Primary and Community Health Steering Group minutes: February 2026

Attendees and apologies

• Co-Chair of the Primary and Community Health Steering Group and Director of Primary Care Directorate, Scottish Government
• Co-Chair of the Primary and Community Health Steering Group and Deputy Chief Medical Officer, Scottish Government
• Chief Allied Health Professions Officer, Scottish Government
• Head of Health and Social Care Analysis, Scottish Government
• Director of Allied Health Professionals, NHS Fife. Deputy also attended: Director of AHPs, NHS Highland
• Director of National Centre for Remote and Rural Health and Care
• Director of Pharmacy, NHS Borders. Deputy also attended: Director of Pharmacy, NHS Shetland
• Scottish Executive Nurse Directors (SEND) Representative and Executive Nurse Director NHS Ayrshire and Arran. Deputy attended: Associate Nurse Director, East Ayrshire Health and Social Care Partnership
• Director of Midwifery, NHS Western Isles. Deputy attended: Director of Midwifery, NHS Orkney
• Chief Executive, Scottish Ambulance Service. Deputy attended: Associate Director of Strategy & Planning, SAS
• NHS Board Optometric Advisor, NHS Greater Glasgow and Clyde
• Director of Psychology NHS Borders and Chair of Heads of Psychology Scotland (HOPS). Deputy attended: Change and Improvement Manager in psychology, NHS Fife
• National Strategic Lead for Primary Care, Health and Social Care Scotland
• Interim Director, Primary/Community Care, Strategy, Performance & Service Transformation, National Services Scotland (NSS)
• Director of Nursing and Systems Improvement & Deputy Chief Executive, Healthcare Improvement Scotland (HIS)
• Chief Executive, National Education for Scotland (NES)
• Director of Digital, National Education for Scotland (NES)
• Director of Place and Wellbeing, Public Health Scotland (PHS). Deputy attended: Consultant in public health medicine, PHS.
• Out of Hours (OOH) Oversight Group Representatives
• Chair, Scottish General Practitioners Committee of the British Medical Association (SGPC BMA)
• Chair, Royal College of General Practitioners Scotland (RCGP Scotland). Deputy attended: Deputy Chair RCGP Scotland
• National Director, British Dental Association Scotland (BDA Scotland). 
• Chair, Optometry Scotland    
• CEO, Community Pharmacy Scotland
• Director for Scotland, Royal Pharmaceutical Society (RPS). Deputy attended: Scottish Pharmacy Clinical Leadership Fellow
• Professional Adviser for Scotland, Chartered Society of Physiotherapists (CSP). Deputy attended: Public Affairs and Policy Manager, CSP
• Policy & Public Affairs Lead Scotland, Royal College of Occupational Therapists (RCOT)
• Director, Royal College of Midwives (RCM) and National Staffside Representative. Deputy attended: National Officer, RCM
• Professor of Medical Education, University of Glasgow and Co-Director of the Scottish School of Primary Care
• Chief Officer of Development, The ALLIANCE 
• Professional Nurse Adviser for Primary Care and Chief Nursing Officer representative, Scottish Government
• Associate Medical Director Primary and Community Services, NHS Borders and Primary Care Leads Group representative
• Head of Digital Services, Practitioner Services Division, National Services Scotland (NSS)

Community Health Sub-group members

• Director of Strategic Planning, NHS Lothian. Deputy attended
• Director of Transformation, NHS Lothian
• Previous SG Principal Medical Officer and prior to that Associate Medical Director at NHS Lanarkshire
• Chief Officer, Argyll and Bute HSCP

Apologies

• Director of Dentistry, NHS Shetland
• Associate Medical Director, NHS 24 and Primary Care Clinical Leads Group representative
• Executive Medical Director, NHS 24
• NHS Board Digital Leads Group representative
• Chief Officer South Lanarkshire Health and Social Care Partnership (HSCP) and HSCP Chief Officers Representative
• Associate Director, Royal College of Nurses (RCN)
• National Coordinator, General Practice Managers Network representative
• Chief Executive and Nurse Director, Queen's Nursing Institute Scotland
• Chief Executive, Voluntary Health Scotland
• Chief Executive, NHS Dumfries and Galloway
• Sub-group member: Director of Nursing, Fife HSCP
• Sub-group member: Deep-End GP and Academic, Glasgow
• Sub-group member: Director of Midwifery, NHS Highland
• Sub-group member: Director of Allied Health Professionals, NHS Lothian
• Sub-group member: Head of Service, Aberdeen City HSCP
• Sub-group member: Head of Service for Primary Care, Edinburgh City HSCP
• Sub-group member: Chief Officer, East Dunbartonshire HSCP

