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Chamber and committees

Official Report: search what was said in Parliament

The Official Report is a written record of public meetings of the Parliament and committees.  

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Dates of parliamentary sessions
  1. Session 1: 12 May 1999 to 31 March 2003
  2. Session 2: 7 May 2003 to 2 April 2007
  3. Session 3: 9 May 2007 to 22 March 2011
  4. Session 4: 11 May 2011 to 23 March 2016
  5. Session 5: 12 May 2016 to 5 May 2021
  6. Current session: 12 May 2021 to 21 June 2025
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Displaying 1207 contributions

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Health, Social Care and Sport Committee

Healthcare in Remote and Rural Areas

Meeting date: 12 December 2023

Dr Sandesh Gulhane

[Inaudible.]

Health, Social Care and Sport Committee

Healthcare in Remote and Rural Areas

Meeting date: 5 December 2023

Dr Sandesh Gulhane

Good morning to the panel. I start with a declaration of interest as a practising national health service general practitioner.

Among the many things that we talk about when it comes to rural healthcare, a big one is the 2018 GP contract, the point of which was to ensure a lot of allied health professionals in primary care. The idea was to take the pressure off GPs. Allied health professionals probably do a better job in many of the specific things that they choose to do. Musculoskeletal work is much better in physio, for example. However, and I have a quote,

“The new Scottish GP contract has been a complete failure based on unachievable promises. At a national level it appeared a sound plan”

but

“In rural areas there were never going to be enough pharmacists, physios, mental health workers and nursing staff to make this work”.

I turn to Sharon Wiener-Ogilvie first. Is that true? If so, what should we do?

Health, Social Care and Sport Committee

Healthcare in Remote and Rural Areas

Meeting date: 5 December 2023

Dr Sandesh Gulhane

I certainly think that my colleagues will pick up on that, so we will not delve into it just yet. You talked about inequity, which I want to come to.

I think that physio is slightly more unique, because you have gone from centralised to local services. I think that a lot of the worry is the opposite way, about local things becoming centralised.

That brings us to the question of inequality. One respondent said that AHPs should be

“equally shared in all practices”.

They used Caithness as an example:

“some ... first contact services are mostly in the NHS managed practices so not equally shared with other or rural practices so patients”

are

“unable to have equal access for care.”

Is there inequality? Clearly, for physios, that does not seem quite to be the case, but are there inequalities when it comes to other allied health professionals, especially looking at vaccinations?

Health, Social Care and Sport Committee

Healthcare in Remote and Rural Areas

Meeting date: 5 December 2023

Dr Sandesh Gulhane

Sorry—my colleagues will come in on the theme of travel, housing and other things. Will you focus a bit more on the contract and the difficulty in getting the numbers that you need?

Health, Social Care and Sport Committee

Healthcare in Remote and Rural Areas

Meeting date: 5 December 2023

Dr Sandesh Gulhane

Thank you. I do not know whether anyone else wants to come in before I ask my next question.

Health, Social Care and Sport Committee

Healthcare in Remote and Rural Areas

Meeting date: 5 December 2023

Dr Sandesh Gulhane

That was my last question. For the record, I have worked in Ayr and recently did some shifts in Fife. I have also worked in the central belt. When I can work with allied health professionals—it does not matter who they are—it is amazing; my life is so much easier. In contrast, when I go to shifts where there are no AHPs, such as the one that I did in Fife, my shifts are so much harder. It is a difficult thing.

Health, Social Care and Sport Committee

Healthcare in Remote and Rural Areas

Meeting date: 5 December 2023

Dr Sandesh Gulhane

We are hearing a lot about wider infrastructure issues, and we have heard a lot about incentives. My question relates to the work of Dr Gordon Baird in Galloway. Do you feel that having a rural and remote advocacy service would be helpful in ensuring equality as well as in holding boards and other areas to account, so that things are in place to allow people to go and work in rural and remote areas?

Health, Social Care and Sport Committee

Healthcare in Remote and Rural Areas

Meeting date: 28 November 2023

Dr Sandesh Gulhane

You have made an interesting point, Dr Makin. I have been told of rural patients who decided not to get their children’s measles vaccinations because it meant a three-hour round trip and, quite frankly, they did not see anyone, so they just said, “What’s the point?” It terrifies me that we are not getting measles vaccinations done.

Another aspect of primary care that I have been looking at is the percentage change in income allocation under the new contract. In general, if you are in the urban belt, you have seen an increase in the amount of money that you get, while in more rural areas, that increase does not seem to have happened. It almost seems as though we are trying to promote general practice and primary care in urban settings. Admittedly, 80 per cent of the population live there, but a substantial proportion of people—20 per cent—live in rural areas. What do you propose that we do for primary care to make things better for people who live in rural areas? That question is open to anyone who would like to answer.

Health, Social Care and Sport Committee

Healthcare in Remote and Rural Areas

Meeting date: 28 November 2023

Dr Sandesh Gulhane

Dr Makin, I see that you want to come in, too.

Health, Social Care and Sport Committee

Healthcare in Remote and Rural Areas

Meeting date: 28 November 2023

Dr Sandesh Gulhane

It seems that not very much money is being offered to GPs for that, which makes it difficult for them to do.

You mentioned Highland, Dr Makin, and I would just note that there has been a big report on bullying at NHS Highland. I am not going to talk about the Western Isles, Professor Smith, as I have not heard anything from there, but I have certainly heard about NHS Highland. How can we get better integrated rural healthcare, given the endemic culture that the report found in that health board?

In your answer to my question about primary care, you talked about those who are on the ground getting things done. I assume that the approach will be similar in secondary care, but how will we move forward in that respect, given the issues that have been highlighted?