Mobilisation Recovery Group minutes: 12 February 2021

Attendees and apologies

Attendees

• John Burns, NHS Board Chief Executives’ Group representative
• Sandra Campbell, Convenor, Scottish Social Services Council
• John Connaghan CBE, Chief Operating Officer, NHS Scotland
• Cllr Stuart Currie, Health & Social Care Spokesperson, COSLA
• Amy Dalrymple, Royal College of Nursing Scotland (deputising for Theresa Fyffe)
• Nicola Dickie, COSLA
• Graeme Eunson, BMA Scotland (deputising for Lewis Morrison)
• Tom Ferris, Chief Dental Officer
• Jeane Freeman MSP, Cabinet Secretary for Health & Sport
• David Garbutt, NHS Board Chairs’ Group representative
• Mairi Gougeon MSP, Minister for Public Health, Sport & Wellbeing
• Cllr Kieron Green, Vice Chair, IJB Chairs & Vice Chairs Group
• Philip Grigor, Scotland Director, British Dental Association
• Annie Gunner-Logan, Coalition of Care and Support Providers
• Clare Haughey MSP, Minister for Mental Health
• Paul Hawkins, Delivery Director, Vaccinations, Scottish Government 
• Pauline Howie, NHS National Boards’ representative
• Caroline Lamb, DG Health & Social Care and Chief Executive, NHS Scotland (Chair)
• Angela Leitch, Chief Executive, Public Health Scotland
• Jason Leitch, National Clinical Director
• Donald MacAskill, Chief Executive, Scottish Care
• Peter Macleod, Chief Executive, Care Inspectorate
• Kathryn McDermott, UNISON National Staff Side representative
• Harry McQuillan, Chief Executive, Community Pharmacy Scotland
• Patricia Moultrie , Deputy Chair of BMA SGPC
• Peter Murray, Chair IJB, Chairs & Vice Chairs Group
• James O’Connell, National Staff Side representative, UNITE
• David Quigley, Chair, Optometry Scotland
• Sir Lewis Ritchie, Mackenzie Professor of General Practice
• Claire Ronald, National Staff Side representative, Chartered Society of Physiotherapy
• David Shackles, Joint Chair, RCGP Scotland
• Cleland Sneddon, Health and Social Care Spokesperson, SOLACE
• Alison Strath, Interim Chief Pharmaceutical Officer, Scottish Government
• Ian Welsh, Chief Executive, Healthcare & Social Care Alliance Scotland
• Carole Wilkinson, Chair, Healthcare Improvement Scotland

 

Apologies

• Jane Anderson, UNISON representative  
• Marion Bain , Deputy Chief Medical Officer
• Derek Bell, Specialty Advisor, Elective & Unscheduled Care, Scottish Government
• Donna Bell, Director of Mental Health, Scottish Government
• Andrew Buist, Chair, GP Committee, British Medical Association
• Dave Caesar, Interim Deputy Chief Medical Officer, Scottish Government
• George Crooks, Chief Executive, Digital Health & Care Institute
• Iona Colvin, Chief Social Work Adviser
• Richard Foggo, Director of COVID Public Health, Scottish Government
• Theresa Fyffe, Director, Royal College of Nursing (Scotland)
• Aidan Grisewood, Interim Director, Primary Care, Scottish Government
• Joanna Macdonald, Chair, Adult Social Care Standing Committee, Social Work Scotland
• Miles Mack, Chair, Academy of Medical Royal Colleges and Faculties
• Fiona McQueen, Chief Nursing Officer
• Lewis Morrison, Chair of Scottish Council, British Medical Association
• Diane Murray , Deputy Chief Nursing Officer
• John Thomson, Vice President Scotland, Royal College of Emergency Medicine
• Linda Walker, National Staff Side representative, GMB
• Andrea Wilson, Convener, Allied Health Professions Federation Scotland
• Gregor Smith, Chief Medical Officer
• Cleland Sneddon, Health and Social Care Spokesperson, SOLACE

