional 1,000 additional staff over the winter season, 750 nurses, 250 support staff, but in closing, alternatives to pathways to primary care can help ease some of the pressures on their GPs and other areas of the NHS. There's a lot of work to do still, and I call the cabinet secretary to go and build on those pathways and to keep the committee in this Parliament updated. Thank you. I call on Gillian Mackay to be followed by Craig Hoy. Thank you, Presiding Officer. As many others have, I would like to start by thanking the clerks, my colleagues on the committee and to those who gave formal, informal and written evidence to the committee. The way services are delivered has changed significantly over the last few years with both primary care reform, as we've heard from others, and the pandemic having an impact. In written evidence, the Royal College of Physicians and Surgeons of Glasgow indicated understanding of alternative pathways to healthcare is poor among patients. It noted that patients may be aware generally about alternative pathways and may be limited about specific pathways. It may also be guided by personal experience of both practitioners and patients and what is available locally. The Royal Pharmaceutical Society also highlighted limited patient awareness of alternative pathways and multidisciplinary teams. There needs to be greater emphasis put on advertising and normalising the use of multidisciplinary teams and alternative pathways, but this is a particularly acute need ahead of winter to ensure that everyone is getting the help that they need. We also need to make sure that the advertisement of alternative pathways reaches everyone. Many don't use social media, some won't see adverts on television because they only use streaming services, so we need to make sure that the ways that we communicate are accessible, clear and show the multiple pathways that people can take to ensure that there is a no-wrong-door approach. Glasgow City HscP argued for action to encourage a change in behaviour from people, automatically seeking help from GPs in their first instance. However, it also acknowledged that such changes can take significant amounts of time to become embedded in practice. There was evidence given to the committee of good understanding of how and when to self-refer to dentists, otometrists and pharmacists, but there was a lack of awareness of the full range of services that those practitioners offered. However, audiology is not currently afforded the same level of access that the National Community Hearing Association Scotland outlined current obstacles to self-referral for patients with non-urgent ear and hearing problems. It said that the current model of NHS care means that each year patients are forced to see their GP for non-medical ear and hearing problems, which can be better managed in primary care audiology settings. It also stated that, in some cases, the GP in a pathway adds costs without adding value, resulting in an overall loss of scarce NHS resources. That is particularly true for most ear and hearing problems where primary care audiology is, in the same way as optometrists for eye care problems, much better suited to managing needs, freeing up GP capacity to address medical issues. Many people will experience the hearing loss over the course of their life and we need to ensure that access to services has parity no matter the sensory issue that people are dealing with. As someone who has the hearing impairment, I may be slightly biased on that, but I can often get easier access to eye tests than I can for primary care support for changes with my hearing. They often do not need support from the hospital audiology team and being able to refer straight to primary care audiology would save time for both GPs and secondary care teams. I recognise the issues of potential duplication of effort raised by the Royal College of GPs in their evidence. There is always a potential for patients to be signposted or self-refer to a service that does not wholly fit the issues that they are experiencing. I am sure that many GPs would say that sometimes the issue that patients come in with is not exactly what they think it is, but there is an issue of ownership for patients of their own care. There was a suggestion made in evidence of a system to request fast-track follow-up by a GP for patients who need it, and I think that that may offer a sensible solution that, if put in place, would need close monitoring and evaluation, including both patients and clinicians. There is a lot to cover in this report, and I do not think that I can do justice in my time remaining, but I would like to use the remainder of my time to focus on one of my favourite topics, data. One of the barriers to allowing smooth sharing of data between multidisciplinary teams is the lack of ability to share data easily. Many of our witnesses cited a single electronic patient record, as we have heard from many others this afternoon, as being transformational and allowing seamless access between services. We also heard from patients that this would prevent them from having to retell their story multiple times, particularly for those accessing mental health support or on-going support because of an impairment. For example, having to retell your story, how you came to experience your symptoms, what led you to accessing the service, is exhausting, sometimes really upsetting and re-traumatising for some. A single patient record is essential, as I said, to ensure that we are not re-traumatising people. There are also very practical reasons for single patient records like being able to take all your information with you when you move, rather than having to request a copy of your records to be sent to your new GP. Thousands of people will move every week out of their current GP practice, and really in 2022 it should be simpler to move your data. I was pleased to hear the cabinet secretary indicate at committee that this is a priority, and I would welcome any update he has. I would like to conclude by thanking again everyone who gave evidence to the committee and those who continue to support us in our on-going work. The Health and Social Care and Sport Committee's report on alternative pathways to primary care highlights a crisis in our primary care sector and makes