Items and actions

Welcoming Remarks

The Co-Chair welcomed welcome everyone and thanked members for their continued contributions and engagement with primary care reform through the steering group, its strategic direction sub-group, and via other forums across the reform landscape. The Co-Chair provided introductory remarks and the purpose of the meeting:

• the meeting would focus on actions & outcomes, and models of care. Members will consider how these areas drive forward and enable our Service Renewal Framework (SRF) commitment (under Major Change 4) to improve access to services and treatments in the community, as well as those of the Population Health Framework (PHF)
• the next meeting of the steering group will discuss further policy areas to inform development of the Primary Care and Community Health (PCCH) Route Map: monitoring and evaluation , governance, and population-based planning
• the steering group’s Community Health Sub-group has had initial discussion on models of care. Sub-group members have been invited to today’s meeting
• recognising the importance of this Model of Care (MoC) work, officials will arrange for a further special sub-group to further discuss models of care before the pre-election period
• the Co-Chair asked that members consider the following in their discussions:
  • how we ensure that we are drawing out Continuity of Care, GIRFE and Realistic Medicine within the model of care that we propose
  • how do we ensure the actions and commitments are designed to contribute to delivering truly holistic, primary and community healthcare wide reform within the sector
• the Co-Chair reminded members that the Community Health Sub-group was established to compliment the work of the Steering Group and reflect feedback on the importance of community health discussions
• the Co-Chair highlighted that the sub-group work comes back to the main Steering Group for discussion and agreement allowing members full visibility and opportunity to comment on outputs

The Co-Chair provided the following government updates:

• the draft Scottish Budget for 2026-27 was published on Tuesday 13th January 2026 and  at the time of the meeting was going through the Parliamentary process.
• this included over £2.4 billion in funding provided for primary care. It also includes our historic £531 million three-year deal secured with general practitioners (GPs), providing over £98 million additional funding in 2026-27 to strengthen the workforce and improve access, quality, patient outcomes, and sustainability
• a £1 billion capital budget will continue to support health research and the improvement and renewal of the NHS estate, including a new programme of community and primary care infrastructure investment

The second Co-Chair provided an overview of the two key areas for discussion; Route Map actions; and models of care:

• following a process of gap analysis led by Scottish Government health and social care analysts, actions were identified and developed through feedback from this group, as well as commitments in SRF and PHF and ongoing policy development
• the paper sets out the actions that have been identified as priorities to achieve change under each outcome area, and hopefully remedy the gaps identified in initial analysis
• although many of the areas may be relevant across primary care and community health, we recognise that engagement to date has been more focused on primary care and will be taking these actions to the community health subgroup in the next couple of months for specific discussion and development
• this is a first attempt to bring these actions together for comment, and there will be further opportunities to develop the key actions for inclusion in the Route Map between now and publication
• members have been provided a paper that sets out a draft model of care statement. This is intended to sit between the overall strategic direction (set out in the PCCH outcomes and wider reform) and the practical actions under the drivers for change to guide future healthcare delivery in the sector, whilst considering critical factors and policies such as Getting It Right for Everyone (GIRFE), Realistic Medicine and continuity of care

Opening presentation – Primary Care Strategy Unit

• the Strategy Unit provided the opening presentation reminding members of the strategic context and reform programme to-date including the three reform product documents, the Operational Improvement Plan (OIP), the Population Health Framework (PHF), and the Service Renewal Framework (SRF)
• officials are actively considering interactions between the SRF, the PHF and the OIP as part of the route map
• officials have been working with the members of the Steering Group’s Community Health Sub-group over the past few months, and members of that sub-group were invited to this steering group meeting to discuss models of care in particular
• officials are considering the future role and operation of the Steering Group and subgroups post route map
• the Primary Care and Community Health Route Map, will be focused around the practical actions that are going to be taken, organised around policy drivers
• the Scottish Government is working to publication of the route map by June 2026. Officials are progressing a programme of targeted engagement before the pre-election period begins on 26 March 2026
• considering Scottish Government and steering group proposed actions alongside SRF commitments, officials have attempted to prioritise and distil an initial list of priority area of actions for consideration. This list will be considered in this meeting and in subsequent engagements
• the objectives for the first breakout session on route map actions are:
  • shared agreement that these initial actions will meaningfully and credibly contribute to that health and social care vision, that they do help us meet the SRF commitments and that they do help contribute towards those outcomes that have been set up for primary and community healthcare services
  • whether the actions are implementable and that we are focusing our energy and resources in the right directions to help us recognise that long term system reform
  • how do we ensure that the actions are applicable across multiple service types and that they benefit the wider system, not necessarily just individual primary care pillars?
  • the actions have been organised under the four primary care and community health outcome areas: ‘System Rebalance,’ ‘Access,’ ‘Coordinated, Connected and Person-led,’ and ‘Quality Healthcare in the Community’