 

In attendance

• Heather Campbell, Interim Deputy Director, Primary Care, Scottish Government
• Mairi Cameron, Strategic Reform Unit, Scottish Government
• Lynsey Cleland, Health Improvement Scotland
• Derek Grieve, Interim Head of Vaccinations Division, Scottish Government
• Helena Jackson, Health Performance & Delivery, Scottish Government
• Helen Maitland, Director of Unscheduled Care
• Stephen Lea-Ross, Deputy Director of Health Workforce, Scottish Government
• Jennie Marshall, Head of Planning and Performance, Revenue Scotland
• Christine McLaughlin, Director, Test & Protect, Scottish Government
• Jessica Milne, Health Performance & Delivery, Scottish Government
• Gillian Russell, Director of Health Workforce, Leadership and Service Reform, SG
• Malcolm Summers, Head of Strategic Reform Unit, Scottish Government
• Yvonne Summers, Head of Operational Planning, Scottish Government

 

Official Support

• Jack Downie, PS/Cabinet Secretary for Health & Sport
• Andrew Fleming, Health Performance & Delivery, Scottish Government
• Angela Gibson, Health Performance & Delivery, Scottish Government
• Dan House, Health Performance & Delivery, Scottish Government
• Jake Macdonald, Health Performance & Delivery, Scottish Government
• Sean More , Health Performance & Delivery, Scottish Government

Items and actions

Item 1: Welcome

1. Caroline Lamb, DG Health and Social Care and Chief Executive of NHS Scotland, informed the Group that she would be chairing the meeting to allow the Cabinet Secretary to leave early to attend another engagement.

2. The Cabinet Secretary thanked Caroline Lamb for agreeing to chair today’s meeting and noted her apologies for having to leave the meeting early.  Having thanked members for their role in the hugely successful vaccination programme to date, Ms Freeman updated the Group on the upcoming formal election period (from 25 March) and, given the need for the Group’s key COVID-19 response and recovery work to continue, felt it was important that scheduled meetings should be maintained during this time; though it may be these need to be chaired by Caroline Lamb.

3. The Chair noted a number of developments since the last meeting, including the recently taken policy decision in relation to the return of schools, which will see a phased return to education, allowing Early Learning and Childcare (ELC), children in primaries one to three, and some senior phase pupils to return to schools from 22 February. In addition, tougher international quarantine measures have been announced by the UK and Scottish Governments, the rollout of the vaccination programme is continuing, and the Independent Review of Adult Social Care report has been published; a substantive   agenda item for this meeting. 

Item 2: Note of Previous Meeting Held on 22 January 2021, Action Log & Matters Arising

4. No amendments had been received from Group members and there were no outstanding items (other than the standing action that encourages members to approach the secretariat with any suggestions for future agenda items); nor matters arising noted.  As such, the note of the meeting on 22 January was agreed and will be published on the Group’s page on the Scottish Government website.

 

Item 3: Overall Review of Pandemic, Winter Planning & Preparedness, and Vaccinations

5. Jason Leitch provided a brief update on the state of the pandemic, drawing on the most recent estimation of the R rate, believed to be between 0.7 and 0.9. Prevalence of the virus in Scotland has not been as low as 50 per 100,000 – the World Health Organisation’s agreed metric for having COVID-19 under control – since September 2020 but, due to the impact of the most recent set of restrictions, prevalence is now at just above 100 per 100,000. The higher prevalence, and the slow rate at which cases are reducing, is due to the UK variant which makes up over 80% of new cases. This means the Government has less head room when making policy decisions on re-opening parts of society; not least as medium-term modelling suggests a fairly flat trajectory in new cases if we remain under relatively tight restrictions.