a number of recommendations that I hope the Scottish Government will act upon. I would like to thank the committee for this report, which only serves to highlight the challenges facing our NHS and the staff who work within it under this SNP Government. The problems are long-running and well-known, and they are well known to Scottish ministers. Staff are overstretched and undervalued. Routine primary care appointments are being cancelled up and down the country, and many patients struggle to access primary care. Self-referral pathways are not clear and they are not advertised well enough. The primary care sector is unable to keep up with rising demand due to poor workforce planning by the SNP Government. Now, for the first time, nurses, the beating heart of our NHS, are set to strike. In my own region, we see the problems first-hand. GP patients are facing challenges in booking appointments in areas such as Gullin, Port Seaton and North Berwick. Pharmacies in Haddington and Galashales have faced repeated unscheduled closures. Boots pharmacy in Haddington frequently has a closed sign pinned to its door. It is shut to patients who need prescriptions or access to the services delivered through pharmacies. Those are important pathways and should remain open. In fact, the British Medical Association has warned that primary care in Scotland faces a critical workforce supply problem, and the Scottish Government must need a credible plan. Just last month, in fact, I warned that a rise in unexpected pharmacy closures due to the Scottish pharmacy contract is an issue of concern. The pharmacy contract means that the Scottish Government continues to pay for pharmacies to stay open even when they are closed without any reason. The Pharmacist Defence Association has warned that some large pharmaceutical chains such as Boots and Lloyds might exploit the loophole to maximise profits at the expense of those in need of pharmacy care and that this is happening without any consequences. However, as the report makes clear, the root of the problem yet again is poor workforce planning by this Government. We need to see the SNP Government putting in place an adequate strategy to recruit and manage GP retention. It is vital that this Government now acts upon that. In 2019, Audit Scotland warned that, by 2027, the Scottish Government's target of recruiting an additional 800 net GPs would not be met. The GP's ministers who are coming through the front door are only being offset by those who are leaving. In the report this year, Audit Scotland continued to warn that recruitment and retention of GPs and, indeed, right throughout the health service should be given more priority by this Government. There is also the issue of mental health, and signposting within the workplace continues to be poor. Every year, up to 650 people in the UK take their own life due to work-related mental health issues. A survey from CME Scotland this year found that 77 per cent of those with poor mental health said that they experienced unfair treatment in the workplace because of their mental health. Support in Mind Scotland's director, Jim Hume, has said that, training staff in mental health can help to break down stigma and discrimination, build awareness and develop skills and enhance confidence. Findings from the project have demonstrated that 91 per cent of people who participated say that they have increased awareness and understanding of mental health following the training, and 87 per cent of participants feel more confident to talk about mental health with their staff and their colleagues. Jim Hume adds that the evidence highlights how mental health training is a valuable resource to build resilience and reduce stigma in the workplace by increasing people's knowledge of mental health, breaking stereotypes and building people's confidence to be a first responder. The committee's report rightly stresses the important role of community link workers and receptionists in primary care in signposting patients, but it is vital that the services are there once that signposting process takes place. I think that there is a concern about government cuts, particularly in relation to the mental health budget. In the last Parliament, the SNP broke its manifesto pledge of recruiting an extra 250 community link workers to GP practices, so could the Government make sure that that is a priority to fill those vacancies? Sadly, that is a pattern of empty promises and shallow words by the health secretary and his Government when it comes to Scotland's health system, and most importantly, those hugely valuable staff that work within it. We need action to support primary care and invest in healthcare up and down the country, and when we offer alternative pathways, for example, as I said to Mr MacLennan through sport and leisure, we must make sure that we properly fund those community organisations and councils to deliver that, rather than seeing real-terms cuts, as we have seen both in good times and in the turbulent times that we now see. Local health and social care services continue to be decimated by the SNP Government. In South Scotland, for example, we have seen the closure of North Berwick's Eddington cottage hospital last year, and that was a hospital with whom local GPs worked very closely to ensure that local need was met. That minister took place without any consultation with local residents or primary healthcare professionals, and we are seeing it writ large now with the SNP's plan to plough ahead with the national care service against the advice of third sector organisations and social care experts. Any problems in social care will only add to the further pressures that we see in an already stretched primary care sector. Presiding Officer, this Government is ignoring the crisis in primary care and a wider crisis in our NHS. Yet again, its priorities lie elsewhere. The minister's priorities lie elsewhere. Humza Yousaf has taken his eye off the ball, and it is time that he was removed from the pitch. Thank you. I call Emma Harper, the final speaker in the open debate. Thank you Presiding Officer. As a member of the committee, I welcome the opportunity to highlight our report, and he will focus on the report. It has been interesting to hear other contributions as well. Our report highlights