Breakout Groups

Members split into three breakout groups with a dedicated facilitator. The facilitator guided the conversation in line with the questions below, with the secretariat capturing key points.

Route map actions and outcomes

1. considering the actions collectively, do they provide a sufficient basis to enable the meaningful change we want to see across the system?
2. are there any critical actions or commitments missing at this stage, or areas where further detail is required?
3. are you content with the draft models of care statement?  What’s your view on critical elements to cover in a "model of care" for PCCH that will support the sector to achieve the agreed strategic direction?​
4. what should the roles and responsibilities of PCCH  in the system be, and how does that differ from what we have just now?

Models of care

1. are you content with the draft models of care statement?  What is your view on critical elements to cover in a "model of care" for PCCH that will support the sector to achieve the agreed strategic direction?​
2. what should the roles and responsibilities of PCCH in the system be, and how does that differ from what we have just now? 
3. what do we need our services to look like to achieve this model of care?  What changes are needed to current delivery models and organisation of care?

Feedback from breakout groups - Primary Care Directorate Officials

Group 1

Route Map actions and outcomes

• how can we make the actions stronger/ “more bitey” and ensure feasibility of delivery.  What’s the trade off?  What are we going to deprioritise to make room for these (across HSC as well as PCCH)?
• can we strengthen digital references, e.g. link with multidisciplinary team (MDT).  Access to own data to enable self-care
• research & evaluation -  embedded systematically as part of holistic monitoring and evaluation (M&E).
• Investment framing -  driving value
• cohesion – how far does the MDT go?  Pharmacy?  Social Care?
• importance of communications & engagement- shared endeavour.  Post-publication - important link to “what does this mean for me”; and access and navigation - universal “once for Scotland”.  Pre-publication – is there more that members could do, including ensuring full IC representation?
• workforce – nuanced analysis of workforce, wellbeing, demographic makeup, preferences as well as intersection with population demand.    Incentives of having people rotating in and out of PCCH

Models of care

• generally people are content with emerging work.
• “team” working part of MDT and how this can be enabled important.  2 way communication really important between professional groups
• coordination & fragmentation – has to start from improving what we have.  “What matters to you” critical. Community anchor for a persons care is important.  Systems need to support this – e.g. IT & digital info across acute and primary  
• operationalising realistic medicine – understanding risk and uncertainty and roles
• consideration of what Roles & Responsibilities mean for different professional groupings.  More clarity important across different interfaces.  Clarity of leadership and decision making
• access, signposting and front door.  Importance of clarity and simplifying a complicated picture for people

Group 2

Route Map actions and outcomes

• there is broad agreement that the proposals are moving in the right direction; however, there remains a lack of clarity around how they will be implemented. There may be opportunities to learn from the GIRFE approach
• funding mechanisms are critical but may be interpreted differently across areas. There is a need to test underlying assumptions about what is required and to consider how performance can be contractually linked to the delivery of agreed outcomes
• there is a gap in how the patient perspective is represented. Stronger links are needed to patient experience, and clearer assurance that the proposed actions will translate into tangible improvements for patients
• currently outcome-focused but greater attention is required on phasing and timing. Effective use of data will be essential to inform sequencing  as well as  considering all resource, capacity to implement the change  
• there is a lack of trust within the system. Improvements will require a whole-system approach, inclusive decision-making, avoiding siloed working. The HSC system must align around trusting PCCH as the core of community engagement, alongside building and maintaining public trust