6. Andrew Fleming provided an update on acute NHS capacity and highlighted to members that, for the first time since early January, COVID-19 cases in acute beds were at a level below the initial peak in April 2020. COVID-19 cases in ICU are also reducing, though at a slower rate and there remain a significant number of longer stay patients In A&E, overall performance is similar to last year even though we are seeing less people presenting; taking account of necessary COVID-19 measures, including flow, infection prevention and control. In short, and in comparison to the update provided at the last meeting of the MRG, the acute sector remains very busy but the position appears to be slowly improving.  

7. Heather Campbell provided an update on primary care and noted that workforce challenges mean that the sector is rated amber overall. Operationally, NHS 24 call answering standards have improved significantly but the increased number of calls received at weekends continues to present challenges. Performance for the Scottish Ambulance Service (SAS) has been stable and no GP practices are currently proposing any suspension of services. Pharmacies are not currently experiencing any major issues, though Optometry and Dentistry are not yet back to full service. Overall, there are clear signs of some improvement across primary care settings.

8. Steve Lea-Ross spoke to the presentation on health workforce issues, noting a week-on-week marginal reduction in COVID-19 related sickness absence across NHS Boards; reflecting the wider state of the pandemic.  There are particular pressures, both COVID-19 and non-COVID related, on absence profiles in NHS 24 and the SAS. There is an ongoing programme of work to look at the range of health and wellbeing interventions which could be employed to assist with staff wellbeing, including close monitoring of untaken annual leave. Based on workforce capacity early warning indicators, Scotland is broadly rated as amber, which means there is ongoing intervention and mitigation taking place; both in terms of redeployment and ongoing recruitment.  

9. On adult social care, Anna Kynaston highlighted some positive news on care homes: the number of outbreaks is significantly down.  In care at home services, overall staff absence has recently increased slightly, which we suspect may be partly due to the introduction of testing; further analysis is underway. Work is ongoing with the Chief Nursing Officer’s Directorate to consider how effective infection prevention and control protocols can be further embedded across the care home sector.  There is also work underway to try and maintain positive morale across the workforce, as well as on preparing to recommence meaningful contact and visiting It was also noted that this is the first year the social care sector has had a winter plan; therefore, the coming months will allow colleagues to reflect on successes and challenges; helping to inform preparations for future planning.  

10. Christine McLaughlin delivered a short update on testing: capacity is relatively stable at around 77,000 PCR tests available per day, with an average utilisation of 25-30%.  Work to increase access through a range of new pathways had been announced by the First Minister in the previous week.   Guidance was due to be published on 15 February for extended healthcare workers in primary care settings; inviting staff to take part in the testing programme from 22 February. Overall, steady progress is being made across the range of pathways, including SAS control room staff, hospices, international travellers, the food processing and distribution sectors, close contacts, schools, and asymptomatic mobile testing in communities.

11. Paul Hawkins provided an update on the vaccination programme and highlighted that Scotland has now administered vaccinations to over one million people. Vaccination call centres have now taken more than 25,000 calls with an average response time of 37 seconds. The programme is significantly increasing the number of call handlers so that it is able to respond efficiently to concerns around potential supply issues in the coming weeks. Overall, the programme is progressing well and will be informed by modelling to make policy and operational decisions, both nationally and at Board level, which support its continued success, subject to supplies; as we move through the extension of the programme to further cohorts, and the administration of second doses.

 

Discussion

12. The Chair thanked everyone for their comprehensive updates and suggested that it would be helpful to understand how delivery partners are balancing pressures across a range of areas, including how we continue to ensure the wellbeing of staff.

13. John Connaghan raised the issue of pent up demand within the system, noting that, whilst we can visualise this in terms of waiting lists, we must also factor in the patients who have not yet come through the system (e.g. delayed cancer referrals) as we move into the next phase of remobilisation; which is likely to coincide with a period of staff decompression.  John suggested that this should come back to a future meeting of the Group for a fuller discussion of remobilisation and the inherent risks.

14. Patricia Moultrie suggested that GPs are worried about the cumulative impact as practices have continued to operate throughout the pandemic, and supported the staffing of assessment hubs and other areas, whilst experiencing a high level of staff absence. Given this context, Patricia noted her concern about whether practices will be able to positively respond to a request to do more under future phases of mobilisation.