that primary health is vital to ensuring that people are seen by the most relevant professional for their needs, and it is crucial in relieving pressure from secondary care, particularly when our NHS is under the most pressure it has experienced in its 74-year lifetime, including as we emerge and recover from the pandemic. We looked at a wide variety of areas in this alternative pathways to primary care report, and I want to thank all the witnesses and the clerks and my colleagues for their input. We heard about community link workers. We heard about ALIS, which is the online local digital system for signposting and supporting people. We heard about the role of digital health and care, single electronic patient records, third sector involvement and lots more. Today, I will focus on social prescribing and recruitment. In the last session of Parliament, social prescribing were words that weren't as widely used, but now we are seeing more and more people understand what social prescribing is, what it means and what the benefits are. In our report, the committee welcomed the increased uptake of social prescribing that we witnessed during the course of the pandemic and the positive lived experience that we heard from those who have used it. The evidence that we heard shows that social prescribing is effective at targeting the causes of health inequalities and can vastly improve mental health and wellbeing. Others have highlighted that as well, as we have heard this afternoon. However, the committee took evidence that, during Covid recovery, patients who use social prescribing are reverting back to contact in their GP in the first instance when on-going use of social prescribing could offer better outcomes. We heard how cost is a critical barrier to access to social prescribing pathways for people, particularly in areas of multiple deprivation. One of the areas that came up is that there is no single national lead on social prescribing. Given that that responsibility is shared between different ministerial portfolios, I asked the cabinet secretary to provide an update on the Scottish Government's work to simplify a national approach to social prescribing and to better align ministerial portfolios so that there is leadership and accountability on social prescribing within alternative pathways to primary care. Turning to recruitment, the committee heard evidence to suggest that sustainable long-term workforce planning will be a critical prerequisite for encouraging greater use of alternative pathways to primary care in the future. Evidence submitted suggests that that must include consideration of how roles and skills requirements are likely to change as a result of advances in technology and the on-going evolution of services and their delivery. I agree with Alison Kerr from the Allied Health Professionals Federation Scotland and others when they indicated that it is really important not to look at workforce planning around team members but to understand it from the point of view of population health need. We must plan the workforce from the point of view rather than saying that we need X number of physiotherapists, occupational therapists or dieticians, etc. I welcome that the health secretary launched a new GP recruitment campaign this June as part of the Scottish Government's commitment to increase the number of GPs in Scotland by 2027. The campaign seeks to encourage GPs from the rest of the UK to relocate to Scotland, highlighting the flexible, supportive collaborative environment available here. That is in addition to the Scottish Graduate Entry to Medicine programme, which is allowing those with healthcare and science degrees to train to be GPs, particularly with a focus on rural medicine. Dumfries and Galloway is part of the Scotland GEM programme, and feedback from the D&G Scotland GEM lead is extremely positive. Scotland is struggling to recruit in social care and nursing. Recruitment is a challenge beside an officer. Due to the fall in the size of the working-age population and the end of free movement of people caused by Brexit, that contributes to the recruitment challenges. While the Scottish Government's steps are welcome, recruitment and retention workforce across multi-disciplinary teams are crucial to success in promoting greater use of alternative pathways to primary care. That is in particular interest of mine as we move forward with the scrutiny of the national care service bill. Our report recommended that the Scottish Government provide an update of its work to assist health boards to develop an integrated approach to workforce planning and to overcome recruitment challenges. Finally, the report also describes strengthening the understanding of the role of medical receptionists who are critical in signposting people to get the support that folks need the most. I welcome the Scottish Government's right care, right place receptionist campaign, which aims to increase understanding of the role of medical receptionists. I am sure that lots of work has gone into creating the campaign, but my concern is that the campaign may not reach the public as effectively as it could. Perhaps resharing and relaunching needs to be done, which is what I will be doing. I will share on my social media and I will encourage colleagues to do that also. Presiding Officer, in closing, there are loads in this report that was published in June 2022, and secure in parliamentary time to debate our reports is absolutely crucial and important, so I am going to encourage members across the chamber to read the report and share because there is a lot worthwhile in this report. Thank you, Presiding Officer. Thank you. We now move to winding up speeches, and I call on Martin Whitfield. I am very grateful, Presiding Officer. It is a pleasure to close on behalf of Scottish Labour this fascinating committee debate. Can I first and deeply express my appreciation for the work that the committee did on this report? Some of the statistics in here are challenging for everyone across this chamber to read, but I think it is the sign of a mature Parliament that we are prepared to go out and find this information and then to address it. So my huge compliments to the committee, to their supporting staff, committee members both present and in the past with regard to this, and