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First, I will just correct you. We are not struggling to find 800 GPs—we are ahead of the trajectory to recruit that number. Also, in relation to recruiting to GP specialty training, this year, we not only reached 100 per cent but even more applied for the training than the spaces that were available.

We are in a strong position to deliver on our commitment to recruit 800 GPs during this parliamentary session and to increase the number of GPs in training. I note that, this year, all specialty options were taken.

In addition, we have been expanding medical training places. We have made a commitment to increase the number of medical students in Scottish medical schools by 500. This year, we have increased that by 300 places and we are on target to increase places by another 200. Believe it or not, the BMA has asked us to slow down a bit, to make sure that there is capacity in the system to train those medical students.

We face challenges in relation to our medical workforce—I would not want to give people the impression that we do not—but it would be wrong to give the impression that we are struggling, because we have been able to recruit to the places that have been made available for general practice and for the training programmes.

However, we must continue to do more, because general practice is under huge pressure. A big part of that is not just the GP workforce but the multidisciplinary team that we have in primary care. A key part of what we must do in primary care is to ensure that we have a broad range of healthcare professionals that can meet patients’ needs and can meet the increasing demands that primary care will face. Having that combination will be key to ensuring that we meet those demands as best we can.

I will deal with those issues in turn. There are challenges in rural general practice—there have been for many years, particularly in single-handed practices. When GPs in such practices choose to leave or to retire, it can be difficult to recruit replacements. That can be for a variety of different reasons, but I agree and accept that there is a challenge in some parts of rural Scotland.

On what we are doing to address some of those issues, first, we have the Scottish graduate entry medicine—ScotGEM—programme, which is about recruiting and encouraging doctors to work in our rural environments. We also have the bursary programme—I wrongly called it the “golden hello”, but that is not what it is—which is, again, about supporting individuals, who may be GPs, to work in rural areas by giving them financial support, or a financial incentive, as part of the programme. The third thing that we are doing is—as the committee will be aware—setting up the centre for remote and rural healthcare, which is a programme designed to consider specifically how we can create and deliver greater resilience, in particular in primary care, to deal with the systemic challenges that we have in recruiting people into our rural areas. That combination of programmes to retain and support people in rural settings, and the creation of those financial incentives, is all aimed at supporting getting people into general practice in our remote and rural areas.

On the point around the number of practices that are now in the NHS, that has happened historically. Over the years, some people give up their contract, which is taken over by the NHS. That happens in urban as well as in rural areas.

Yesterday I had a meeting with the health and social care partnership in Grampian and the chairs of the integration joint boards, so I know that they are taking forward a programme of work to look at creating a much more sustainable approach to the delivery of primary care within the NHS Grampian area, and that they have a plan to deal with some of the very specific issues that they are experiencing within the NHS Grampian area. They expect to have that programme of work completed by the end of this year. I have explained to them that I want them to look at how they can work in an innovative way using the existing system to deal with some of the particular challenges that they have in their area.

Before I bring in Ms Minto, I should say that a range of work is being taken forward by boards through the long Covid treatment pathways, which are being delivered as part of the £10 million that we have made available for long Covid services. I think that nine of our health boards have their long Covid treatment pathways in place, and around five are still developing them.

For example, NHS Greater Glasgow and Clyde’s long Covid service allows general practitioners to make direct referrals of patients for assessment and for appropriate treatment options to be made available. We have also allowed boards to design services that best reflect their local circumstances and what they believe to be most appropriate for patients in their areas.

A range of services is available, but one of the challenges has been to ensure that clinicians know that such services are available to refer patients to. Some of our boards have therefore been undertaking work with colleagues across general practice to ensure that they are aware of how patients can be referred directly to these services. Some will also accept self-referrals from patients for assessment and for an appropriate treatment programme to be put in place that reflects their individual circumstances.

I do not know whether Ms Minto, who leads on some of this area of work, has anything more to say.