15. Graeme Eunson asked about the plan for exiting restrictions, given concerns around new variants and incidence appearing to plateau rather than quickly reducing; in the context noted by Patricia: many staff have been working without a significant break for around a year now and are fully aware of an oncoming wave of unmet need.  As such, it is crucial that the public understands that there likely cannot be a return to normal business once the pandemic is over; and that future planning takes account of the risk of staff considering different career paths, if they cannot see a light at the end of the tunnel.

16. Jason Leitch acknowledged the concerns raised. On new variants, he said the current advice from virologists is that the UK variant is dominating others, given its distinct advantage in transmissibility. On the route out of lockdown, the vaccination programme rollout is progressing successfully and will reduce transmission, whilst testing is getting better and quicker.  The virus will change, and may change for the better; and we have improving treatments for acute infections. Nevertheless, there will continue to be mutations and the global dimension will have to be taken into consideration when governments make policy decisions, noting the inherent trade-offs to keep levels of infection under control and to protect health systems.

17. The Cabinet Secretary thanked stakeholders for their input and suggested that the issues raised here go to heart of the major decisions governments need to make. Notably, the Scottish and UK Governments need to continue to clearly and consistently explain that the UK variant responds more slowly to lockdown-level restrictions than the previous dominant strains of the virus. Understandably, people are reflecting on their experience of the initial outbreak when talking about the forthcoming summer and potential holidays, so we need to increase the wider public understanding of the impact of the UK variant, which has implications for the pace of safely removing restrictions. This matters as it lays the groundwork for the substance of what the Group is discussing: how do we get the balance right between reducing cases and bringing down COVID-related pressures on the NHS and planning partners, without people thinking there will be no other pressures on services and staff?

18. NHS Boards are being asked to develop the next iteration of their remobilisation plans on the basis that they have a very pressured resource – the workforce – which needs time to recover.  In accepting that it is therefore likely to take longer to remobilise, we will need to prioritise effectively across whole systems. The Government and delivery partners need to ensure the public understands that remobilisation has to be managed in this way to ensure a safe recovery, alongside innovations and new ways of working. The Cabinet Secretary echoed John Connaghan’s comments and agreed that this key topic of remobilisation, not least in the context of ensuring staff wellbeing and recovery, should come back to the MRG as a substantive agenda item.

19. James O’Connell agreed that effective public messaging is crucial. On the UK variant, he suggested it would be helpful if there was data to inform us on where in society most transmission is happening. Harry McQuillan also noted that NHS Pharmacy First was launched during the pandemic which clearly demonstrates there is a role to play for pharmacy in making sure these innovations are being utilised appropriately and effectively; taking pressures of other delivery partners and colleagues.

20. Jason Leitch responded, recognising the wide-ranging impact of effective partnership working across the primary care sector. On transmission, this is occurring wherever people meet, including workplaces, schools, early learning centres and domestic settings.  Whilst this is a smaller list due to the current restrictions, the overall level of infections is still relatively high; and the pace of the downward trajectory is currently quite slow.  

21. Caroline Lamb thanked everyone for the discussion and noted the action to bring remobilisation back to a future meeting of the MRG as a substantive agenda item; exploring how we can effectively address pent up demand across systems, whilst being mindful of staff wellbeing and resilience.

 

Item 4: Independent Review of Adult Social Care

22. Christina Naismith opened this item and acknowledged the work that had been done by the review panel led by Derek Feeley. The principal aim was to understand how we can improve Adult Social Care (ASC) support for everyone involved in the system, including workers, families, carers and, not least, residents. This entailed a huge amount of stakeholder engagement and a real emphasis on lived experience. The review took a human rights based approach and a full range of stakeholders were very keen to be involved from the outset.