I echo what my colleague Carol Mocken has said that Scottish Labour supports the findings of this health and social care and sport committee report. Before dealing with some of the contributions that have been interesting for a committee debate, I will address that. There are two aspects from the report that I would like to pick up simply because of my own interests. I may look to the cabinet secretary given that this was a Scottish Government funded research for comments on it. The first is in relation to children under 18 and whether any attempt was made to capture their experiences of primary care, because I think that journey into adulthood is one that is often shaped sadly by too many journeys to the GP surgery, too many journeys to the dentist, and in my young children's cases far too frequent visits to accident and emergency, but I also look at the report, please do it. Gillian Martin. I just want to commend it to Martin Whitefield. The other report that we did on children and young people and access to healthcare from them, which has a lot more detail. Martin Whitefield. I accept that invitation wholeheartedly, but the other aspect from the statistics that are disclosed in here, and particularly in a very nerdy way, I'm going to talk about figure 15 on page 25 of the report, that the experience of 18 to 29 year olds is different to almost any other demographic group in respect of this. It is a level of concern because to the question thinking about your work, family and other commitments, how difficult or easy is it being available for appointments during opening hours? And this group between 18 and 29 were the only group for whom it was far more difficult than any of the other groups to attend appointments during opening hours. And in a roundabout way, this has been referred to in a number of the contributions that I would like to turn to. And I think there have been some very powerful contributions from Sandel Golhany, who was always able to give a real lived experience of what the day of a GP is. And it certainly echoes the many GPs that I have spoken to about the challenges that are there. Of course, I rightly echo Carol Mocken's very powerful speech on it. But I will pause at Willie Rennie's speech. I hope he is concerned as not in anticipation of any detriment that I would say to it because I think it is important that we look at the background on which this report sits. And I think it does the report an injustice not to recognise the challenges that exist in our health service. And I think to echo the latter part of Willie Rennie, there is without doubt the opportunity of a pathway to a better future. But that's going to be a very hard pathway to follow. And I would urge the Government to recognise the challenge, which I hear so often in this chamber, but also to do that so that those who are working across the whole of the national health service, working across the whole of primary care, working across the whole of our communities, that they see the support that is so often promised from that point. I need to apologise to Paul MacLennan and that I had to step out for an alternative primary pathway reason from my family. But I will take the opportunity to read back. But I think it was interesting, I called it at the end, his discussion about the promotion of community prescribing to our GPs in training. And I wouldn't underestimate the challenge in trying to alternate undergraduate courses having tried to do it with regard to teaching. But I do think it is an important element of how we train a better group of professionals coming forward in their recognition of this very valuable service. I have to pause at Sarah Boyack simply because I think to bring into the discussion of the importance of culture is a hugely important one. Culture has always taken the role of protecting our community's mental health from art that you hate, art that you love, music that is too loud for your parents, music that is the best that you've ever heard, dance that annoys the boys, poetry that sometimes annoys the girls, particularly if it runs in February in a Valentine's card. But the role of culture in supporting the human being to be a human being cannot be underestimated and the value of that in respect of prescribing out with the tradition of drugs or indeed treatment is so crucially important and I think it would be a great missed opportunity, particularly at this time. I would like to pause at Stephanie Callaghan's contribution, which I find incredibly powerful, and it actually captured one of the biggest discussion points that we've heard today, the challenge of taking this information out to our communities and the need to do that. The fact that we have plenty of good examples, Covid has taught us the simple pleasure of walking outside, walking by the sea, but the understanding that people have of what a GP does, what primary care is, is crucially important if we are going to make this work and I think her call to review how that is announced, how that is put out to our communities is of crucial importance. In the few seconds that I have left, I would just like to make mention of GPs who in fact have just contacted me today this morning on this to say that there is a discussion that has to be had about the GP contract. There is disappointment for the GP's feel about, as is phrased in the letter to me, the reneging by the Scottish Government in respect towards that with the cut and fundings that have been announced, and I know that there is a massive pressure on government budgets because of inflation, but that same inflation is hitting every GP's surgery, it's hitting every pharmacist that can't close, it's hitting our dental surgeries, it's hitting our ophthalmology departments, it's hitting our communities across Scotland and I think the people of Scotland hear the challenge that the Scottish Government have, I hope the Scottish Government hear the challenge that they have about how to make this better and move forward. Thank you Presiding Officer. Thank you and I call Tess White. Thank you Presiding Officer. I'm pleased to close today's debate for the Scottish Conservatives. We do all agree on the importance of the work of this committee. The undeniable reality is that our NHS is severely overstretched, and that is especially