Sir Lewis Ritchie’s independent review of Primary Care out-of hour’s services said that more needs to be done, especially in multidisciplinary working1. There needs to be more investment in the workforce and in infrastructure, and a drive towards changing the culture, centred on a model of urgent care resource hubs. The importance of reforming primary care was also emphasised in the National Clinical Strategy.
It is estimated 90% of healthcare is provided in the community by a wide range of professionals and an ageing population with increasingly complex co-morbidities has led to increasing workloads for GP surgeries. It is estimated that 18% could be seen in a community pharmacy.
Primary Care Transformation Fund
In June 2015, the Government (working with BMA Scotland and RCGP) announced it would invest £50 million over three years into addressing immediate workload and recruitment issues, as well as putting in place long-term, sustainable change within primary care. The resources will enable GP practices to try out new ways of working that can deliver first class care and improve the working lives of GPs.
Pharmacist Independent Prescribing
Part of the fund, £16.2 million will be allocated to recruiting up to 140 new pharmacists who will work with GP practices.
The 140 new pharmacist posts will work as part of a multidisciplinary medicines management team who deliver prescribing support, polypharmacy reviews and a clinical role within GP practices.
The posts will optimise quality, cost-effective and evidence-based use of medicines that include: undertaking prescribing reviews/ audits and facilitating the implementation of local and national guidelines. They will lead on key projects or clinical areas to deliver improvements in safe and cost-effective prescribing.
Urgent Care Resource Hub
The urgent care resource hub, a model recommended in Sir Lewis Ritchie’s independent review, will be tested at Crosshouse Hospital in Ayrshire, and will involve a multidisciplinary team working in a hub to support primary care patients out of hours.
GP numbers and recruitment
A recent BMA survey reported the number of GP vacancies was increasing. While at the same time the number of GPs in Scotland has increased by 7%2.
Although according to the National Clinical Strategy for Scotland:
“The sustainability of the GP workforce continues to be affected by the existing shortfall in GP numbers, the trend towards flexible working, the high proportion of GPs over the age of 55 who are likely to retire in the next five years and the fact that GP specialty training places are difficult to fill.” This is to be addressed in part by “a refocussing of GP activity towards more complex care needs. That would also see a reduction in the more routine tasks and provide an opportunity for other health professions in the practice and the wider community team to work to the “top of their licence” i.e. taking on roles that their professional training has prepared them for.”
National Clinical Strategy for Scotland
There needs to be more investment in the workforce and in infrastructure, and a drive towards changing the culture, centred on a model of urgent care resource hubs. The importance of reforming primary care was also emphasised in the National Clinical Strategy.
Purpose/outcome sought from inquiry
The inquiry will provide an introduction to the Government’s approach to primary care reform. It will consider ‘the crisis’ in recruitment for GPs and the extent to which the proposed hub approach will assist in reducing demand on GPs. It will also identify how pharmacists will fit into the new hubs and how their contribution will be measured.
Two sessions are proposed the first focussing on the proposed new hubs with particular reference to the role of pharmacists and other health professionals. The second looking principally at the current position around GP numbers and other initiatives being introduced to assist.
1. The Scottish Government sought feedback on the report until the end of January 2006 to respond in March 2016. Our understanding is the response is now due in September 2016.
2. Official Report 8 June column 8 answer by Cabinet Secretary.
The Committee received the following submission from Royal College of General Practitioners
On 17 October 2016 the Committee received a letter from the Cabinet Secretary following her appearance before the Committee.
On 8 November the Committee received a letter from the Cabinet Secretary for Health and Sport providing an update on the GMS contract.
On 9 November the Convener wrote to the Cabinet Secretary for Health and Sport following the evidence sessions on GPs and GP hubs.
On 14 December the Committee received a letter of response from the Cabinet Secretary on primary care hubs.
On 18 January the Committee wrote to the Cabinet Secretary for Health and Sport on Primary Care in Scotland.
On 25 January the Cabinet Secretary for Health and Sport wrote to the Convener with recommendations of the improving general practice (GP) sustainability, cluster advisory and premises of short life working groups.
On 3 February 2016 the Cabinet Secretary for Health and Sport responded to the Convener's follow-up letter on Primary Care in Scotland.