23. The report, published on 3 February, falls into three distinct but inter-related parts: shifting the thinking or paradigm, strengthening the foundations, and redesigning the system. The first part requires everyone to acknowledge social care as an investment. This means moving to new ways of thinking about social care. There is much to be celebrated in ASC but we know there have been challenges in implementing some of the recommendations from previous reviews and initiatives. There are, of course, some ASC settings which provide excellent care but this needs to happen uniformly and consistently. We need to focus on the quality of care provided, via a quality improvement approach in care homes, self-directed support, and in procurement. Another key area of focus is strengthening the social care workforce to ensure they feel much more engaged, valued, supported and rewarded; building more trusted relationships.  As part of this approach we need to recognise that, without unpaid carers, we would not have a sustainable social care system; they need to be provided with a stronger voice and support networks, including appropriate respite consideration.  

24. The report concludes that a National Care Service (NCS) is required to drive the necessary improvements in the three priority areas, including the development of national standards; as well as better and more effective integration with the NHS; thereby offering national oversight and accountability for the required changes. 

25. Kate Hall noted that Scottish Government will formally respond to the report in due course. In the immediate term, the Cabinet Secretary will lead a Parliamentary debate on 16 February.  Gillian Barclay noted that Scottish Government officials are carefully considering a programme management approach to the report’s recommendations; and assured the Group that they and other stakeholders would be consulted on the next steps.

 

Discussion

26. Cleland Sneddon commented that the lived experience testimony described in the report will be recognised by everyone who works in the sector.  All providers have shared those frustrations for a long period of time and hopefully this report takes us in a positive direction to fair work principles and a rights based approach. Cleland commented that the report’s recommendations would need to be supported with resources to effect the necessary change; noting that there are faster and better ways to make change without launching directly into a structural change programme; and that this must be driven as a whole systems’ approach.

27. Annie Gunner-Logan thanked Christina and the review team for the comprehensive work undertaken in such a short space of time; taking full account of the considerable material and analyses which had already been completed in this area, rather than attempting to replicate it all.  Annie suggested that colleagues should look at the report’s recommendations in terms of the difference it will make to the people we support and employ, rather than from the point of view of an organisational response. She felt some areas need further consideration - notably the application of improvement science, inspections, structural change and the NCS proposition. Overall, this was viewed as a remarkable piece of work and it is therefore important to understand how we can support the effective implementation of the recommendations.

28. James O’Connell confirmed that Unite had broadly welcomed the report, noting that it is grounded in person-centred care and that is paramount. He suggested that, ultimately, enacting change will be a matter of political will. Unite supports swift progress on developing recommendations around fair work principles, national collective bargaining proposals and the NCS.

29. Stuart Currie, who was a member of the Advisory Panel supporting the review, noted that the extensive engagement undertaken with organisations and individuals was key. He welcomed the recognition that to materially change and improve social care would require substantial additional funding.  Stuart reflected that the report addresses main long-standing issues in social care which have had more exposure as a result of the COVID-19 pandemic.  He welcomed the shift in approach to workforce, including trades union recognition and collective bargaining.   He concluded by commenting that the worst thing that could happen is that areas where there is consensus are not progressed because there is a disproportionate focus on governance. 

30. Peter McLeod suggested that the first part of the report – the paradigm shift – is very important and needs to be supported by leadership from key partners to ensure delivery. In terms of regulation, there is an issue of consistency and quality across the country and that is related to current commissioning practice. Recognising the value and worth of social care, both in terms of language and delivery, backed by necessary investment, is key. Peter concluded by commenting that, if the implementation of the report recommendations can deliver parity of esteem for health and social care, this will lead to significant, positive, rights based improvements.

31. Harry McQuillan noted the review concluded that a different system and way of thinking is required; welcoming the reference to self-directed support and importance of community based assets, such as the community pharmacy network; often situated at the heart of disadvantaged communities, actively tackling inequalities, with medicines as the biggest intervention in keeping people safe and well at home; so, community pharmacy should be at the heart of developing and implementing the policy responses to the report.