the case for primary care. Despite the best efforts of GPs and frontline staff in surgeries across Scotland, primary care is struggling to keep pace with demand and increasing complex patient needs. Stephanie Callaghan quite rightly talked about the value of the personal stories to the committee. Evelyn Tweed has said, no doubt primary care is under pressure. That is, Presiding Officer, a massive understatement. The deputy chair of the British Medical Association's Scottish GP committee put it bluntly. As she rightly should, this is a particularly terrible time for general practice. But there's a wider issue here, which is that the whole system is overwhelmed from GP practices to A&E. With record waiting times after months, things are getting worse, not better. The NHS is on its knees. As our convener to the committee, Gillian Martin, has highlighted, and I quoted, workforce and capacity issues, poor signposting, digital exclusion, limited public awareness and people feel fobbed off. There simply isn't the capacity in place, yet public messaging from Humzy Yousaf and the health boards, such as NHS Grampian in my region, is directing patients away from emergency departments to non-critical care. As the Royal College of General Practitioners says, this approach means that pressure is not relieved, it's only reallocated. The question is how to navigate through this crisis so that patients receive the timely, targeted and high quality care they need and primary healthcare professionals do not experience burnout. It's here that the Health, Social Care and Sports Committee's work on alternative pathways to primary care makes an important contribution. As we've heard during today's debate, the Scottish Conservatives believe that alternative pathways to primary care provide a vital way to alleviate the burden on overstretched GPs and other healthcare professionals. My colleague Craig Hoy warned again of a rise in unexplained pharmacy closures due to the Scottish pharmacy contract, a key alternative pathway to primary care. I've got a lot to go through in the first five months of this year alone, staff shortages caused pharmacies to close in almost 1,800 times. Sue Webber raised the relevant and revealing inputs to the committee, the appalling case of her constituent struggling to get an appointment with a cardiologist to diagnose a heart condition. He had to seek private treatment at significant cost. As Minister Marie Todd calls the front door to the NHS, the Scottish Government feels that it has communicated well with the public around seeing physios, pharmacists, optometrists or even podiatrists. However, as Sandesh Gilhane says, the public largely do not know. What a huge concern, as Dr Gilhane tells us, 42 per cent of junior doctors lack access to food, and that obviously leads to burnout. The renegotiated GP contract in 2018 changed the delivery of primary care so that GPs would provide fewer services directly, and multidisciplinary team working would be enhanced. However, the committee's report highlighted concerns that public awareness of these changes is limited. That has certainly been my experience talking to constituents in the region I represent. It's heartbreaking, and Willie Rennie, in his passionate words, said at some point, We must pray that this Government will take some responsibility. Gillian Martin outlined the need for advertising. I agree with that. Patients are bewildered by signposting to alternative health practitioners when they have simply requested to speak to their GP. They don't understand why their winter vaccinations are being delivered an hour away and their bus hasn't come again when they usually just nip down the road to their local surgery. They are getting frustrated with practice receptionists who are often the faces of systemic change that has been poorly managed and poorly communicated to the public by this SNP Government. The most recent health and care experience survey should be a wake-up call to the Scottish Government. Only 67 per cent of patients said that they were positive about the overall level of care provided by their GP, down by 12 per cent on the previous year and the lowest level since the survey began. Primary care does need to be reformed, but that process needs to be clearly articulated to the public. It needs to be patient-centred, not just system focus. As my colleague Carol Mocken points out, the Scottish Government has failed to communicate its vision. The narrative of this SNP Government, she says, is simply not true. Services are overwhelmed. We know, of course, and as the British Medical Association has warned, that Scotland is in the middle of a primary care workforce crisis. Minister, your front door to the NHS is off its hinges and there is a gail blowing. The BMA is clear. Without additional health care professionals across a range of areas, it will be near impossible for primary care to offer the range of services communities need or expect. This is a crisis of the SNP's making over many years. The Health Secretary simply isn't doing enough to provide the resources alternative pathways to primary care desperately need to ease the pressure on GPs. As winter approaches, this crisis cannot become a catastrophe under the SNP Government. Thank you to Martin Whitfield, who highlighted the importance of people, people in the NHS who are watching us today and the people who are receiving life-saving services. Patient safety and the wellbeing of staff is at stake, and so are people's lives. Thank you, and I call on Humza Yousaf. Thank you very much, Presiding Officer. It's been generally quite a good debate with lots of important themes. Highlight it, can I thank, of course, the committee, all the members who are on the committee, for an excellent report. I thank all those who gave evidence. I thank, of course, the committee clerks who we know do the real hard work. I'm just kidding. Of course, our members do fantastic work, but we know the clerks are instrumental in producing such an excellent and high-quality report. Can I reflect on some of the common themes that were mentioned by members right across the chamber? First of all, I think that almost every member spoke about the really challenging context and primary care. Dr Gohani gave his own personal example in terms of a day