NHS Recovery Plan: annual progress update

Primary and Community Care

We recognise that primary and community care is for many people, the front door to the health service, where their needs are first raised. We are supporting primary care, not just to reduce pressure on hospitals, but to provide essential care where it is needed most – in our local communities. To support this, we have increased funding for multidisciplinary teams (MDT’s) to £170 million this year, which will be the minimum funding position for future years.

Steps we have taken

We have already ensured a record number of GPs are working in Scotland’s NHS, with more per head than any other country in the UK. We’re committed to further increasing the number of GPs in Scotland by 800 by 2027. At 30 September 2021, there were 5,195 GPs working in General Practice in Scotland (headcount). This is a rise of 74 compared to last year. A further update is expected to be published by Public Health Scotland (PHS) later in the year.

In March 2022, there were 3,519 dentists working in Scotland (headcount). Of which 2,883 were General Dental Service (GDS). The longer-term trend shows an increase of 32% in dentists providing NHS dental services for the period 2007 to 2022 despite the incredibly challenging pandemic period, with disruptions to the education and training of dentists.

Our focus in community dentistry has been to return the sector to at least pre-Covid-19 levels of activity. The latest statistics from PHS on 13 September show we are on the road to recovery – averaging 225,000 examination appointments per month since April to tackle the backlog of appointments. This is an increase of 80% in examination appointments per month on average compared with the period January to March 2022, reflecting the impact of reduced infection controls and the re-introduction of payments linked to seeing and treating patients.

Box 1: Multidisciplinary team (MDT) working in NHS Forth Valley

In Forth Valley, MDT working has allowed patients to directly access a range of additional services in their community and has reduced the need for patients to travel away from home, taking time away from work or education. Advance practice physiotherapists in GP practices now offer direct access appointments mean less patients require follow up with a GP and less are referred to secondary care. In addition, the Primary Care Mental Health Nurse service is delivering more appointments each month, meaning far more direct contact with mental health services with less people being referred back to GP care. The service is also offering 15 and 30 minute appointments, which allow longer conversations to personalise care, and reduce the likelihood of secondary care referral.

One patient commented how helpful it is to be able to contact the Mental Health nurse for advice, support, and treatment rather than the GP. The ability to access the mental health service rather than using a GP appointment meant that they were able to quickly speak to the right person, and get the personalised support and treatment they needed.

Sources: NHS Forth Valley Staff News | Service User Experience | Primary Care Mental Health Team | GP Practice Team

We have also recruited over 3,220 primary care Multi-Disciplinary (MDT) team members, as of 31 March 2022. The recruitment of these professionals, including pharmacists, advanced nurse practitioners, mental health workers, MSK Physios and Community Link Workers, is helping create additional capacity in practices. An update on this recruitment will be published in Spring 2023.

Feedback from local teams suggests that multidisciplinary teams ensure both patient and practitioner time is used effectively, reduces multiple appointments for the same issue, frees up time for longer appointments.

The role of community pharmacy continues to be crucial to providing care close to home.

To underscore that importance, we made the commitment that by April 2022, we would have Board-delivered pharmacy and nursing support in all 925 of Scotland’s General Practices, or direct additional support to Practices where this is not the case. Despite multiple waves of Covid in the last year, we have made significant progress, with over 95% of practices having access to some Health Board-delivered pharmacy support and with over 75% having some nursing support.

NHS Pharmacy First has helped patients to be seen quickly for minor ailments and common clinical conditions, and relieved pressures on GP practices, out of hour and Emergency Departments. The service has provided over 2.9 million consultations across the national network of 1,258 community pharmacies in 2021/22.

Treatments are now available for common clinical conditions including Shingles, Urinary Tract Infections, and skin conditions and patients can receive treatment without the need to see their GP or have a prescription. This service will continue to build on the range of conditions to be treated over the next few years with the introduction of further Patient Group Directions for conditions such as bacterial vaginosis, hay fever and treatment of sore throats.

200 community pharmacies also offer NHS Pharmacy First Plus, where a pharmacist can use their prescribing qualification to treat conditions beyond the Patient Group Directions conditions. Just over 100,000 consultations provided advice on self-care or treatment for common clinical conditions which would ordinarily have required an appointment with the GP or a visit to an out of hours service.

In the last year, a Digital Prescribing and Dispensing Programme has also been established and work is underway to develop requirements to produce an electronic prescribing prototype to enable more sustainable processes across primary and secondary care.

Finally, we introduced the pharmacy women’s health and wellbeing service, and in November 2021 we ensured community pharmacies could provide a short-term supply of the contraceptive pill to bridges the gap between emergency contraception and longer-term contraception. The Bridging Contraception pharmacy service has supplied over 1,400 items up to June 2022, enabling women to access contraception without the need to see a GP or ask for a prescription.