Models of care

• shouldn't be too prescriptive on the "how". Areas can deliver via different means but still achieve the same outcomes.  Focus should be ensuring high level quality across the srvices, consistency with delivery of care
• mapping and data are key to development, including baseline of current models. What can we learn from existing models/standards?
• roles and responsibilities – clarity on who should be doing what. Inclusive decision making that considers professions and services, as well as patient voice. Need to consider role of third sector, and providers outside NHS
• how is this will all be communicated to services users will be vital

Group 3

Route Map actions and outcomes

• be deliberate on baseline - what we want to see, not what happens now – including patient experience
• feels like genuine shift towards a ‘human-centered’ focus – this lens could be set out more explicitly, via design principles, GIRFE etc.   Risk is not sufficiently challenging current system patterns. Route Map is an opportunity to engage and empower – but needs shared language and different approach to communications and implementation.  Self-care / public health narrative. Clarity on where actions sit. Stronger focus on interface
• route map sets out evidence-based approach, this needs to be consistent, noting references to actions both around assessing evidence and which set out change in those same areas.  RM is a medium/longer-term, need to ensure evidence base is still relevant at time actions are being progressed
• more detailed discussion of national/sub-national planning changes. More specific on primary care interfaces – current and future – with overall digital direction of travel.  Bring out contribution/opportunities arounout of hours

Models of care

• MoC should describe relational care as fundamental  ‘design feature’.   Make this lens clear – and use to set out specificity on MoCs, not higher-level statements on cross-system working
• overarching and specific MoCs – for primary care and for independent contractor areas – acknowledge difference
• think about articulating MoCs from a patient / person-centred over system perspective.  To have impact, MoCs needs to talk to how people can navigate system (including role of self-care/prevention) as well as how system provides care.  Digital/technology – what are person/system roles and responsibilities
• how do we articulate roles and responsibilities around building and developing community assets/infrastructure and the value of this? Capture preventative work, including through budget processes
• role of leadership – national, collective and local – in making this work.  Scale good leadership so it is the norm

Plenary – feedback from members

• there is potential for a genuine shift towards a more human-centred (vs person-centred), relational view of healthcare.  We should be clear that this is the intention and movement towards this should be incentivised, otherwise we risk just tweaking the current system
• we need to use evidence and continue to invest in high quality research to deepen and broaden our evidence base
• GP Walk In clinics are a pilot so they may not be present long term which makes planning a challenge. Its really important to be led by the evidence 
•  incentivise improvement towards success
• as well as what matters to individuals in terms of care (outcomes), it's also what people have already told us matters in terms of design (how they wish to experience care and support)
• considering how to evolve Health and Care Experience (HACE) survey and HACE methodology can show us HACE through time and not HACE at a point in time - recognising the role of Public Health Scotland and other organisations in supporting change in NHS Scotland, and gathering insight from users: https://publichealthscotland.scot/publications/health-and-care-experience-survey/health-and-care-ex… 
• articulating models of care  from user perspective and from person working in the system perspective

Annex 1 - Breakout groups summary

Breakout group 1 - Session 1 – Route Map actions and outcomes

Question 1  - Considering the actions collectively, do they provide a sufficient basis to enable the meaningful change we want to see across the system?

There was broad agreement that the actions provided were good but there were suggestions for how the list of proposed actions could be improved and expanded.

General feedback on the actions and the route map design

• the actions should be distilled down into an accessible version
• there was feedback on how some of the actions are described particularly under outcome area 3 and this could be thought about differently. Example given enabling interservice data sharing and expanding data collection beyond protected characteristics – for digital to be the enabler it is crucial that it delivers on the infrastructure side.
• before publication, it would be helpful to have an opportunity to comment in detail, and this will provide opportunities to highlight work already underway within the system which can then be communicated through the route map and supporting communications and engagement

Delivering transformative change

• investment needs to be directed where it will add the most value
• challenge provided on whether the actions were sufficiently transformative and if they would shift the landscape
• need to be clear on what is being disinvested in or deprioritised to allow the shift to a stronger primary and community care model and the rationale
• recognise and meet policy intent in SRF to lower the footprint of secondary care through prevention, MDT working, digital, Realistic medicine and out of hospital care
• importance of preventative spend tagging and bringing together data around preventative activity. This is an enabler of improvement though recognise it is gradual

Monitoring and evaluation

• research and evaluation should be embedded within the actions and be more visible

