Scottish health secretary Nicola Sturgeon speaks to Pulse’s guest editor Dr Georgina Brown and tells her the coalition plans for GPs might not necessarily be appropriate across the UK
Will a UK contract still be viable given the coalition’s desire to give more commissioning responsibility to GPs in England?
Our first objective is to make sure the GP contract reflects Scottish priorities. Up until now we’ve chosen to negotiate on a UK-wide basis and that’s served us reasonably well. But we’ll continue to make judgments about that depending on how things develop. We’ll seek to do that in consultation with the profession as much as possible.
There’s no doubt that increasingly the models of delivery for healthcare north and south of the border are diverging. They look very different and we have to make sure the arrangements we have in place in Scotland reflect that.
Do you think there’s a risk UK Government plans could clash with the Scottish Government’s positions and policy?
We may find policy developing in different directions. We’ve already seen that over the past few years so it won’t be something new. One of the things we’ve done in Scotland is legislate to prevent the commercialisation of GP practices, which is actively encouraged in England.
So we’re going to see diverging policy directions. I don’t think that inevitably leads to a clash. We have devolved responsibility in Scotland for health, so we’re absolutely free to take our own direction.
There is a push in England for GP federations to be responsible for commissioning a range of services. Will this extend to Scotland?
Well, my view is we should fashion solutions that are right for Scotland. Sometimes that will mean learning from other places, but we shouldn’t always be looking over our shoulder.
There’s two things that are really crucial in terms of delivering primary and community care. One is that we listen to the voice of professionals. Second, we have better integration between health and social care because often it’s in the cracks between the two that people fall through.
How about GPs commissioning out-of-hours services?
When responsibility for out-of-hours was taken from GPs and handed to health boards, provision did go through a very shaky period. That has settled considerably. Patient satisfaction levels with out-of-hours are actually very high.
That’s not to say we don’t need to continue to improve and I think there is a lot of work to be done around helping the public better understand who to turn to on out-of-hours, because there is understandably a bit of confusion – do you phone NHS 24, GP out-of-hours or the ambulance service?
Speaking of access, there has been talk of GPs opening eight to eight and across the weekend. What are your views on that?
Well, the core hours of GP practices are eight till 6.30. We’ve made it clear we want to see more flexibility of access to GPs outside of those core hours. So a directed enhanced service that encourages more flexibility already sees GPs providing appointments earlier in the morning, later in the evening or at the weekends. That’s a good thing, because people want flexibility.
It doesn’t mean we’re looking at eight till eight on a seven-days-a-week basis. Nor does it mean we think we should hand back out-of-hours provision to GPs.
I’d like to move on to deprivation now, because many of the most deprived practices are in Scotland. Is there any potential for a realignment of the global sum to help practices that provide care to these areas?
Tackling health inequalities is a big priority for us. It’s not something that can be done in a four-year term, it’s a long-term objective, but we must make steady progress. We want to see resources aligned to that objective, and are keen to see the allocation formula reflect that and to have discussions about how that can be the case.
We are in an era now of very tight resources and budgets are going to be under serious pressure. But that doesn’t mean that we shouldn’t try to ensure resources are as far as possible meeting need and closing that gap between richest and poorest.
There are a few other things happening in England that I’d be interested in your comments about. Scrapping practice boundaries is happening in England – are there any plans for that here?
We have no plans to go down the road that England appears to be going down, and again I think that’s down to our different circumstances.
In England it’s more common than it is up here to commute quite long distances for work, so perhaps there’s a stronger case for allowing people to make that choice of GP. Up here we’ve got a system that works well.
Can I ask about health checks – are there any plans for that in Scotland?
We have made clear we want to pilot health checks for people in the over-40 age groups – an age group I will soon be in myself, although there’s no vested interest there.
Keep Well health checks focused on deprived communities have been successful and we would hope to take that from pilot stage to a mainstream position over the next wee while.
But I do think there’s also a very strong argument for looking at whether health checks can help us more generally in preventing ill-health. Doing these things on a piloted basis allows us to build up that evidence.
The other question I’ve got to ask is about the patient survey. Why is general practice the only part of the NHS which has its income dependent on patients’ views?
There’s a couple of things I’ll say about the patient survey. The survey and the particular points in the QOF were agreed between the governments across the UK and the profession. It wasn’t something imposed.
Second, the surveys are designed to test patients’ perceptions of access to GPs. Now I know a lot of GPs provide extremely good access. Others will say they are providing good access, and perhaps patients’ perceptions of that vary a wee bit.
I do think it’s appropriate to ask patients what they think, as well as ask GPs what they think of the service they’re providing. We have responded to some of the concerns of GPs to the results of the survey last year.
We’ve lowered the thresholds which meant some GPs who didn’t get any points originally got some points, and we’re the only part of the UK that has responded in that flexible way. I hope that shows a willingness to listen and discuss solutions.
What are your priorities for the future for health, particularly general practice?
It’s always difficult when somebody asks you that question to pick one thing over another. The biggest challenge in the NHS over the next two, three or five years is going to be the financial climate. As a government we’ve taken steps to protect the health budget for this year – we’ve said we’ll continue to do that as far as we can for future years. But nevertheless it’s going to mean tighter budgets.
So I guess my priority is to work with those who work in the NHS as closely as possible to make sure we can get through a very difficult period maintaining the quality of care we deliver.
Scottish health secretary Nicola Sturgeon Scottish health secretary Nicola Sturgeon Watch the full interview