in the life of a GP. It won't surprise him that I've met many GP in this role who described some of our workload challenges. In fact, I was meeting with Dr Andrew Bust of the BMA of the Scottish General Practice Council last week, and he described those really challenging pressures. He's not going to have any denial for me as a health secretary of the scale of that challenge because I meet with general practice and others in primary care on a very regular basis. In particular, I know that Willie Rennie was attempting to set some context on others too. Not just primary care, but the entire health and social care system has really been hit in the last couple of years or a few years by huge shockwaves. I would say that at least a triple-lammy, in fact, I think, would probably be even more than three shockwaves, but Brexit has undoubtedly caused huge impacts. I know that Willie Rennie would recognise that, again, particularly in social care. He was right, as were a number of other members, that social care has been hit particularly hard because of the impact and effect of Brexit. Talk to any care home provider or those who represent the care home sector, such as I, Donald MacAskill, whom I spoke to yesterday, and they will tell you the enormity of the impact that Brexit has had. Obviously, it has had the pandemic, and there is no way that I could justice to the scale of the impact that the pandemic has had. I completely accept from every member that there were challenges pre-pandemic. I am not suggesting that there was not, but there is a world of difference between pre-pandemic, where we are not meeting the 95 per cent target, for example, for A and E, where we were a few per cent off or five per cent off, compared to where we are now, where performance is not where I would like it to be in the 60 per cent isle in England in the 50s. That is a world away from where we were pre-pandemic, so the scale of the challenge has been clearly impacted by the pandemic. Of course, I will give way to Willie Rennie. That is slightly at odds with what Paul Gray said, the former chief executive of NHS Scotland, who said that this day was coming, just Covid brought it forward. It has been building for years. Does he not accept that? I do not think that it is at odds, because what I am accepting is that there were clearly challenges. There is a debate and a discussion to be had how we reform our services moving forward, while preserving central ethos, which I believe, and I suspect that Willie Rennie undoubtedly believes in ensuring that our NHS is free at the point of use. It is difficult to just really… I do not think that we know the full impact, I have to say, of the pandemic yet. We know certain impacts, at a certain scale of that impact. That goes back to the point that, again, was made by a number of members across the chamber, which is that we are seeing patients presenting whether it is in primary care, which is rightly the focus of this report, or whether it is in secondary care, with higher acuity. They are sicker, and therefore they are needing more complex interventions than perhaps they needed before. The third shock wave that has hit our primary care services and indeed our whole health and social care system is the cost crisis that has come about because of the UK Government's complete mismanagement of public finances and the economy. Although that high inflation, which is impacting public finances and budgets, is a public health crisis, I would suggest, and we are seeing that triple whammy at hitting primary care. So, when colleagues speak about budget challenges, whether it is Sandish Grohaniak, whether it is Carol Mocking or others, they are, of course, right to challenge us on budgets like that. It is absolutely the job of Opposition to do so, but I want them to know that, as Cabinet Secretary for Health and Social Care, I do not take those decisions lightly, but they are necessary, given again that our budget is now worth £650 million less than when it was set in December. If we want to pay NHS workers fairly, as I do, putting a record pay deal higher than the pay deal being offered in England, higher than the pay deal being offered in Wales, then we have to be able to afford that. I heard Dr Grohaniak this morning in the radio when he was challenged about trying to find where that money would come from. He was unable to do so. He started talking about the fact that we apparently privatised rail, which is not what we have done. In fact, we have brought it into public ownership. When I challenged Carol Mocking on her contribution, I agreed with a bit of vision, but I am sorry that she was not able to identify a single penny that she would put towards that £650 million inflation recost or towards a pay deal. I agreed with members on the focus on the whole system. I can give an absolute guarantee that, when it comes to trying to alleviate the pressures on primary care and those alternatives, I hear what they are saying about the communication. That is a very fair point that has been made by the committee in its report. I thought that it was well made by Emma Harper and the convener of the committee and many other members right across the chamber that we can do more about the communication. I thought that Gillian Mackay was absolutely right that we should go to where people are. We should make sure that we are on the platforms, we are ensuring that we are on the places that they frequent and you mentioned the issue around streaming services, for example. That is something that we are considering and what more we can do, because I don't think that a disagreement in those pathways is necessary and effective. On some of the other issues that were raised, many of members raised the issue of social prescribing. I want to give an absolute assurance that we are looking at the recommendations of the report. The national lead on social prescribing is something that I have asked officials to consider. There is a wide portfolio interest in social prescribing—understandably so—but I am not opposed in principle to the idea of potentially examining and exploring a national lead. On a single electronic patient record again—a theme that came up very regularly from colleagues right across the chamber—again, I would refer them to our Scottish health and