³ÉÈË¿ìÊÖ

The 2018 GP contract included a programme of service redesign to ensure that arrangements for GP services better met the needs of the whole system and the needs of communities; it makes no new requirements of remote and rural GP practices. The 2018 GP contract is intended to reduce current risks to practice stability and sustainability by addressing some of the key risk factors relating to rising workload, premises and employment of staff. This in turn intended to make the partnership model more attractive to newer generations of GPs.

The Scottish Government established the Remote & Rural Working Group chaired by Professor Sir Lewis Ritchie in response to the concerns of rural GPs about the 2018 contract. The group produced the Shaping the Future Together report in January 2020 and various actions were undertaken as a result.

The first cohort of 52 ScotGEM students graduated in summer 2022 after completing the four year course. Of these, 45 undertook Foundation training in Scotland with 42 completing their required foundation year 2 (FY2) in August 2024; a small number opted to go less than full time. Of those 42 individuals, 10 have chosen GP training and have taken up GPST 1 posts in Scotland, with two of these in the North which contains the areas denoted by the question, as follows:

a) Highland - 2 trainees

b) Western Isle – 0 trainees

c) Orkney – 0 trainees

d) Shetland – 0 trainees

e) Grampian – 0 trainees

The NRAC formula is an objective measure of the need for health care services across Scotland.

Under the existing formula the additional cost of providing health services in remote and rural areas is factored within one of the key components in determining funding allocations, with the formula giving greater weights to areas where there is evidence of unavoidable excess costs of supplying healthcare services.

The Scottish Government have committed to continually review the funding formula. This process is managed by the Technical Advisory Group for Resource Allocation (TAGRA) and supports vital work to reduce health inequalities; ensuring that we continue to allocate funding according to the relative need for healthcare in each Board area. Work is underway to review this, however, funding formulas are inherently complex and the review will take time.

The Scottish Government does not hold this information.

NHS Boards are responsible for managing their contracts with GP practices, whether General Medical Services contracts (referred to in the question as “17J contracts”) or Primary Medical Services agreements.

Such data as exists on practice closures, mergers or other changes of contractual status does not record whether or not practices “chose” to change.

The Scottish Government conducted an initial survey of residential rehabilitation providers in Scotland and published the in November 2021. This showed that, at that time, there were 12 reported beds in Highland and 6 in the Western Isles. None were reported in Orkney, Shetland or Grampian.

The following table provides the number of practices which have held General Medical Services contracts (sometimes called 17J practices due to the relevant clause in the National Health Service (Scotland) Act 1978) in NHS Highland, NHS Western Isles, NHS Orkney, NHS Shetland, and NHS Grampian for each year since 2018.

Table 1 - Practices with General Medical Services contracts

The Scottish Government recognises that career pathways such as earn-as-you-learn can widen access to health and social care careers, including those who are settled and rooted in our rural and island communities.

That is why, we are funding a dedicated resource within NHS Education for Scotland (NES) to scope the current skills landscape and identify where earn as you learn programmes could be expanded and where further development work is required with the aim of widening the pathways into health and social care careers.

The Rural and Island Workforce Recruitment Strategy will focus on a sustained model of direct support and will take cognisance of broader cross-government work such as the exploration of earn as you learn models to provide a long-term, dynamic and connective approach to support employers to recruit successfully.

The Scottish Government is working closely with NHS Education for Scotland (NES), to identify and deliver training opportunities for health and social care workers in rural and island areas. Through the National Centre for Remote and Rural Health and Care, housed within NES, 30 practitioners have undertaken the MSc in Rural Advanced Practice in 2023 and 2024, supporting career development, increasing equity in education and supporting the sustainability of primary healthcare services. The Centre will continue to develop new rural specific recognised qualifications to address skills gaps and drive innovation.

We are currently funding a dedicated resource in NES to scope the current skills landscape and identify where earn as you learn programmes could be expanded and where further development work is required with the aim of widening the pathways into health and care careers.

The Open University already provides distance learning Nursing degree education, which is accessed by Healthcare Support Workers already employed by NHS Boards, enabling them to train in their local area and continue to work.

Further, work is being explored via the Allied Health Professional and Healthcare Science education reviews’ recommendations and the Nursing and Midwifery Taskforce on how best to diversify the delivery and flexibility of education programmes.

Whilst the Scottish Government sets the strategic policy direction for the NHS in Scotland, operational matters including staffing requirements are in the first instance the responsibility of the relevant Health Board. As such, recruitment is a matter for Health Boards. The National Health Service Reform (Scotland) Act 2004 has created a duty on Health Boards to co-operate with each other to secure and advance the health of the people of Scotland, enabling the arrangement of travelling consultants

While the Scottish Government provides the overarching guidance/framework for patient travel expenses reimbursement, NHS Boards are responsible for developing local policy to best meet the needs to their populations, and for assessing eligibly for financial support and level of that support. The cost of reimbursement is met from Boards’ budgets and all Boards must balance value for money with patient need, ensuring that patients are supported in identifying and accessing available support and that patient care is at the centre of all decisions.

The Scottish Government has committed to a review of the overarching patient travel expenses reimbursement guidance. However, a start date for the review is not confirmed at this time; it is important that the review is considered within the context of wider reform on access to health care.

It is recognised that transport to health is a key enabler to ensure equitable access to healthcare, and work to bring travel/transport and health planning closer together is in progress. This work will include bringing local bodies together at a regional level to consider the options for transport to health. This work will also inform how and when a review of the overarching patient travel expenses reimbursement guidance is taken forward.