Digital

• we are missing the transformative approach provided by digital self-management tools (powered by AI and modern technology) and the significant impacts these can have (e.g. in diabetes management and physiotherapy)
• MDT working will only improve if there are enabling changes in digital platforms
• digital needs to not just focus on ‘what can it do’ but also how it is successfully integrated and influences behaviours

Communications and engagement

• importance of work on this reform is articulated to frontline practitioners. Role for steering group members in communicating and engaging with their respective groups

Multidisciplinary teams (MDTs)

• the reference to the MDT team was mainly regarding general practice but there are other stakeholders so should be broadened out to other parallel providers

Legislation

• any prospective Primary Care legislation  may be opportunity for community pharmacy to be involved alongside optometry and dentistry

Workforce

• there should be more mention of workforce in the actions

Question 2 - Are there any critical actions or commitments missing at this stage, or areas where further detail is required?

Design of the route map

• what has been set out is good as a consolidation of work but only a few significant new departures from existing approaches. The actions collectively represent the 'what' but there is a lack of detail on ‘how,’ but perhaps this represents the stage of the process 

System rebalance

• regarding preventive spend tagging, this could be pushed further. Preventive tagging is exciting but want to ensure spend is on right areas. Need to push that more and enable some of the levers in investment in primary care health. Allow upstream care that avoids downstream costs

Access

• under quality of care - screening / identification / intervention and good chronic disease management to support people to live healthier lives for longer (and therefore shape demand for secondary care) - thinking of Cardiovascular Disease Directed Enhanced Service (CVD DES) and diabetes prevention.
• regarding community nursing – within access section – there is mention of the walk-in services and community hubs, however, are we missing housebound people and frailty which has a level of complexity
• regarding access - it is good to see strategic communications built in for staff and public navigating these new structures

Workforce

• need to be more mention of workforce
• where does the future workforce feature (e.g. students)?
• there is an action for secondary care specialists to spend time training in the community and vice versa but should this be a wider scope?
• people are often keen for more portfolio careers, which includes working full time but not all delivering patient facing care. Enabling this could help support workforce sustainability
• from a primary care perspective, unsure if this is nuanced enough and it all becomes a vicious cycle. There is a need to think what works across the systems and plan for the unintended consequences if only doing one bit of the workforce. Workforce planning needs to recognise prevalence of non-full time working models

Data and digital

• data collection and sharing needs to be linked to its purpose e.g. improved clinical decision making and GIRFE
• support providing patients with access to data and linking to digital front door and guiding patients to the right care
• regarding patient access to digital services, many here will want access to their own healthcare data. This is a significant change
• digital needs to not just focus on ‘what can it do’ but also how it is successfully integrated and influencing behaviours in the system
• a data consideration is how can we capture data on hospital admission avoidance.
• we need digital to have a higher profile in this work both to support people to self-manage through more virtual inputs and also for our digital systems to better facilitate improved sharing of patient information between the multidisciplinary team members

Communications and engagement

• if we want to ensure that these actions are deliverable – who else do we need to engage with beyond this room to make sure this works in practice?
• how do we communicate out a strong message that this is what the system will look like to the public? This needs to be high-level and strategic to set a direction but make it meaningful to people
• good to see strategic communications built in for staff and public navigating these new structures – importance of pointing to reliable public information and Once for Scotland resources at universal level as the first stop and to enable signposting 
• considering diversity across independent contractors, do we need to look at how we engage with the breadth of individual stakeholders and how we reflect that diversity of opinion of workforce?

Breakout group 1 - Session 2 – Models of Care (MoC)

Question 3 - Are you content with the draft models of care statement? What’s your view on critical elements to cover in a "model of care" for PCCH that will support the sector to achieve the agreed strategic direction?​

• the overall structure and principles of the MoC are good but need to ensure continuity of care is featured, to deliver the right care for people with complex needs
• a particular challenge is delivering realistic medicine across different professionals and roles who are handling different aspects of care and to avoid overdiagnosis and overtreatment
• person-centredness needs to be a priority and this raises the importance of the coordination role and the ‘centre of gravity’ in the health and social care system must be in community
• there are important differences in how professions are trained to hold risk and manage uncertainty, and this shapes how care is delivered
• need to clarify what is implied within a MoC for individual service areas/delivery partners and how they fit into the system
• feedback on role of specific service areas was provided:
  • community pharmacy is a front door service so what responsibilities is it taking on as a first point of contact, how can data be strengthened to allow that and where do we fit in this? It would be great if community pharmacy was more linked in and that there is a two-way manner with other health care professionals. Could take a more proactive role on medicine use, freeing up capacity within our service areas
  • from a paramedic perspective, there is a twofold role. The autonomous role already working in primary care and prescribing etc but then in addition to that we have paramedics that are conducting home visits for GPs. If this is scaling at pace, then what are the clinical decision-making structures behind the support to do so on a national basis
• digital is another key enabler - being able to have access to patient records (more than just ECS) across settings will allow better coordination of care
• should there be a practical reference/driver to shifting the balance of resources/budget related to shifting the focus from acute care to prevention and community-based models? This includes PC and Community Health but also need to recognise the third sector, especially at a time where budgets are extremely challenged
• where does the governance sit regarding decision making? This is not always clear