care strategy. What we intend to do is that the convener highlighted in her contribution very well to ensure that we have medical records stored, linked and shared securely according to the information that is needed in terms of how we will do that. We intend to publish a delivery plan in the coming weeks, and I will make sure that that is shared to members who have an interest. There are many other areas that were raised. Forgive me for leaving off so that I have not been able to cover them all. I want to once again commend what was a fantastic report by the committee and thank members for all their contributions. I call Paul O'Kane to wind up the debate on behalf of the Health, Social Care and Support Committee up to 5 o'clock. I am pleased to have the opportunity to close this important debate on behalf of the Health, Social Care and Support Committee. In common with colleagues across the chamber, I put on record my thanks to the committee clerks, the support staff and all committee colleagues for their work and contributions to the inquiry and the report. As we have heard this afternoon, the inquiry has highlighted several challenges to the implementation of primary care reform and to improving access to and uptake of alternative pathways to primary care. I think that we have had a good debate this afternoon and I want to thank all colleagues for their contributions and to many of the contributions that highlighted issues in their local communities across Scotland and where alternative pathways are proving very successful and, of course, where some are still struggling to take hold. I think that it was important to hear that breadth and depth of what is happening across the country. From our public survey as part of the inquiry, we heard that there were high levels of uncertainty from respondents about the availability of health practitioners locally and very few respondents had self-referred directly to most non-GP health practitioners. Again, I think that we heard some of that reflected in the debate today. Comments from the members who have spoken have shown that there are on-going issues with the uptake of alternative pathways to primary care. I think that many members in their contribution, particularly the opening speeches, sought to give perhaps something of the wider context. Sandish Gohani, Carol Mawkin and Willie Rennie sought to set out that context because, as Martin Whitfield said in concluding, we cannot get away from that and that is an important debate to have. However, we must ensure that we look at all aspects of what is going on in this space and ensure that we engage in a constructive manner. To the Government's contributions, both from Marie Todd and, indeed, in closing from the cabinet secretary, I welcome the cabinet secretary's written response to the inquiry and, indeed, his contribution today, in which he has outlined, along with Marie Todd, the Scottish Government's ambitions and where it intends the progress that it is making and the progress that it intends to make in the future. I know that the committee will continue to take a very keen interest in that dialogue and holding the Government to account on that place, because we have to ensure that parents and patients can access the right healthcare professional at the right place and the right time, and I think that that front door approach. Certainly I will take an intervention from the convener. I am leading in very nicely to what you have just said, because I think that sometimes in the debate we talked about diverting people away from GPs, and that has been the primary reason for terms of pathways, but it is actually about getting people the right care at the right time with specialists that have the right equipment. I think that that is important to acknowledge, and I think that it is difficult sometimes in the context because of the pressures that we know are on GPs to perhaps take a step back from that and understand that actually this is about holistic services and that people getting that support. I think that we have heard from Marie Todd and from others about that door approach and that no-wrong door approach, and I think that we have to ensure that that is at the heart of everything that we are doing, and that it is not simply about diverting from one place or another. Because there are many non-GP primary healthcare practitioners in Scotland who are available to give patients the help that they need, but as has been highlighted during the debate, I think that there is still much to do to ensure that we reach that outcome. I recognise Martin Wittfield's contribution on children and young people, and I would certainly endorse the convener's intervention to him to look at that report, and I know that he will. However, during the committee's inquiry into the health and wellbeing of children and young people, we heard from young people who encountered real challenges with trying to access support at a time when they were experiencing a crisis, particularly with their mental health, problems with being believed or taken seriously very often. The ability to self-refer to a mental health professional would provide a real lifeline for people in that situation, enabling them to get quicker and easier access to get the help that they need when they need it, and not always to feel overly medicalised in that space. Mental health services that were highlighted to the committee are particularly difficult for patients to refer themselves to, and self-refero is not an option in most health board areas. However, Dr Jess Susman of the Royal College of Psychiatrists told us that it is possible in Glasgow where 46 per cent of referrals to primary care mental health teams are self-referos. Those mental health teams can then assess whether the patient has a mild to moderate mental health problem or something more serious, in which case they would then be referred to secondary care. The committee believes that self-refero to mental health services is an important step and that all health boards should be making that available. Again, I hope that the Minister for Mental Health and Wellbeing is in his place as well, and I am sure that he will be keen to engage with boards in that respect as well. Although I think that we have to be fair that it is not without its