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Spice Briefing Pàipear-Ullachaidh Spice Primary Care in Scotland

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Spice Briefing Pàipear-Ullachaidh Spice Primary Care in Scotland SPICe Briefing Pàipear-ullachaidh SPICe Primary Care in Scotland Lizzy Burgess This briefing outlines how primary care operates in Scotland to inform the Scottish Parliament's Health and Sport Committee's inquiry into "What does primary care look like for the next generation?". 29 May 2019 SB 19-32 Primary Care in Scotland, SB 19-32 Contents Executive Summary _____________________________________________________4 Primary Care ___________________________________________________________5 The Case for Change ____________________________________________________6 Experiences of care ____________________________________________________7 Primary Care Policy _____________________________________________________9 The Primary Care Team _________________________________________________ 11 Regulation of Healthcare Professionals ____________________________________14 Workforce Planning ____________________________________________________15 Workforce Data _______________________________________________________16 Training _____________________________________________________________18 Cost of Training _____________________________________________________19 Cost of Primary Care ___________________________________________________21 Cost Book ___________________________________________________________22 Paying for Services ____________________________________________________23 Primary Care Service Planning ___________________________________________24 Independent Contractors ________________________________________________26 The 2018 Scottish General Medical Services (GMS) Contract ___________________29 Data ______________________________________________________________31 Factors Impacting on Primary Care _______________________________________33 Sustainability _________________________________________________________33 Out of Hours and NHS 24 _______________________________________________35 Remote and Rural Primary Care __________________________________________37 Health Inequalities _____________________________________________________38 The Role of Technology ________________________________________________40 Multidisciplinary Team Workforce _________________________________________41 Sharing Best Practice and Evaluation ______________________________________42 Conversation with the Public _____________________________________________43 Audit Scotland ________________________________________________________45 Scottish Parliament Action ______________________________________________46 Complaints ___________________________________________________________47 Annex A: A vision for primary care in Scotland: 21 principles__________________48 Annex B: The Scottish Government's key recommendation and actions in reforming primary care services, from the National health and social care workforce plan: part three Scottish Government, 2018________________________50 Annex C: Primary Care Improvement Plans ________________________________55 2 Primary Care in Scotland, SB 19-32 Annex D: Scottish Governments Oral Health Improvement Plan: Commitments __56 Bibliography___________________________________________________________59 3 Primary Care in Scotland, SB 19-32 Executive Summary 1. Primary care is normally a person's first point of contact with the NHS and it is where most patient contacts occur. 2. Primary care is provided by generalist health professionals including GPs, Nurses, Dentists, Pharmacists, Optometrists and Allied Health Professionals (AHPs) such as podiatrists and physiotherapists. The primary care team also includes non -clinical staff such as administration staff, managers and receptionists. 3. The Scottish Government's vision for the future of primary care services is of "general practice and primary care at the heart of the healthcare system. People who need care will be more informed and empowered, will access the right professional at the right time and will remain at or near home wherever possible. Multidisciplinary teams will deliver care in our communities and be involved in the strategic planning of our services" 1 . 4. The Scottish Government hopes that the transformation of primary care will help to put in place long-term, sustainable change that can better meet changing needs and demands 2 . 5. The Scottish Government's Scottish Budget: 2019-20 puts the budget for Community Health Services at £1.854 billion. This includes primary care services, community pharmaceutical services, general dental services, general ophthalmic services, mental health services and additional support for social care. 6. There are 31 Integration Authorities (IAs) in Scotland. These IAs have developed Primary Care Improvement Plans. 7. Like all areas of health and social care, primary care faces a number of challenges iaround an ageing population and an increase in the number of people with long term conditions. 8. The Scottish Parliament's Health and Sport Committee is running an inquiry into the future of Primary Care in Scotland, posing the question: What does primary care look like for the next generation? 4 Primary Care in Scotland, SB 19-32 Primary Care For most people, primary care is their first point of contact with the National Health Service (NHS) and it is where the majority of patient contacts occur 3 . In 2011/12 GPs and practice-employed nurses combined had an estimated 24.2 million face-to-face consultations with patients i. Primary care is provided by generalist health professionals including GPs, Nurses, Dentists, Pharmacists, Optometrists and Allied Health Professionals (AHPs) such as podiatrists and physiotherapists. The primary care team also includes non -clinical staff such as administration staff, managers and receptionists. In May 2017, a number of professional organisations representing clinical staff drew up an agreement, the future of primary care in Scotland: a view from the professions, which explained what is meant by the term ‘primary care’ and included a set of shared principles (see Annex A). It stated that: “ Primary care is provided by generalist health professionals, working together in multidisciplinary and multiagency networks across sectors, with access to the expertise of specialist colleagues. All primary care professionals work flexibly using local knowledge, clinical expertise and a continuously supportive and enabling relationship with the person to make shared decisions about their care and help them to manage their own health and wellbeing.” NHS Boards are responsible for providing or securing primary care services for their populations. (The responsibility for running the NHS in Scotland is predominantly devolved by the Scottish Government to the 14 territorial health boards). i ISD published information on the number of consultations until 2012/2013 when the Practice Team Information (PTI) data collection ceased. This information should become available through SPIRE but currently no timelines exist to when this might be likely 4 . 5 Primary Care in Scotland, SB 19-32 The Case for Change As with many areas in the health and social care sector, primary care is facing an increase in demand for services placing increasing pressures on existing resources. Projected demographic changes will see the number of older people increase in relation to the number of younger people, as well as an overall rise in the number of older people. The number of people aged 75 and over is projected to increase by 27% over the 10 year period, 2016 and 2026, and by 79% over 25 years (between 2016 and 2041) 5 . Figure 1: Projected age of Scotland's population between 2017 and 2041 National Records of Scotland This demographic shift will impact right across the health and social care sector. An increase in chronic conditions, such as diabetes, and changing models of care that see a move from acute to community care will result in a considerable impact on primary care services and resources. 6 Primary Care in Scotland, SB 19-32 Figure 2: The most common conditions for seeking a GP or practice nurse consultation 2012/13. ISD Scotland (latest available data is from 2012/13 from the Practice Team Information data). Experiences of care In 2015, the Scottish Government launched a national conversation on what a healthier Scotland would look like. This asked three questions: 1. What support do we need in Scotland to live healthier lives? 2. What areas of health and social care matter most to you? 3. Thinking about the future of health and social care services, where should our focus be? A summary report was published in 2016, Creating a healthier Scotland - What matters to you. This highlighted a number of key themes: • leading healthier lives - focusing on preventing illness, education and responsibility. • wellbeing and connected communities - focusing on the importance of mental health and wellbeing, early intervention, social isolation and the role of communities. 7 Primary Care in Scotland, SB 19-32 • person centred care - focusing on self management, continuity of care, involvement and information. • social care and caring - including the role of unpaid carers and the importance of respite care and information. • a responsive and seamless journey of care - the importance of an accessible and flexible service and the need for joined up care. • pressures and priorities - including the role of the third sector and learning from good practice. Experience of General Practice The Scottish Government undertakes a biennial Health and Care Experience Survey which asks about people's experience of: • accessing and using their GP practice
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