Question 4 - What should the roles and responsibilities of PCCH in the system be, and how does that differ from what we have just now?

• If we want the centre of gravity to move into the community then we need more into alignment around that on responsibility and when things go wrong or right. There are legal and clinical reasons why a GP feels responsible when something goes wrong. Shift of centre of gravity will mean quite a structural change.
• Areas are currently duplicated now and there is failure demand that comes into system at various points.
• There is a duplication issue and is quite often a lack of information continuity.
• How do we work together better and use technology to enable better access (including artificial intelligence)?

Breakout group 2 - session 1 – Route Map actions and outcomes

Question 1 - Considering the actions collectively, do they provide a sufficient basis to enable the meaningful change we want to see across the system?

General feedback on the actions and the route map design

• there was broad agreement regarding the changes that are needed but there is a question of ‘how’ these changes will be implemented and realised. Determining the ‘how’ can take a lot of time, support, and energy for healthcare professionals.
• we are missing a baseline of how we are doing so far. It is important to look at the data and learn from how changes have been implemented elsewhere. It was useful in the paper to look at examples such as NUKA and learn from the challenges they had.
• the targets being set out are not unachievable, but there are a lot of assumptions in this space, particularly around the time required to enact significant changes.
• concern that we are doing things in isolation from the rest of the system, which risks failure of meeting the aims and outcomes.

Decision making and participation

• question of where patient voice and role fits in, wondering if we are missing a key perspective in this process. It is important for there to be trust between the patient and the system

Navigating services and the system

• the more layers that are added into the health and social care system, the more complicated it becomes for patients which could see people struggle to access the right care at the right time. These challenges may be particularly significant among lower socio-demographic groups and could negatively impact health inequality

Finance and funding mechanisms

• having the correct financial mechanisms is vital and key to delivery, however there is no specific service specification. There remains a large amount of work in terms of descriptions of outcomes and how we contract performance to meet these outcomes

Question 2 - Are there any critical actions or commitments missing at this stage, or areas where further detail is required?

System rebalance

• regarding inclusive decision making, emphasising the importance of getting opinions from all within the service in building trust. We need greater strategic leadership, who would then exploit the links between community provision, social care, and the third sector

Access

• for community rehabilitation we would like to see a single point of access and strategic leadership to support pathways and bring together the right teams and agencies to support individuals across health and social care and the third sector in community settings
• need to think about the messaging around how these changes are going to be communicated to service users

Coordinated, Connected and Person-led

• there is a missing element of continuity and capacity within both acute and community settings noting that staffing has to be at the right level for this to be accommodated. Transitions from acute to the community will need to be carefully planned and managed
• regarding workforce modelling, how we will know what workforce we need at the end point?
• we may need a management operating concept (MOC) or target operating model (TOM) to answer the workforce question – we need to clarify the ‘how’ with respect to workforce challenges. MOC is what linked to ‘why’ (commissioning side) and TOM is how linked to ‘what’ (provider side). Start from what do people need and from a volume perspective (number of the people who need a thing)
• can we work to conceptualise ‘missingness’ as well as a check for effectiveness of MOCs rather than as a thing itself

Quality healthcare in the community

• some ambition is missing around continuity of care, suggesting that potentially hiring a missingness person who could improve this process
• we cannot afford to lose the relational continuity of care we have, especially in the fiscal climate we have. Any effort to replace with protocol lead teams costs more to all involved
• it is worth recognising and learning from patients who only or overwhelmingly attend their community pharmacy, as they do receive continuity of care here
• people are not recognised as key stakeholders. We risk continuing a  paternalistic path of health care delivery, from one-to-one interaction all the way through to system design
• the same people working as part of a team, as a continuous group of people (less turn over) - can deliver continuity to a degree close to the same person, to the same person on each occasion
• useful to understand from the Primary Care and Community Health Quality Framework which drivers are being embedded to have shared records and records access across providers

