Review Body on Doctors' and Dentists' Remuneration (DDRB): written evidence - 2024-2025 pay round

A. The Scottish Context

Health and Social Care Strategy and Covid Recovery

6. Through the Scottish Government’s policy prospectus we have a clear vision for Scotland and the outcomes the government aims to make progress on by 2026 to support the three missions of Equality, Opportunity and Community.

7. The NHS and wider Health and Care system can make a decisive contribution to those three missions – and we know, in turn, that making progress here is fundamental to preventing poor health across our communities. The mandate letter from the First Minster to the Cabinet Secretary for NHS Recovery, Health and Social Care makes clear the commitment to: ‘Set out a common approach for the reform of the NHS to improve population health and system sustainability to meet the needs of our diverse population of Scotland’.

8. We are giving this focus through Care and Wellbeing, which brings together our key reforms within a single portfolio to accelerate progress on our efforts to improve population health and wellbeing, reduce inequalities, and create a more sustainable health and social care system. The Portfolio is committed to the recovery and renewal of the NHS and Social Care systems including focusing on building more sustainable health and social care services.

9. The strategic development of the Care and Wellbeing Portfolio (CWP) continues to progress with ongoing discussions on delivering commitments to long term health and care service reform and improving population health. We know our approach to planning and delivering health and care services needs to change to enable recovery and sustainability.

10. In the coming months we will be working with partners across the health and social care system, Local Government and wider stakeholders, to set out our shared long term planning and proposals for population health and integrated health and social care services.

Primary Care

11. Since 2018 we have significantly expanded the multi-disciplinary primary care workforce, with total staff of 4731 WTE working in MDT services including physiotherapy, pharmacy and phlebotomy at March 2023. We are supporting development of these teams and invested £190 million in 2023-24 through the Primary Care Improvement Fund.

12. Local monitoring and evaluation shows that MDT delivery is freeing up practice time to focus on more complex community care, reducing referrals into secondary care, streamlining inefficient practice processes, creating upskilling training pipelines for staff and encouraging self-management where appropriate.

13. However, we know that implementation gaps remain. There is significant variation in how the MDT has been implemented combined with ongoing workforce availability challenges. We are introducing an additional ‘phased investment programme’ working with a small number of areas, at different stages of implementation, to demonstrate what a model of full implementation can look like in practice, over an initial 18 month period in 2024/25 and 2025/26. The findings from this work will inform long-term Scottish Government investment for all areas.

14. In parallel, we are committed to driving improvements and supporting learning from best practice in all areas to support more efficient and effective MDT working. To underpin this, we will develop an extensive programme of quality improvement and monitoring and evaluation support, working with Healthcare Improvement Scotland and other national partners.

15. As set out in the 2018 GP Contract Offer^[1] we remain committed to delivering Phase Two of the Contract to further support the stability and sustainability of general practice. Under the proposals for Phase Two, GPs will have assured income and pay progression (comparable to consultants). It will also see the direct reimbursement of agreed GP expenses (e.g. staffing costs), reducing risk to GPs. We are developing a refreshed delivery plan for this work – this will include a revised timeline for delivery.

Primary Care Out of Hours

16. Like other areas of the NHS, Out of Hours services across Scotland remain under pressure with workforce being the main challenge. We have continued the GP Out of Hours Development Fellowship scheme and have agreement in place with NHS Education for Scotland for final year Speciality Training GPs to undertake additional shifts beyond their contracted training hours to support out of hours services, particularly over public holidays.