Primary and Community Health Steering Group minutes: June 2025

Attendees and apologies

• Co-Chair and Director of Primary Care Directorate, Scottish Government    
• Co-Chair and Deputy Chief Medical Officer, Scottish Government    
• Professional Nurse Adviser for Primary Care and Chief Nursing Officer representative, Scottish Government     
• Head of Health and Social Care Analysis, Scottish Government         
• Director of Dentistry NHS Shetland        
• Director of Allied Health Professionals, NHS Fife
• Associate Medical Director, NHS 24 and Primary Care Clinical Leads Group representative         
• Director of Pharmacy, NHS Borders. Deputy attended too: 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
• Chief Executive, Scottish Ambulance Service (SAS). Deputy attended: Associate Director of Strategy & Planning, SAS
• 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 of Primary Care and Counter-Fraud Services, 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: Public Health consultant, PHS
• Out of Hours (OOH) Oversight Group Representative  
• Chair, Scottish General Practitioners Committee of the British Medical Association (SGPC BMA) 
• Chair, Royal College of General Practitioners Scotland (RCGP Scotland)     
• Associate Director, Royal College of Nurses (RCN). Deputy attended: Senior Nurse Professional Practice, RCN
• National Director, British Dental Association (BDA) Scotland 
• Chair, Optometry Scotland
• CEO Community Pharmacy Scotland      
• Director for Scotland, Royal Pharmaceutical Society (RPS). Deputy attended: Policy and Practice Officer, RPS
• Professor of Medical Education, University of Glasgow and Co-Director of the Scottish School of Primary Care 
• Chief Officer of Development, The ALLIANCE. Deputy attended: Director of Development, The ALLIANCE
• Chief Executive, Voluntary Health Scotland (VHS)
• Head of Digital Services in Practitioner Services Division, National Services Scotland (NSS)
• Policy and Public Affairs Lead, Royal College of Occupational Therapists (RCOT)
• Director, Royal College of Midwives (RCM) and National Staffside Representative    

Apologies

• Chief Allied Health Professions Officer, Scottish Government
• Delivery Director, Preventative and Proactive Care Programme, Scottish Government
• Associate Medical Director Primary and Community Services, NHS Borders
• Director of National Centre for Remote and Rural Health and Care
• Executive Medical Director, NHS 24
• NHS Board Optometric Advisor, NHS Greater Glasgow and Clyde
• NHS Board Digital Leads representative 
• Chief Officer South Lanarkshire HSCP and HSCP Chief Officers Representative       
• Nurse Director, Angus Health and Social Care Partnership
• Out of Hours (OOH) Oversight Group Representative
• National Co-ordinator, Scottish Practice Management Development Network, National Education for Scotland (NES)
• Professor of Health Economics, University of Glasgow
• CEO, Queen's Nursing Institute Scotland (QNIS)
• Professional Adviser for Scotland, Chartered Society of Physiotherapists (CST)

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 the other forums across the reform landscape.

Members were reminded that the Health and Social Care Service Renewal Framework (SRF) and the Population Health Framework (PHF) were published on 17 June 2025, accompanied by a parliamentary statement by the Cabinet Secretary.

The Co-Chair highlighted that the Public Service Reform Strategy was published on 19 June 2025, which includes discussion of primary prevention across public services.

This set of publications are milestones in setting out a clear, long-term ambition to realise the shift to a preventative, person-centred and community-based approach to health and social care. They are significant in their scope and ambition and the collective challenge for us all is how we implement and deliver them in practice.

This Steering Group and its work have directly informed and shaped the SRF and PHF Primary Care and Community Health are strong and central within both documents, and that is in large part because of the valuable and collaborative dialogue between the Scottish Government and the primary care sector on both the case for reform and the practical actions and shifts needed to deliver it.

The Service Renewal Framework commits the Scottish Government  to publishing the Route Map for Primary Care within the first year of SRF implementation.

There is direct recognition within the SRF of the importance and role of the Steering Group. It is recognised in this key policy document as a source of dialogue, collaboration and advice on primary care and community health that can help embed a shift to a preventative and community-focused model across the whole system.

It was highlighted that the Scottish Government are proposing to continue this group and its work, with a continued focus on the Route Map for Primary Care but also on informing and influencing  wider reform as it is delivered across the system from a primary care and community health perspective. It was noted to members that discussion would focus on the timeline and next steps for development of the Route Map..

