Review Body on Doctors' and Dentists' Remuneration 2023 to 2024: Scottish evidence

B. The Scottish Context

Health and Social Care Strategy and Covid Recovery

7. As Scotland emerges from the COVID-19 pandemic we urgently need to tackle the long-standing inequalities in health and wellbeing that have been exacerbated by COVID-19.

8. To do that we've created the Care and Wellbeing Portfolio which brings together work aimed at improving population health and reducing health inequalities, with health and social care and wider public sector service reform.

9. The Portfolio brings together significant programmes of work, including the Preventative and Proactive Care Programme along with Place and Wellbeing.

10. These new programmes are designed to deliver on the priorities of the
Christie Commission and the ground-breaking work of Sir Michael Marmot.

11. That means working with communities, the third, public and private sector organisations to reduce health inequalities and drive improvement in health and wellbeing locally; and recognising the impact of public services as Anchor Institutions within the community to support local employment and community wealth.

12. As a Portfolio we are also working across all of Government to develop the Care and Wellbeing contribution to other significant programmes of work including on climate change, on improving outcomes for children and young people including child poverty and the Promise, and driving innovation in healthcare. These are the priorities set out in the SG and CoSLA joint Covid Recovery Strategy and reflect the priorities set out in the Scottish Budget on 15 December.

13. The diagram below sets out the overall Portfolio Mission, objectives and outcomes, three priority areas of the Covid Recovery Strategy that this work contributes to, and that in turn improve health, and the programmes and enabling workstreams that are core elements of the Portfolio.

14. We have systematically focused on how change is enabled. That means Enabler Programmes on workforce, co-design with service users, financial sustainability, digital and data, innovation, analysis and evidence, and change and leadership. Rather than each Portfolio Programme have separate workstreams for these enablers we have established them to do it once for the Portfolio.

Primary Care

15. Scottish Government provided an advance of £20 million to GP practices at the beginning of the pandemic. This was money that GP contractors were able to draw down as the occasion arose to meet any new costs. Slightly over £10 million was retained by GP practices to cover the costs of remaining open over the public holidays in April and May 2020 with the rest of the money being spent on covering sick leave, additional locum costs and enhanced infection control measures. Not all practices have spent their advances yet while others have received more. A reconciliation exercise was later carried out.

16. Practices have also received funding to support new telephone systems and meet increased costs of dispensing to remote patients.

17. Addressing the wellbeing needs of the Health and Social Care workforce is now even more crucial than it was prior to Covid-19 and is key to both retaining our GP workforce at the current record level of 5209 and as we press ahead with our commitment to increase the GP population in Scotland by at least 800 additional GPs by end 2027

18. We are investing in a number of measures that are accessible to GPs to support the physical, mental and emotional needs of the workforce, including:

• the National Wellbeing Hub and National Wellbeing Helpline;
• investment of £2 million in targeted support to the primary care and social care workforces;
• the Workforce Specialist Service, which is a confidential multidisciplinary mental health service with expertise in treating regulated health and social services professionals;
• Specific GP Coaching for GPs thinking of leaving the profession;
• additional funding to NHS Education for Scotland (NES) for the provision of psychological interventions and therapies to the Health and Social Care workforce;
• guidance to promote effective wellbeing conversations;
• enhancing occupational health provision;
• improving access to quality assured peer support and reflective practice; and since autumn 2021 we have been developing a new National Wellbeing Programme, with workstreams covering specific areas of work including ICU, nursing, primary care and social care.

19. We are also working with the Scottish General Practitioners Committee of the BMA with the aim of making Practice Learning Time formally available from 2023/24. While practices can set aside learning time on their own initiative, we are considering how this can be supported at a national level.

(Primary Care) Out of Hours

20. Out of Hours services across Scotland remain under considerable pressure with workforce being the main challenge. To support services we negotiated with NHS Education for Scotland for GP Speciality Trainees (in year 3) to undertake paid OOH shifts once they have completed 4 (of their contractual 8) training shifts. This scheme has been more popular in some Boards than others and those Boards who have secured GPST3 support have reported a positive impact on their ability to operate a full service.

21. The Scottish Government have invested an additional £35 million over the last 5 years to take forward the recommendations made in Sir Lewis Ritchie's Review of Out of Hours. This investment began as part of the Primary Care Transformation Programme (which no longer exists) with an initial investment of £10m for Out of Hours in 2017/18. From 2018/19, funding of £5 million p.a. was secured and ring-fenced for Out of Hours Service reform.

Patient Engagement in GP Quality of Care

22. Public engagement is at the heart of any change to Primary Care and we will continue to engage with the public and with patient groups.

23. The Scottish Government run national campaigns to help the public access the right services properly in relation to their health care needs, including helping them to understand changes which have taken place since the COVID-19 pandemic. The 'Right Care Right Place' campaign has been running through November and December. This highlights the pressures on NHS services and provides people with information to help them decide which service is most appropriate for their health condition. Whilst the 'Receptionist' campaign (aired in March on the television, radio and digital platforms) focuses on the role of the receptionist as a care navigator. This campaign addresses public misunderstanding of the role of the receptionist and explains that when a receptionist asks a caller about their health issue this is confidential and is intended to ensure the patient gets the right care for them at that time. Other campaigns we have run include the 'General Practice Access' and 'RESPECT' campaigns.

24. We gather evidence from patients and the wider public on their experiences of, and their views of, general practice through a variety of channels. This includes National Statistics from our biennial Health and Care Experience Survey (see below for more information)^[1], ad hoc surveys and research^[2], and through the Our Voice Citizens' Panel^[3].

25. We have recently established a short life working group to consider the implementation of Community Treatment and Care Services through the GP contract and we will be engaging with patient representatives as part of this work, to ensure that care is patient-centred and that people see the right person at the right time.

26. The General Practice Access Group will work to understand the challenges and issues accessing appointments with GPs. It will work to establish principles to support patients' accessing the right care at the right time. The group will establish high level core principles to support and enhance patients' experience of accessing 'The Right Care, Right Time, Right Place'.

27. The voice of lived experience is essential, particularly in relation to health inequalities and those whose voices are heard less often. For example, for our work on health inequalities, we have developed an ongoing working relationship with Chance 2 Change, a community-based, peer-led patient group in north Glasgow. Initially, this was as part of the Primary Care Health Inequalities Short Life Working Group^[4]. We are building on this by, for example, a variety of actions/projects led by their peer-facilitator, including sharing learning about how to meaningfully involve lived experience stakeholders in discussions about general practice.

28. HACE is the key source of robust data for patient experiences of general practice^[5]. A total of 130,352 people responded to HACE in 2021 with the results weighted to be representative of the Scottish population for age and gender^[6]. Key findings included:

• Overall care provided by GP – 67% positive
• Easy to contact GP practice in the way that they want to – 75% positive
• If they need to speak to a doctor/nurse quite urgently seen within 2 working days – 85% positive
• Received a face to face appointment at their GP practice – 37% respondents
• Received a telephone appointment with their GP practice – 57% respondents
• All results except for the telephone appointments have decreased compared to the 2019/20 survey.