The Future of Primary Care

The RSE has responded to an Inquiry by the Scottish Parliament Health and Sport Committee on the Future of Primary Care.

The response presents recommendations on the changes that are necessary for primary care to become the major source of care in the future. The Society also considered the barriers to change and how the Scottish Government should address these, as well as the monitoring and evaluation of new initiatives such as GP clusters and multidisciplinary teams.

Paper summary

The Royal Society of Edinburgh (RSE) welcomes the inquiry from the Scottish Parliament Health and Sport Committee into the Future of Primary Care in Scotland. The inquiry comes at a critical point for primary care and the healthcare system in Scotland as there is general acceptance across the system, and the Scottish Government, that primary care needs to be the major source of care in the future.

We support the approach taken by the Committee in gathering evidence from public surveys and panels to inform their Phase One report, as well as the research from the Scottish Parliament Information Centre (SPICe). However, it is important that this inquiry distinguishes between scientific evidence and lay opinion. Phase Two is crucially important as it provides an opportunity to generate and draw upon research evidence and data sources as well as input from health professionals. The Committee’s final report on the future of primary care must be firmly grounded in evidence, while also taking account of public opinion.

Significant changes across the system, most notably a substantial shift of resources from acute and secondary care, will be necessary for primary care to become the major source of care in the future. Resources will be required to support staffing as well as the development and evaluation of GP clusters and multidisciplinary teams. The ambition of the Scottish Government to recruit an additional 800 GPs and improve the provision of primary care is supported. However, this will require significant resources to develop new physical infrastructure in communities to help accommodate new staff numbers and demand.

Additional resources will help to improve the provision of care through clusters and multidisciplinary teams but will also allow professionals to focus on research and professional development. Research evidence is a crucial, but underfunded, resource for the development and sustainability of primary care in Scotland. There are contrasting trends in numbers of academic GPs (roles that combine research, teaching, and clinical work), the capacity, and funding to conduct primary care research between England and Scotland. With Scotland falling behind, efforts need to be made to encourage more graduates to become academic GPs and to improve the level of funding and support available to primary care research in Scotland.

The collection and sharing of patient data will be critical to the development and future of primary care. Scotland is in an advantageous position to collect and share data across different levels of the healthcare system due to the unique Community Health Index (CHI) Number. However, the Scottish Government has failed to fully grasp this opportunity, failing to collect and share data across the whole system. Improvements must be sought through the delivery of new strategies on data sharing and collection; these strategies should be well resourced and regularly evaluated.

They should address challenges in the collection of data in the social care sector as the provision and consequently, the data are mostly controlled by the private and voluntary sectors. Achieving change throughout the system will face a significant challenge in political and public acceptance. It will be important for the Scottish Government to embark on efforts that will help change the current political, professional and public expectations. This will be achieved through sharing of scientific evidence and routine data showing improvements in health and efficiency of resources.