Because of their crucial role in supporting healthcare provision in the community, there has been expansion in the capacity of NHS 24. NHS 24’s new site in Dundee, with a total headcount of 130 operational staff, and Lumina in Glasgow, with a total headcount of around 309 staff, gives NHS 24 the opportunity to expand in line with the redesign of urgent care, Covid-19, and the expansion of their mental health hub 24/7. We will continue to support the Service as they expand both their services and their workforce.

We have also continued to increase the Scottish Ambulance Service (SAS) workforce, and an additional 540 frontline staff were recruited in 2021/22 – the highest number of staff ever to have joined the Service in a single year. This includes Advanced Practitioners who work in multi-disciplinary teams within the Ambulance Control Centre, enabling patients to be seen and treated in their own home, often without the need to be transported to A&E.

Steps we are taking

We are working with the British Medical Association (BMA) and Royal College of General Practitioners (RCGP) to increase accessibility to primary care, including increased use of face-to-face appointments. We reaffirm our ongoing commitment to maximise patient access, and we will ensure that every GP practice has the capacity to book appointments in advance.

We are well aware that some people will prefer, or need, to access services digitally, and we are continuing to scale up and expand Near Me, NHS Scotland’s free video consulting service. Near Me improves access by enabling appointments from home. The service is now widely used across NHS Scotland for health and care appointments with around 20,000 consultations being held every week in comparison to around 1,200 pre-pandemic: an increase of over 1500%.

Box 2: Benefits of Near Me

• Reduced travel to appointments: time, cost, convenience
• Reduced time away from work, school or home
• Easier to attend if you usually need someone to take you to appointments
• Enables you to have someone with you for support at your appointment (either with you or joining the consultation by video from another location, even from abroad)
• Better for the environment
• Reduces spread of infectious diseases

Source: Video Appointments through Near Me

We are also reforming the way national eye care services are delivered with increasing emphasis on shifting the balance of care to community optometrists. This includes a new national Community Glaucoma Service to safely discharge lower risk glaucoma, and treated ocular hypertension patients, into the management of accredited community optometrists. When fully implemented across Scotland, this investment has the potential to benefit a significant number of low-risk patients, reducing the pressure on NHS hospital eye care services.

NHS dentists will continue to receive financial support through winter and into next year to help tackle the threat that high dental inflation, increasing lab fees and rising energy costs pose to dental teams. Sustainability payments will also be provided to all GP practices to support them with winter pressures.

Steps we will take

The development of a new digital service, based around safe and secure use of an app and an online platform, will support people to take greater control over their health and social care data, and access a range of services. Initial engagement is already underway with key stakeholders as well as through a citizen panel that will inform developments. It is hoped that this new service will allow people to access information and services directly, self-manage, and access and contribute to their own health and care information online.

We will continue to invest in the recovery of the dentistry sector whilst taking forward a reform programme that will explore opportunities to improve the oral health of the population of Scotland. Our ambition remains the introduction of free NHS dental care to all adult NHS-registered patients.

Equally, we remain committed to developing community hearing services that are on a par with primary care services by the end of this Parliament. As such, we are developing new models of care to shift the balance of care towards early intervention and provide treatment and services closer to the communities it serves. We are also providing grant funding to the RNID ‘Near You’ pilot scheme to support local services in early intervention, hearing aid repairs and information to service users.

Box 3 – Improving Oral Health in Communities

Through a new project we are improving the oral health of the community. The project will commence this year and is designed to drive oral health improvements for those living in areas of relative deprivation and affected by socio-economic and racialised inequalities.

The project, ‘Eat Well for Oral Health’ will be delivered in partnership between NHS Lothian and two Third Sector organisations Edinburgh Community Food and LINK net. These organisations have experience of working with families in areas of deprivation and ensuring that families from minority ethnic backgrounds living in such areas are not doubly disadvantaged.

Source: Eat Well for Oral Health

We are clear that where clinically necessary face-to-face consultations will always be available to those who need them. We will maintain the buddying-resilience measures created for the pandemic where Health Boards can ask practices to temporarily support their neighbours.

In support of ensuring people can speak to, and be treated by, the right person at the right time, we will continue to support NHS 24 with delivering on their recruitment targets as part of the £20 million investment funding to ensure they have adequate resources within all sites to meet demand.

Building on the success of NHS Near Me, we will soon launch a learning programme to support wider adoption, including for example how Near Me can support the Women’s Health Plan to support diagnosis and treatment of Endometriosis and Menopause.