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29 October 2003

S2M-192 Primary Medical Services (Scotland) Bill: Stage 1

The Presiding Officer (Mr George Reid): The next item of business is a debate on motion S2M-192, in the name of Malcolm Chisholm, on the general principles of the Primary Medical Services (Scotland) Bill, and one amendment to the motion.
14:44
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16:43
Stewart Stevenson (Banff and Buchan) (SNP): This is an interesting and important debate, which has raised a number of issues.
Donald Gorrie suggested that we should be cautious about a 48-hour target for a patient first being seen. If my memory serves me right, target 6 in the draft health and community care budget for 2004-05 commits the Executive to providing 48-hour access to a GP, nurse or other health care professional. I say that from memory; the Deputy Minister for Health and Community Care can correct me if I have got the data wrong.
One of the things that that commitment does not appear to do is provide access to dentists; however that is an issue not for today but for another occasion. The Minister for Health and Community Care may be sure that it is one to which I and other members in the chamber will return—will we not, Mr Rumbles?
John Farquhar Munro spoke eloquently about the issues in rural areas. The opt-outs cover from 6.30 in the evening until 8.00 in the morning, weekends, bank holidays and public holidays. However, what are bank holidays? By and large, the banks do not observe the legally defined Scottish bank holidays any more, so which dates are we talking about? Only two public holidays are nationally recognised in Scotland—does the opt-out also apply to local public holidays? There are lots of little ambiguities.
Perhaps the real issue is that in rural areas throughout Scotland there are more than 100 incentivised GP practices that have particular problems and for whom the opt-out may not be available. Another issue is that if we are allowing practices that have access to the opt-out to stabilise their work load and take some of the distress out of the job for GPs—stress is good, but distress is bad—do we not leave rural GPs still having difficulties in arranging holidays, for example, because it is difficult to find and pay for locums?
The worthy proposals that are before us today may exacerbate the differentiation between the quality of life of rural GPs and that of urban GPs, but the answer is not just to provide more money for rural GPs and their practices. I am given to understand that around 300 people now practise as locums in Edinburgh, because they can make more money doing so and can be more in control of their work load. Is the NHS to follow the path that has afflicted nursing? The NHS is in the precarious situation of relying increasingly on expensive bank nurses. Will we see bank GPs?
On the basis that we should welcome any measure that will shrink the differentials between GPs in England and Scotland, we welcome the bill. I am not quite sure what David Davidson was saying when, seven minutes and 15 seconds into his speech he said that he did not like to be in the culture of making anything work. That simply confirms what we knew about the Tories' attitude to the NHS. We will have to read the Official Report of the meeting, but I think that David Davidson will find that that is what he said.
We have had some discussion and further illumination of the distinction between essential, additional and enhanced services, which is welcome. Paragraph 2.9(vi) of the NHS Confederation's document "Investing in General Practice: The New General Medical Services Contract" mentions the "cryocautery of warts"—which means burning them off—as an additional service. If that service is additional, not all GPs will necessarily provide it, so perhaps we should reconsider those definitions. My GP father used just to hand me the necessary instrument and I burned my warts off, although I am scarred as a result. The world has changed a little since then. Amusingly, under the heading "Influenza immunisations", that document also says that "Informed dissent will apply." I look forward to finding out what that means.
Carolyn Leckie's intervention was rather ill judged. There is no question but that all members of the Parliament extend our sympathy to her in her personal circumstances, but we cannot excuse the disengagement of her party from the process of the bill. I say to her: engage or be ignored and marginalised.
I have counted 39 instances of the word "may" in the bill, but only 13 instances of the word "must"—the debate has been tedious at times. An important point about secondary legislation underlies that comment. Normally, when a committee considers at stage 2 a bill that is of importance to people in Scotland, we would expect all members of that committee, and people beyond the committee, to lodge amendments that seek to improve and enhance the bill. The Executive has a good record of responding to sensible amendments from all parties. To move the essence of the bill into secondary legislation denies parties the opportunity to lodge such amendments—we can say only yes or no. That point is not only for the Health Committee and this bill; it is a general one for Parliament.
The SNP is happy to support the bill's general principles and we wish it good speed.
16:49

Stewart Stevenson
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