The second Co-Chair stated that the SRF sets out both ambitions and considerable challenges to everyone in the system. Moving to a preventative and community-focused system will have to be a collective endeavour.

For colleagues across Health and Social Care – whether in primary and community health, in acute hospital based care or in social care – there are challenges, questions and opportunities around thinking differently about what the offer is in terms of building up capacity and cohesion in the community,  as we make the fundamental shift in the balance of care described in SRF, and in the PHF and Operational Improvement Plan (OIP).  Delivering reform will need strong clinical contributions as we develop new ways of thinking about and delivering pathways of care.

Overview Presentation - Primary Care Strategy Unit

The Primary Care Strategy Unit provided an overview of the PHF

• PHF is a ten-year, cross-sector approach focused on primary prevention to tackle the root causes of poor health and reduce inequalities
• the PHF sets out two initial priorities: embedding prevention in our systems and improving healthy weight. alongside thirty initial actions across the prevention drivers of health and wellbeing
• specific commitments within the PHF, and where a strong leadership role for Primary Care and CH will be necessary, include development of a Health and Work Action Plan and a Healthcare Inequalities Action Plan  
• the Equitable Health and Care section of the PHF is also of particular relevance, spanning all healthcare and including the important contributions of Primary and Community Healthcare. Healthcare inequalities approaches in both dental and General Practice policy are specifically referenced

The Strategy Unit provided an overview of the SRF. With reference to an SRF diagram (the first visual found on page 6 of the SRF) the Strategy Unit highlighted:

• at the top of the visual is an image representing the vision for health and social care. The 5 renewal principles are shown underneath this – prevention, people, community, population and digital, and the key change areas shown under that.
• these are supported by 3 key enabling shifts – in resources, outcomes and planning
• the SRF sets out a framework for a system which is nationally led and locally delivered, with the importance of primary care and community health within whole system planning and decision making specifically recognised and brought out

Questions/feedback

• language is really helpful. ‘Rebalancing’ is really helpful in terms of the narrative and showing how the work of the group is embedding
• very encouraging. A lot of groundwork has gone into this, and it is good to see the reality approaching. On co-design and co-production, the need for learning along the way is important. Important that we learn together as well as work together
• important to highlight that the new special health board NHS Delivery is not just a merger of NES and NSS; it is a new organisation that will have additional functions

Feedback from breakout groups

Enablers discussed

• Rebalance financial resources and monitor the balance
• Rebalance of workforce
• Implement outcome-based approaches, develop a whole systems outcomes framework
• Strengthen data and infrastructure systems
• Digital
• Governance, engagement and planning
• Assurance and improvement

Group 1

• difficult to narrow down critical enablers as they are all closely connected
• opportunity to learn from examples of where we have been able to make things work and why things might not have worked in the past
• clarity around what we're rebalancing to in terms of models of care and delivery models, and the role our group can play in defining that for community health
• underpinning theme about supporting the workforce to shape and lead change
• population health planning – critical role for our group in understanding what population health planning looks like and where it best happens, from practice level right up to national level, and making sure boards' strategic needs assessments include primary care
• cultural change and the need for changing behaviours across the system
• support for change - once we know what we are changing to, need to consider support for change processes
• understanding where we are starting from – fundamental changes to how health and social care is understood and accessed, how different parts of population  use digital to access health and social care services
• focus on continuity and relational care, person-centred models of care
• assurance – delivery of what people think matters

Group 2

Which of these enablers are most critical, and why?

• rebalance of finance
• rebalance of workforce
• digital – especially to facilitate better communication between
• outcomes, governance, assurance & incentives
• cultural shift that respects the positive impact that PC/CH, risk appetite

What from a Primary Care / Community Health perspective needs to be in place to implement them effectively?

• workforce being enabled to engage, work, learn, and connect, time
• measurement and data - & developing PC and CH outcomes measures to input into wider system
• role of different parts of PC in the system, clarifying this and updating roles and responsibilities

Which need addressed first?

