NHS recovery plan

Primary and Community Care

A huge volume of the care our NHS provides is through primary care and a GP consultation is almost always the first step of a patient's journey. GPs are our health system's expert medical generalists and like the rest of the NHS our GPs and their practice teams have continued to provide care through the pandemic, but often in very constrained circumstances.

Through this Recovery Plan we will increase wider primary care capacity and urgently seek to fully restore face to face consultations in GP surgeries and other primary care services as a priority. To support this Public Health Scotland will imminently publish updated guidance for primary care settings covering key issues such as physical distancing requirements, access for patients and infection prevention control.

Primary care teams moved swiftly to utilise digital and telehealth services to deliver care through the pandemic, and these will continue to play a part in the delivery of care as part of the mix of service provision. This form of care will not be suitable in all circumstances or for all patients, but it is a welcomed option by many as it allows them to get care without disrupting personal and work commitments, and reducing unnecessary travel. To support this we will continue to scale up the use of 'NHS Near Me' with £3.4 million a year. Prior to the pandemic usage of NHS Near Me was limited to around 1,200 consultations per month, but with the rapid scale up due to the pandemic this now stands at 12,000 per week.

This year, we are investing £155 million to provide General Practices and their patients with support from a range of healthcare professionals in the community, all underpinned by a joint implementation plan with Health Board, Integration Authorities and the BMA signed in July 2021. This plan includes, for example, the recruitment of further pharmacists to help with patients' repeat prescriptions and medicine reviews, community nurses to assist with diagnostic tests and chronic disease management as well as physiotherapists to treat musculoskeletal issues in the community. By April 2022, we are aiming to 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. This is in addition to our existing commitment to deliver 800 additional GPs by 2028, as well as the recruitment of Mental Health Link Workers supporting GPs as outlined above.

All of our efforts to enable primary care recovery is underpinned by our commitment to deliver an increase in primary care spending of at least 25% by the end of this parliament.

This investment and the additional staff it supports will help to alleviate pressures on GP services while ensuring we all get the care and support we need from a qualified professional. Community pharmacies, acting as the first port of call, will be a key provider in unscheduled care, supporting the recovery of the NHS. That's why we introduced the NHS Pharmacy First service, backed by £7.5 million of investment this year, which means your community pharmacist can help with a range of common clinical condition treatments We're going to increase this investment by £2.5 million in 2022/23 to enable community pharmacies to provide an even wider range of advice and, treatment, avoiding unnecessary GP and out of hours appointments.

Over the next year we will develop and introduce a new pharmacy woman's health and wellbeing service through our public health services. This new service will provide greater access to advice, guidance and if appropriate treatments in areas such conception, contraception and menopause. In the second year of this plan we will also establish a community pharmacy hospital discharge and medicines reconciliation service to help speed up the process for people being discharged from hospital. We are investing in developing new digital solutions such as ePrescribing and eDispensing to make the prescribing process paperless which will free up capacity for healthcare professionals so that they can see more patients. It will also make it easier for patients to access their medicines quickly and safely.

We will also take forward public consultation and engagement to develop a safe and secure digital app that will support people to access information and services directly, self-manage, and access and contribute to their own health and care information.

For NHS community dentistry our immediate focus will be on returning the sector to at least pre-Covid levels of activity as soon as is practicable. The impact of the pandemic on NHS dentistry services has been particularly hard because of the aerosol particles generated by many dental procedures and the additional risk of spreading the virus that this brings. We are working on a four nations basis on revised infection, prevention and control (IPC) guidance, with a review of the guidance due to report in September 2021. We have invested £5 million to improve the ventilation capability of dental surgeries, and £7.5 million in new dental equipment. Both of these measures will reduce that risk and therefore help us to increase capacity in our dental surgeries. Both these initiatives will increase the capacity of dental practices to see more NHS patients under the present restrictions.

Over this parliament we will remove all NHS dental charges and work with our frontline dentists to deliver service reform that ensures that are sustainable long into the future. We're committed to maintaining at least the range and scope of procedures that are available through an NHS dentist, and building on our established Oral Health Improvement Plan (2018). Our first step in removing charges is to remove charges for anyone aged under 26. By improving access to primary dental care we can help reduce pressure on acute dental services in the future.

Enhancing primary care specialist services can help reduce demand for acute services – freeing up capacity in the acute sector. Pre-pandemic ophthalmology was the largest hospital outpatient specialty. That's why we are reforming the way in which eye care services are delivered, with a focus on managing significantly more patients in the community instead of in hospital. We are investing £2 million initially for a range of innovative projects, increasing to around £9 million per annum by the end of the five year Plan, including: a new National Low Vision service for visually impaired people provided by accredited community optometrists and dispensing opticians; enabling more complex anterior (front) eye conditions to be managed by Independent Prescriber optometrists; and stable glaucoma and treated ocular hypertension patients to be discharged from hospital into the management of accredited community optometrists.

This year we are also investing £200,000 to pilot enhanced community audiology services, and we aim to develop community hearing services that are on a par with primary care services by the end of this parliament.

All the work set out above will be supported and built on by two national boards that directly support healthcare in the community - NHS 24 and the Scottish Ambulance Service. These services ensure patients have 24/7 access to urgent care in their communities where this is appropriate, either through advice to support appropriate self-care or referral to the best available health care professional.

NHS24 work will continue to work collaboratively across the whole healthcare system as a key contributor to the redesign of urgent care to direct people to the right care in the right place. We are investing over £20 million additional funding in NHS 24 to ensure call handling times are appropriate and that they can continue to respond to the needs of the community on a range of health care asks.

The Scottish Ambulance Service to continue to grow their specialist practitioner workforce to be able see and treat more patients at home avoiding attendance at hospital. We are investing £20 million this year in SAS as part of their demand and capacity review to help tackle the biggest challenges they face, including hospital turnaround times.