Some of the additional finance that we are making available for the increase of pay rates, for example, will obviously benefit those organisations in the voluntary sector in relation to the payment of their staff. All parts of social care will benefit if we can retain and recruit staff—the independent, voluntary and public sectors.

We need to make the career environment attractive to individuals, so the rate of pay must reflect that. Would I like to go further on pay in the social care sector? Absolutely. However, we have to operate within the current financial environment. The reality is that £12 per hour is a significant uplift, but going beyond that would create significant financial challenge across the portfolio.

Offering the right pay is one aspect of making the environment attractive to people. As I mentioned in answer to Paul Sweeney, another is creating good career pathways. As you will know from your own pathway, that is critical to supporting not only social care but healthcare in general.

I do not know where the 2,000 figure from the BMA comes from, or from what analysis. I understand that groups such as the BMA lobby and push for what they think is the best approach. I always engage with the BMA in a meaningful way, and, in fact, I think that I am meeting it to discuss primary care this afternoon.

We will continue to look at what more we can do to support primary care as a critical part of our healthcare system, which will be under even greater demand in the years ahead, given the demographics that we have as a country and the disease burden that we face. I will always look to see where there is more that we can do, and engage with the BMA around the issues that it raises to understand the rationale behind the calls that it makes.

The challenge is that people can choose to leave general practice at different points in their careers. It is not always the case that they choose to retire when they get to retirement age; some might choose to do so earlier. The challenge, therefore, is trying to plan to ensure that we have the right intake into medical education and the right cohort of specialities available to allow people to specialise after their foundation years and to do all that in a way that reflects future need and demand.

Moreover, the vast majority of our general practitioners are independent contractors, and they can choose to change the hours that they work, retire earlier and so on. There are variables in there that we cannot always control, but we have to try to balance the system to ensure that the training and education and the move into specialities are sufficient to meet what we think will be the intended need. At local level, the health boards, which have the direct contracts with general practice, will be monitoring the situation and trying to put in place the right arrangements that might be necessary, should the numbers of GPs in their area change or should there be a significant increase in their population, to ensure that they have the right level of services to meet local demand.

The challenge is that if we try to do what we think should happen in Grampian, say, remotely here in Edinburgh, we will not always get that right, because we will not be as close to the community as we need to be. That is why designing local services is best left to local health boards, because they can engage with local communities, understand exactly what is needed locally and therefore try to design the most effective services. It is about trying to balance the system at a national and a local level, and to do so over the long term. It is challenging, but it is exactly what we are trying to do.

Yes, that is our intention. We are engaging with the unions, in particular, to manage implementation. I think, from the discussions that have been had, that there is a desire on everyone’s part to deliver implementation within that timeframe, but in a way that does not create unintended problems for existing NHS staff. So far, our engagement with the unions has been very much about trying to get the balance right. I do not know whether Caroline Lamb has anything more to say, but that is still our intention. We are just trying to ensure that we take the employee side with us in order to get the balance right.

Yes, it does. I am aware that Dumfries and Galloway has benefited from the ScotGEM programme. I raised the issue at the last meeting of the four nations’ health ministers, where we discussed recruitment and retention issues—in particular, issues in our more rural areas. I highlighted the ScotGEM programme to the other ministers and I have offered to share our information on how the programme operates and the benefits that we have had from it. There is interest in looking at how the ScotGEM programme has worked.

On your latter point, it is still our objective to achieve the 10 per cent target within the current parliamentary session and to take that forward over the next three years.

I do not have the information on the specific measures that you asked about to hand, but I would be more than happy to come back to the committee to give it some more detail about specific measures that we are looking to take to address the consistency of service provision.

John Scott made a range of recommendations in his report, and we accepted all the key ones. Implementing some of them will require changes to primary legislation and I hope that we can aim to introduce primary legislation during the current parliamentary session to give effect to some of the measures that will be needed to do that.