• mapping around quick wins and what would take longer etc.
• measurement framework first priority to clarify cross system priorities
• finance, workforce, digital
• workforce interface and ways of working

Annex 1: Breakout Groups Summary

Group 1

‘Digital’ and ‘strengthen data and infrastructure systems’ (considered collectively) and ‘rebalance of workforce’ were the most cited enablers, with ‘rebalance of financial resources and monitor the balance’, ‘governance’, engagement and planning’, and assurance and improvement’ being the second most cited, and ‘Implement outcome-based approaches, develop a whole systems outcomes framework’ being cited least.

Q1 - Which of these enablers are most critical, and why?

Digital and data and infrastructure systems

• identifying opportunities for leveraging new technologies including artificial intelligence (AI). AI identified as a positive opportunity but the priority needs to be the provision and use of foundational digital/data technology and systems (incl. for data capture) that are effective, user-friendly, and integrated across the health and care system
• artificial intelligence has applications within clinical care and applicability within different settings are emerging, for example the College of Optometrists have issued an interim position statement
• improvement in data and digital systems will help improve measurement of system activity and outcomes
• opportunity for workforce capability to be improved with digital technology.
• need to support changes in  workforce behaviour to realise full benefits of digital (e.g. ensuring test/investigation results are posted onto the relevant system/app)
• independent contractors (ICs) can tend to invest in their own data/digital systems which can add complexity to the landscape (e.g. in terms of interoperability of systems between ICs and NHS)
• we can see local innovation in use of digital and these should be learned from and seen as opportunities

Rebalance financial resources and monitor the balance

• financing being more global than distributed by illness or patient group

Rebalance of workforce

• a workforce plan which put people in the right places is needed
• recruitment and retention are critical to workforce sustainability

Assurance and improvement

• making the voice of the community heard – we don’t make enough use of existing structures such as GP Clusters
• whichever assurance framework is developed needs to be about measuring, understanding, and delivery of what people have said matters to them. Key that assurance is not abstract but is about human values, needs and societal expectations for how services should be available, accessed and experienced - people led

Governance, engagement and planning

• precision population health planning needs to underpin everything we do
• population planning and the interface with ICs is key. We think a lot about the national conditions for delivery, and now we are thinking about national enablers in a local context, but there may be a need to  ensure that local structured dialogue (GP clusters, Local Medical Committees etc.) can shape some of the population need. It will need a lot of data sets and insights, but some of the testing and assurance needs both top-down and bottom-up approaches
• collaborative planning as a whole system is needed and will support joined-up workforce plans
• independent contractors can sometimes work in operational silos. Consider creating forums where all contractors could work together to manage "patient" cohorts so they can work collectively on the right patient, at the right place, and at the right time
• shaping delivery so it works for people in the community with optimally integrated team working models being incentivised to shift workforce into primary care. The International Foundation for Integrated Cares 9 pillars provide a structure which supports rebalancing and care design

Implement outcome-based approaches, develop a whole systems outcomes framework

• importance of effective leadership to drive forward change

Q2 - What from a Primary Care / Community Health perspective needs to be in place to implement them effectively?

• looking at it from a prism of inequalities, you can get closer to population health needs
• cultural conditions - making sure that within all areas of PC that all practitioners have a voice and have leadership enabled to share that voice
• we need to think about leadership and management, especially where decisions are made. Need to think about the model we are going to use. On teams, the relationship between GP, nurse and patient is really important. Pleased to see relational continuity mentioned specifically

Q3 - At what level do they need to be driven/ taken forward/ implemented? – ICs, boards (territorial/national), government)?

• unlocking consistent structures and methods to allow boards to do that with Public Health Scotland and other partners. Local Dental Committees and Area Dental Committees would be good places to start. Perhaps development of managed clinical networks too. Area Clinical Forums as a location as all professions represented together. Collective voice is key

Q4 - Which need addressed first?

• support resilience and valuing the workforce. How do we take the workforce along with us to a place where they feel engaged and supported?
• there are barriers within the system which delay or frustrate clinicians in the community holding more of the risk. For example, in the case of Community Glaucoma Service, delays in discharge out of secondary care and resourcing challenges
• consideration required of what workforce support, education, and learning is required to support staff working in community settings to manage conditions within the community which typically are referred onto secondary care
• need to be conscious that wider providers  are impacting  the shape of access to care and will impact expectations of how care is accessed and delivered across the system

Q5 - What needs to be prioritised for further thinking and work to develop?

