Primary Care – What Next?

Richard Foggo, Deputy Director, Primary Care Division, Scottish Government gives us his response to the initial key themes emerging from the National Conversation on a healthier Scotland.

What you’ve said about primary care

We‘ve all benefited from primary care services.  Whether that’s the friendly family doctor, or dentist, or any of the great many caring health professionals we see outside hospitals.  While you get a great service from many of these people, you have told us you still occasionally experience problems in accessing local health services [including getting an appointment with your GP when you need one].

As well as issues with access you told us about the need to prevent more problems before they happen; about how we could do more on mental health; about how people want to be treated with dignity; and lots more.

Very often, people’s contact with the health service begins and ends at the GP surgery, and that’s as it should be.  Our 2020 Vision says that people should be looked after at home or in a homely setting as far as possible.  Keeping people out of hospital, unless they really need to be there, is what people want – and it’s the right thing to do.

Our healthcare services in the community are valued and really important to people, that much is clear.  It’s the first point of contact in health care for most people and can include GPs, community nurses, pharmacists, optometrists, dentists and allied health professionals.  As we integrate health and social care from April this year, the links between primary care and social care will become closer than ever.  And our vibrant voluntary sector also has an important role to play.

All of this at a time when Scotland is changing.  We have an ageing population.  Long term and multiple conditions are on the rise.  And obesity is a serious and growing concern.  We need to both help people to stay as well as possible, for example by promoting physical activity for everyone, and ensure that when people need healthcare, they can get it.

What we’re doing with what you’ve said

These are serious issues and require addressing.   That’s why, in June last year, we announced a three-year primary care funding package of £60m to support frontline primary care workers and improve access to their services.  In the budget we announced another £25m on top of that.  The new investment is the beginning of the process towards redesigning primary care services for the future and is part of building a healthier Scotland.

One strand of that fund is £6 million of funding dedicated to the Primary Care Digital Services Development Fund, which will be used in part to enable more online appointment booking and repeat prescriptions and enhanced digital services.  These will improve patient choices.

£16.2m over three years has also been allocated to put pharmacists in GP practices.  Up to 140 whole time equivalent pharmacists with advanced clinical skills training, or currently undertaking training will be recruited. These pharmacists will manage caseloads of patients with complex medicines needs (eg patients on multiple medicines) , carry out medicines reviews for a range of patients, including the care of patients with long term conditions –  freeing up GP time for other priorities.

Another £1.5m will be funding the purchase of pachymeters (medical devices used to measure the thickness of the eye’s cornea) for all optometrists in Scotland.  This will enable them to screen for patients suspected of developing glaucoma.

£20.5m has also been dedicated to a Primary Care Transformation Fund which will allow GP practices to test new ways of working to address their current demand and findings from this will inform the new GP contract – and on 22 January 2016 we launched a major project based in Inverclyde to test new ways of structuring primary care services.

We also need to make sure the services are right when GP surgeries are closed.  Sir Lewis Ritchie recently undertook a full independent review of GP of out-of hours care, and he told us that we need to do more, and be better at, multidisciplinary working, with more investment in the workforce and in infrastructure, and a drive towards changing the culture, centred on a model of urgent care resource hubs. He said that we need large-scale tests of change, moving quickly to whole-system change, and we’ve announced an initial investment of £1 million to allow us to begin the process of testing.  We’ll publish an implementation plan in spring.