Breakout group 2 - session 2 – Models of Care (MoC)

Question 3 - Are you content with the draft models of care statement? What’s your view on critical elements to cover in a "model of care" for PCCH that will support the sector to achieve the agreed strategic direction?​

• question over whether we have the right balance of knowledge and understanding to make good decisions and the model needs to go deeper to enable people to make good decisions
• opportunity to use data from service users to improve technological engagement
• people within health boards are best placed to decide how the service is run and designed, and any model of care should allow a level of flexibility for local discretion and there needs to be opportunities for sharing good practice across the system
• in the past care has been too disease-centric rather than person-centric, which has resulted in layers of bureaucracy and inefficient care. There is large variance across localities in what is being delivered regardless of budget, there are not enough specifications and a lack of standardised performance metrics
• greater understanding was needed on why the current system works against stability

Question 4 - What should the roles and responsibilities of PCCH in the system be, and how does that differ from what we have just now?

• we should return to ‘who should be doing what.’  There is not enough context to fully answer the question but there are already roles and responsibilities within integration authorities
• need to consider how we balance professional voices in the system with what people need from the system, therefore we need to design the system to ensure that people are given an influential voice
• draw learning from the implementation of Getting It Right For Every Child (GIRFEC) - lead professional co-ordination and team around the child. Not fully transferrable, but what has worked and some of the pitfalls
• consider role of patient participation groups (PPGs) in exploring and communicating changes with people receiving care and this could be embedded as part of contractual reform

Breakout group 3 - session 1 – Route Map actions and outcomes

Question 1 - Considering the actions collectively, do they provide a sufficient basis to enable the meaningful change we want to see across the system?

General feedback on the actions and the route map design

• acknowledgement of the work done to-date. The Route Map, models of care and GIRFE represented a genuine shift in designing functioning systems
• the documents point to the right direction, but without explicitly naming relational continuity and human-orientation as core design principles, there's a risk that the actions reinforce existing system patterns rather than driving meaningful change.  We need to be explicit what ultimately changes and how service users and workforce will experience the system.
• need to clear set designs principles and not just tweaking existing pathways, which will support transformational change
• needs to be accessible/relatable language and not sounding too ‘management speak.’ Language needs to be relatable and there is anxiety around change
• need to find common language (closer working, better interface). Some of the other language can feel independent contractor-centric and exclusionary
• the actions are welcome but greater clarity on the 'so what?' for clinicians would be welcomed. There is a lot in there and how and who is going to deliver it, and when, needs some consideration and clarity.  
• sequencing needed given dependencies between actions and be clear on where responsibility lies for delivery of actions
• not all parts of the route map will affect all parts of the system. Lack of background knowledge may affect receptivity to the proposals
• the contractual elements can infer we are only talking about contracted services, not all services in CH space are contracted
• referencing both contractor frameworks and agreements (with change levers)
• board employed workforce and other services is key. We need clarity, signposting, and effective change across all elements
• important to clearly discuss cultural change elements and the overarching mission
• urgent care needs to be embedded alongside proactive and planned care
• logic of route map is to capture existing service delivery and workforce landscape, and what we expect change to facilitate. How do we maximise independent contractor and NHS employed in similar way.
• there are three key aspects that are missing about the delivery:
  •  partnerships: how we work with industry/third sector/academia to delivery system change
  • ‘test, adopt, and scale’: understanding where there are ways of working/patient facing products or services/pilots that exist already and are showing as beneficial in the NHS
  • identifying the key pinch points: Are there specific clinical areas that are becoming an increased burden on the providers of care? What are they? What can we do to identify opportunities to change and ensure that's clearly articulated

Communications and engagement

• getting people together for whole system planning is worthwhile. When presenting this need to be careful in understanding current moral in the system (e.g. not they are doing well enough)
• need to be careful with communications on this work as morale of teams in community can be impacted – we need to avoid inadvertently saying to the workforce they aren’t doing well enough
• the reform work can appear hidden to the ordinary practitioner. How do we address and create awareness and understanding of the different parts affected
• consider what kind of conversations can be had at the stakeholder level e.g. between dentists

Workforce

• population workforce planning needs population service planning first

Governance and planning

• Sub-national planning (including East and West) and its impact on primary care needs clarified

Question 2 - Are there any critical actions or commitments missing at this stage, or areas where further detail is required?

