Doctors' and Dentists' Remuneration - 2025-2026 pay round: Scottish Government's written evidence

B. The Scottish Context

7. The Darzi review findings^[1] reported on the challenges facing the health service, which in turn informed government’s 10-year plan to reform the NHS in England^[2], published on 12 September 2024.

8. Given the scale of growing demand our health service faces, the NHS requires major reform to ensure that we have a sustainable health service. Our vision for health and social care^[3] was set out to parliament in June and is supported by four key areas of work: improving population health, a focus on prevention and early intervention, providing quality services, and maximising access, all underpinned by a person-centred approach. This requires work across health and care, government and public sector partners, and support for individuals and families, including on the First Ministers 4 priority areas of eradicating child poverty; growing our economy; tackling the climate emergency and improving public services.

9. Our reform strategy is explicitly focused on service reform. We will drive new models of care, and improved productivity through innovation, technological advancements, and workforce models that will directly respond to the challenges in our system.

10. Significant change is already underway to ensure sustainability of services, improvement of productivity, reduction of health inequalities, adoption of innovation and technology, and overall improvement of health outcomes in Scotland. We are already taking forward a range of work to deliver the Health and Social Care vision and provide a strong contribution to the overall package of Public Service Reform that delivers our 4 strategic priorities. In terms of the specifics around these 4 strategic priorities, we are:

• Developing a National Clinical Framework to reform and improve NHS acutes services across Scotland, aiming to increase effectiveness, safety, productivity, and sustainability.
• Supporting Primary Care to deliver high quality preventative health and care services by increasing the capacity of, and access to, general practice, community pharmacy, dental and community eyecare services by end 2026, as part of a Route Map for Primary Care reform.
• Developing a Mental Health Transformation Programme to deliver the implementation of a number of related transformation projects and activities detailed in the Mental Health and Wellbeing Strategy Delivery Plan (2023 - 2025).
• Establishing a National Care Service Board by 2026. This will provide national oversight and improvement of social work services, social care support and community health services which fall within the scope of the National Care Service.

11. In addition, building on the positive and innovative actions we are already taking across areas including tobacco and alcohol control to improve population health and reduce health inequalities, we are developing a long-term Population Health Framework, taking a cross-government, cross-sector approach to improve the key building blocks of health – which we anticipate will be published in early 2025. The Framework is being developed in collaboration with key partners, including COSLA, and Public Health Scotland.

12. We continue to deploy digital technologies to modernise services, including launching the first version of a personalised digital health and social care service which, over 5 years, will provide digital notifications, access to personal health information, and options for interacting online with health and social care services.

13. We recognise that services require fundamental reform to ensure that we have sustainable services for future population need. However, the fundamentals of Scotland’s NHS will not change; we remain committed to free access to health, to the improvement of health outcomes across Scotland, and to the reduction of health inequalities that persist in our communities.

Primary Care

14. The 2018 General Practice (GP) Contract^[4], developed in partnership with the British Medical Association (BMA), is a key step toward making General Medical Services (GMS) in Scotland more sustainable through easing pressure on general practice while introducing new ways to deliver care.

15. Since 2018 we have significantly expanded the multi-disciplinary primary care workforce, with total staff of 4731 Whole Time Equivalent (WTE) working in Multi-Disciplinary Team (MDT) services including physiotherapy, pharmacy and phlebotomy in March 2023. We are supporting development of these teams by investing £190 million in 2023-24 through the Primary Care Improvement Fund.

16. We remain committed to Phase Two of the 2018 GP Contract and ensuring the stability and sustainability of general practice. Discussions with the BMA on Phase Two are ongoing, and we are developing a refreshed plan for this work – this will include a revised timeline for delivery. Phase Two is committed to introducing an agreed income range with pay progression for GPs comparable to consultants, and directly reimbursing practice expenses. Data on income and expenses will underpin any business case for further investment in general practice. Key to this will be demonstrating robustly how investment delivers on our shared aims.