32. Amy Dalrymple thanked the review team for an excellent piece of work and the RCN was very happy to contribute to it; particularly welcoming the significant steps on thinking, commissioning and workforce.  The RCN is concerned, however, that there is a lack of context in the report in terms of the increasing complexity of need, which is a long term trend in those using social care services.  There is reference to loosening eligibility criteria leading to more prevention, but people will still need healthcare interventions, including a significant, ongoing contribution from nursing.

33. Kieron Green suggested that, from a Health and Integrated Joint Board (IJB) perspective, there does require to be more clarity on governance, including how any changes will affect other parts of the system, and the overall approach to integration. 

34. John Burns noted that NHS Board Chief Executives have had an initial discussion on the report and are very keen to be involved in the next steps.  John felt the presentation slide on the paradigm shift captured very well and succinctly what the report was setting out to achieve.  From experience in the NHS, John explained that improvement science can have a significant positive impact over time.  Given the many important issues set out in the report he felt there would need to be some clear prioritisation and, as such, welcomed the programme management approach that had been mentioned.  He concurred with the view that we should avoid becoming pre-occupied with debate around structures; and must progress this through the lens of our citizens and those who use the services; thereby strengthening health and social care integration. 

35. Donald Macaskill noted that he was very impressed with the report and what struck him was the sense that it was describing the need to create a social covenant around health and social care. He outlined three key characteristics of the report: the fundamental importance of human dignity and delivering person-led care, the sense of common good, and the need for clear stewardship.  In short, we need to ensure the recommendations and aims of the review are implemented through real partnership working.

36. Caroline Lamb thanked everyone for their contributions and noted the consensus around vision and commitment to the report’s outcomes; it is now up to the Government, planning partners and stakeholders to understand what we can achieve in partnership on next steps and implementation, as part of a carefully considered and clearly defined programme management approach.

Item 6: The Lived Experience of COVID-19

37. Lynsey Cleland took the Group through the key findings of the Citizens’ Panel Report on people’s health and care experiences during the pandemic, and their priorities for the future.  A citizens’ panel is demographically representative of Scotland’s population and is a means to understand peoples’ views; mainly providing quantitative data. It is intended to complement the qualitative data within the ALLIANCE report.  It is also important to note that the feedback was received before the current lockdown.

38. The report outlined a range of findings in relation to health and care experiences, virtual visiting, community support, and what matters most to the public.  64% of panel members said that their health and wellbeing had largely stayed the same between the start of the pandemic and December 2020; around 3 out of 10 responded by saying that their health and wellbeing had got worse, and females were more likely to be part of this group.  Around two thirds of respondents had accessed or tried to access health and care services, and just under half had difficulty accessing services: the most common reason was longer waiting times, but 40% said they were unable to contact services and 30% said poor communications contributed to difficulties accessing services.  Looking to the future, the opening up of routine appointments was the top priority (73%) for panel members, followed by better access to GP services and shorter waiting times. 64% of panel members would be willing to use video consultations with 58% willing to use telephone consultations. Just over half would be willing to update information about their condition/s via texts, applications or web-based services. Those in the over-65 age group said there were less likely to use digital means to access services.  In terms of the experience of virtual visiting to keep in touch with loved ones during the pandemic, only 47 panel members had used this but 88% of them were satisfied with the experience and 82% felt this would be an important option for future use.  On community support for health and wellbeing, 53% of respondents saw no change, whilst 36% felt it was stronger, and 11% felt it was weaker.