• important that the public are fully informed about what is happening and what are the benefits for them. Changes to services will get pushback if we are not careful
• not just strengthening Primary Care and Community Health , but optimising the model of provision (great models from abroad such as the Alaskan Nuka system) so that it works for people (to mitigate risk of creating more fragmentation) and being clear enough on what the desirable model is

Group 2

Q1 - Which of these enablers are most critical, and why?

There was broad agreement on the importance of cultural change in underpinning the enablers, particularly for financial rebalance. Every enabler was mentioned to varying degrees but the following were highlighted most frequently:

• rebalance financial resources and monitor the balance
  • noting changes in funding levels for primary care
  • finance required for recruitment/staffing, training, education, and delivering of continuity of care and relational care in the community
• Rebalance of workforce
  • GP:list sizes and ratios considerations
  • opportunities to expand MDT
• Digital/strengthen data and infrastructure systems
  • challenges around legacy systems still in operation  

Q2 - What from a Primary Care / Community Health perspective needs to be in place to implement them effectively?

Rebalance financial resources, and monitor the balance:

• need to measure and manage rebalance of funding - 'what gets measured gets managed'
• defining our terms when we collectively discuss rebalancing  - how can we measure and manage the rebalance in a funding in a meaningful way

Rebalance of workforce

• recognising community professionals, MDT, the value and importance of the range of roles that come together within a community context, opportunities for cross-system culture changes and collaboration
• deliver a Health and Care Experience Survey (HACE) equivalent for providers
• we need to consider future undergraduate workforce training as well as what we need from post graduate perspective to meet our future population/cultural needs.  There needs to be protected resources for education and training as part of our rebalancing of resource and care
• capacity as a central theme and challenge/enabler. Being engaged in pre-emptive discharge planning is not possible whilst core services are struggling with demand. We have a funding restriction leading to a paradox of record level of demand and GP underemployment

Strengthen data and infrastructure systems

• challenges in communicating across services. Multiple systems need to be updated with the same information and can be difficult for acute services to communicate with a patient’s MDT

Digital

• we should also consider carefully service user digital accessibility/inclusion. There will continue to be non-digital demand which we cannot lose sight of, even with the future introduction of a whole new suite of digital tools.

Governance, engagement and planning

• clear accountability is required to bring people along with the change

Assurance and improvement

• need to incentivise reform, whether that is through new contract or by using mechanisms within the current contract
  • need to ensure that there are not any unintended disincentives created
  • need to incentivise being able to do things differently and have an environment that encourages innovation. This will require communication of a different risk-appetite
  • need to incentivise high-performing practices
  • Shetland has a very good performance improvement setup
• create training capacity across sectors, as this allows collaboration and breaking out of silos
• space for learning must be protected; this was a significant issue when removed alongside 2018 GP contract, preventing taking on of new MDT and allowing headspace to properly consider patient flows and look at the big picture
• lack of investment in post graduate training damages the ability to have career progression, impacts on workforce retention, and continuity which will impact on the ability to have service improvement

Q3 - At what level do they need to be driven/ taken forward/ implemented? – ICs, boards (territorial/national), government)?

• contracts (possibly in form of a contractual framework) needs to be determined nationally but include local flexibility, allowing pockets of innovation or local differences and to foster a permissive environment for innovation

Q4 - Which need addressed first?

Financial and workforce rebalance

• rebalance of both the workforce and the corresponding financial resource in the first instance whilst working on the longer-term enablers 

Strengthen data and infrastructure systems

• data governance needs to be simplified and streamlined and needs to be incentives for better data sharing
  • health board role and leadership onbetter data sharing
  • data controllers are part of structures that need to change
  • this is needed to prevent logjams & repetitive requests

Q5 - What needs to be prioritised for further thinking and work to develop?

• target operating models with local flex, tied to an outcomes approach and frameworks across Primary Care and Community Health an area to think about, though would need to have clear linkages to workforce and resource considerations
• we need a measurement framework (or at least a first version of that)
  • Acute services have comprehensive framework which helps them describe the pressures they are under and allows resources to be directed towards trying to alleviate those. Need to develop Primary Care equivalent

Plenary

• Route Map opportunity to set out tangible changes in how services are planned and delivered to both public and professionals, building confidence in reform