challenges but that Glasgow has shown what can be achieved when it is done successfully. The cabinet secretary told the inquiry that promoting self-refero to appropriate support will be one element of the new multidisciplinary mental health and well-being services in primary care, which is due to be implemented this year, and the committee does welcome that commitment also and looks forward to that becoming a reality very soon. Many members have spoken during the debate about the benefits of social prescribing, and I thought that some excellent contributions in that regard. I would particularly highlight Sarah Boyack's very passionate advocacy for therapeutic intervention in culture. We can all recognise something in that and the importance of making that more mainstreamed and better supported. I support all the comments that we have heard on social prescribing. Many of our witnesses that we saw in committee identified significant potential for wider social prescribing, particularly for people presenting with problems that are rooted in non-medical issues. However, again, the committee heard that a key barrier to the greater use of social prescribing is the reliability of information on services that are available locally. That is a broad theme that we have heard across the chamber today about getting it right in terms of how we communicate with people, how we tell people what is available and how we ensure that they can have access. Indeed, Citizens Advice Scotland told the committee that social prescribing is beneficial for a certain group, which is the group that is aware that self-care works and that social activities can help and alleviate issues, but it does not seem to work for other groups, and that can be down to a lack of public awareness. If people knew what was available to them, it might increase the uptake. The issue of poor signposting was raised many times during the inquiry, and I think that we have heard it raised again in the debate today, and certainly Stephanie Callaghan and Gillian Mackay, my colleagues in the committee, made strong contributions in that regard. We need to have reliable, comprehensive and up-to-date information about local and national services, and I think that that would greatly assist signposting of patients and encourage greater use of alternative pathways. I think that we have had some contributions on Alice today, and I know that my colleague Emma Harper is, in committee, always a strong advocate for the use of Alice. That is the local information system for Scotland database, which is run by Health and Social Care. I am trying to interrogate the ways that Alice could work better or local versions of a library could work better as well. Alice is obviously run by the Health and Social Care Alliance and funded by Government, so, while the committee recognises the value of such a database and sees the potential for Alice to help improve signposting, there are concerns about the constantly changing landscape of providers and non-GP primary care services limiting perhaps the reliability of information that is available, and that need for that kind of constant monitoring and updating. By significantly improving general awareness of it among health practitioners and the accuracy reliability and comprehensiveness of information that it contains, the committee believes that Alice has the potential to become an authoritative source of data for those seeking to signpost patients towards alternative pathways to primary care. Our report calls on the Scottish Government to work in partnership with the Alliance to undertake an assessment of the actions and associated funding required to achieve that. I am pleased to note from the cabinet secretary's written submission to the Scottish Government that he has since met with Alice to progress that work, and we look forward to further information on that. In drawing my remarks to our clothes, I want to again thank everyone who contributed to the debate this afternoon, echoing the convener's words of gratitude for the contributions that we received during the inquiry. As we have heard today, despite a debate that was at times sparky, it is fair to say that we have managed to all agree that the principle of primary care reform and that people getting care in the right time and the right place is something that we all share in this chamber. However, it is clear that, for that to happen, there are a number of important challenges to overcome. The public must have greater confidence that, in many instances, a GP might not be the first port of call and that using an alternative pathway might give them quicker and easier access to the treatment that they need. The option of self-referral needs to be more widely available, accessible and better understood. Information needs to be up-to-date and available to all, both online and offline, because we cannot forget about a whole section of society that does not have access to the internet and who still finds it challenging to access information in that space. By addressing those challenges, alternative pathways have the potential to transform how patients experience primary care, shifting the focus towards a more preventative approach with quicker and better outcomes for everyone. I think that very clearly today is not a full stop, but a comma in our debate and our discussion on those issues, and we look forward to continuing to progress the recommendations in this report. That concludes the debate on inquiry into alternative pathways to primary care. It is now time to move on to the next item of business, which is consideration of parliamentary bureau motion 6711 on approval of an SSI, and I ask George Adam on behalf of the Parliamentary Bureau to move the motion. Minister, the question on this motion will be put at decision time. There are two questions to be put as a result of today's business. The first is the motion 6702 in the name of Gillian Martin on behalf of the Health, Social Care and Sport Committee on inquiry into alternative pathways to primary care be agreed. Are we all agreed? The motion is therefore agreed. The final question is that motion 6711 in the name of George Adam on approval of an SSI be agreed. Are we all agreed? The motion is therefore agreed. That concludes decision time, and I close this meeting.