39. Ian Welsh spoke to the slides on the People at the Centre programme.  He noted that a literature review was used to triangulate the findings from the research.  Over a thousand people had shared their experiences from all 32 local authority areas. A number of respondents had welcomed the availability of telephone and digital methods to access services, whereas some continued to prioritise in-person access to care and treatment; this was particularly marked in accessing mental health support.  Peoples’ experience of accessing health care services has been mixed and often contradictory.  On the negative side of this experience, particularly people living with long term conditions described concerns about the longer term impact on their health and wellbeing, as well as effectively managing their condition in the short term.  There were quite significant levels of fear and distress amongst respondents who had care or treatments paused or postponed during the pandemic. Poor communication was also seen as a barrier to healthcare, particularly in issues relating to health literacy and inclusive communication.  Where people did feel consistently well informed, they shared feelings of reassurance.  There was an impression that the needs of disabled people or people whose first language was not English had sometimes been overlooked.  Underlying issues that lead to inequity of access had clearly been exacerbated during the pandemic.

40. Unpaid carers reported the practical and emotional challenges of providing ongoing care during lockdown, in terms of access to support and respite.  Experiences of pregnancy and maternity services during the pandemic had, in some cases, been anxiety provoking and isolating due to the reduction in post-partum services and support.  Care home residents had reported feelings of powerlessness and anger due to the implementation of restrictions around visits from friends and family, as well as social and outdoor activities.  People with sensory impairments have experienced new barriers, such as: loss of lip reading due to face masks; the inability to easily access appointments whilst accompanied by a support worker; navigating public areas under social distancing requirements.  Ultimately, the need for a more flexible approach and systems was raised.  Amongst some respondents there is a perception of power imbalance: people who do not feel they have been able to make or share decisions about their care.  Respondents have also described a wide variety of positive experiences, particularly with emergency, pharmacy and link worker services; as well as the often swift, effective, innovative and adaptable response of third sector organisations and communities.  Clearly, there is also likely to be a long term legacy of mental health and wellbeing issues caused by the pandemic across a very wide range of people.   

41. Caroline Lamb thanked Lynsey Cleland and Ian Welsh for their presentation; noted the clear and powerful messages received; adding to the challenge referred to earlier in the meeting about providing access to more services, balanced with the need to ensure staff have time to properly decompress.  

 

Discussion

42. Graeme Eunson queried whether the HIS report was able to be shared further. Lynsey Cleland stated that the report was nearly finalised. The Group Secretariat undertook to provide members with a link to the final report when it is published.

43. Harry McQuillan noted from the HIS report that pharmacy has overtaken A&E as place to go for non-life threatening  care, which is a positive development in terms of right care, in the right place, at the right time. The People at the Centre review had highlighted how pharmacy services had exceeded communities’ expectations and Harry referenced the new home delivery service for NHS prescriptions as an example, with 144,000 delivered across Scotland in the second week of operation.

44. Peter McLeod noted the work on Near Me and how digital appointments might not be for everyone, even though this is recognised as a positive and beneficial innovation. He offered Ian Welsh the opportunity to take this work to the Digital Citizen Board (DCB) to understand how this can inform the further development of Near Me and similar digital access initiatives.  Ian Welsh thanked Peter McLeod for the offer and agreed that it would be helpful to take this to the DCB.

45. David Shackles welcomed the reports and recognised that there is much for general practices to carefully consider. He noted that 43% of respondents in the HIS report were seeking better access to GP services and that this would need to be considered as part of the wider work on NHS remobilisation.  This necessitates effective whole system working using the totality of primary care, and accepting that remobilisation may need to be slower and steadier than patients would perhaps like.

46. Patricia Moultrie noted that face to face consultations have continued throughout the pandemic, where necessary.  We need to improve public messaging to better explain that a remote consultation is still a full consultation.  Digital consultations were used before the pandemic and will continued to be used as they are often the most appropriate and convenient medium for patients.

47. Caroline Lamb concluded this agenda item, noting that the key messages would be crucial when planning for remobilisation.

Item 7: Any Other Business and Future Meetings

48. There was no other business.  The Chair invited Group members to approach the Secretariat with any suggestions for agenda items at future meetings and noted that the minute of the last meeting will be agreed via correspondence.  The next meeting of the Group is scheduled for Friday 5 March 2021 between 09:00 and 11:00. 

49. The meeting closed with the Chair thanking all presenters and Group members for their valued contributions.