Access

• there are some service gaps in GP, including psychology, OT, and social work.  Dedicated funding will be needed to support time-limited tests of change.  Otherwise, services are unlikely to have capacity to shift upstream. 
• alongside incentives for rural practice, we may also need to incentivise more human-centred, relational ways of working, as these represent a fundamental shift in how general practice operates
• need to understand more about role of GP OOH and how enhancement can support physical pathways (MH), digitally, and informational
• be more specific on PC interface to MyCare.scot

Self-care and self-management

• consider actions on self-care in the actions and something that we could empower/enable patients to do.   Self-directed primary care and enabling patient-led decision making before accessing primary care. However, people may still need to contact a trusted provider for help with this. How do we walk alongside people in their self-care journey? 
• important aspect of self-care is providing simple advice about things you can do if you feel unwell - lots of advice on NHS Inform but could we teach more in schools about minor illness etc
• with self-care, looking at examples with NHS Oxford/Milton Keynes - you can share your health data collected in android/apple devices with your provider and your care record. How are these moves going to impact the delivery of this primary care model? 

Coordinated, Connected and Person-led

• must be aware of our missed opportunities for intervention, particularly early interventions. We could benefit from cross-system data analysis on presentations in secondary care that could have been held in the community.
• interface between PC and SC - it says interface in doc twice. The 'how' is critical. Actions to enable this need to be more detailed and thought out

Quality healthcare in the community

• there are evidence around optimal primary care MDT models that have identified optimal patient numbers and ways of working. Thinking here about Nuka.  It would be good to know more about models which have been shown to work
• What is the baseline and what does it mean? We often baseline on current activity/action but that isn't always what we want to do (e.g. no. of appointments in GP currently versus what they should be)
• Baseline, idealised end state, what it takes to realise change across the piece and how we share change across the system
• need digital prescribing in dentistry

Breakout group 3, session 2: Model of Care (MOC)

Question 3 - Are you content with the draft models of care statement? What’s your view on critical elements to cover in a "model of care" for PCCH that will support the sector to achieve the agreed strategic direction?​

• the draft statement aligns with the strategic direction set out in the route map skeleton and the Service Renewal / Population Health Framework ambitions referenced in Steering Group papers, particularly around shifting care into the community, strengthening prevention, and clarifying roles across the system.
• pverall happy with content but finds definition wordy. MoC should describe core interventions. Person-centredness should be a fundamental and intentional design feature, not an addition. Lens should be human orientation rather than system tweak
• need clarity on who the draft statement for: professional or public? MoC will be different for GP and dentistry and public, therefore is this an overarching approach?
• makes sense and is broad and wide enough for scope for reform but needs to be underpinned with specific statements covering different services and independent contractors. Ambition to do things differently but not changing how the other models work
• relational care and practice are not optional nice to haves.  They are core interventions that shape engagement, experience, and outcomes, and should be recognised as a fundamental and intentional design feature rather than an add on.  For example, there is a difference between improving access by expanding the range of MDT in GP versus how that MDT will work together to optimise the GIRFE principles and improve experience for users and workers
• consider two versions of the route map, one for staff and another for people receiving care

Question 4 - What should the roles and responsibilities of PCCH in the system be, and how does that differ from what we have just now?

• PCCH (as part of an MDT model) should act as a relational anchor and system coordinator, with clearer leadership for continuity, coordination, and accountability.  This differs from the current fragmented approach, where responsibility is diffuse and duplication is common
• need to be careful about one size fits all with different groups, and do not want to inadvertently disengage other groups
• interface is crucial as primary care operates within its own right and is a micro system within the wider system. Dependencies – clear and visible with wider system leadership across wider systems
• consider how community planning partnerships play role at different levels and how to interface route map on enablers and MoC on service design against wider aspects of reform, and how this is all brought together in planning space. Open question in complex environment, considering wide breadth of stakeholders across primary care
• preventive action and behaviours may be a gap. Consider user journey mapping and user profiles alongside patient experience
• Workforce should be enabled to identify what they should be doing around prevention and palling to identify where they need to go
• coaching and building assets in the community including role of services beyond healthcare including police and others
• each part of system is the lead in its own part of system