Primary and Community Health Steering Group minutes: May 2025

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
• Professional Nurse Adviser for Primary Care and Chief Nursing Officer representative, Scottish Government
• Head of Health and Social Care Analysis, Scottish Government
• Director of Allied Health Professionals, NHS Fife - Deputy attended
• Associate Medical Director, NHS 24 and Primary Care Clinical Leads Group representative
• Director of Pharmacy, NHS Borders - Member and deputy attended
• Scottish Executive Nurse Directors (SEND) Representative and Executive Nurse Director NHS Ayrshire and Arran
• Executive Medical Director, NHS 24 - Deputy attended
• Chief Executive, Scottish Ambulance Service - Member and deputy attended
• NHS Board Optometric Advisor, NHS Greater Glasgow and Clyde
• Director of Psychology NHS Borders and Chair of Heads of Psychology Scotland (HOPS) - Deputy attended
• Chief Officer South Lanarkshire Health and Social Care Partnership (HSCP) and HSCP Chief Officers Representative
• National Strategic Lead for Primary Care, Health and Social Care Scotland
• Interim Director, Primary/Community Care, Strategy, Performance & Service Transformation, National Services Scotland (NSS) - Member and deputy attended
• Head of Digital Services, Practitioner Services Division, National Services Scotland (NSS)
• Interim Director of Nursing and Systems Improvement, Healthcare Improvement Scotland (HIS)
• Chief Executive, National Education for Scotland (NES) - Deputy attended
• Director of Digital, National Education for Scotland (NES)
• Director of Place and Wellbeing, Public Health Scotland (PHS) - Deputy attended
• 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)
• Associate Director, Royal College of Nurses (RCN) - Deputy attended
• National Director, British Dental Association Scotland (BDA Scotland)
• Chair, Optometry Scotland - Deputy attended
• CEO, Community Pharmacy Scotland - Deputy attended
• Director for Scotland, Royal Pharmaceutical Society (RPS) - Member and deputy attended
• Policy & Public Affairs Lead Scotland, Royal College of Occupational Therapists (RCOT)
• Professional Adviser for Scotland, Chartered Society of Physiotherapists (CSP)
• Director, Royal College of Midwives (RCM) and National Staffside Representative
• Professor of Medical Education, University of Glasgow and Co-Director of the Scottish School of Primary Care - Member and deputy attended
• Chief Executive and Nurse Director, Queen's Nursing Institute Scotland
• Chief Officer of Development, The ALLIANCE 

Apologies

• Delivery Director, Preventative and Proactive Care Programme, Scottish Government
• Director of Dentistry, NHS Shetland
• Director of National Centre for Remote and Rural Health and Care
• Associate Medical Director Primary and Community Services, NHS Borders and Primary Care Leads Group representative
• Director of Midwifery, NHS Western Isles
• Head of Audiology Services, NHS Tayside and Board Member of the British Academy of Audiology
• NHS Board Digital Leads Group representative
• Nurse Director, Angus Health and Social Care Partnership
• General Practice Managers Network representative
• Chief Executive, Voluntary Health Scotland
• Professor of Health Economics, University of Glasgow

Items and actions

Please note: views expressed during the meeting include working positions under development, which are not reflective of current Scottish Government policy.

Welcoming remarks and updates

The Co-Chairs shared opening remarks, providing an overview of the three health and social care reform publications - Operational Improvement Plan (OIP), Population Health Framework (PHF) and Service Renewal Framework (SRF).

Presentation – Primary Care Strategy Unit

Strategy Unit set the scene around SRF development at the time of the meeting, linking the SRF to the Cabinet Secretary’s vision for HSC.

SRF likely to set out the case for renewal, highlighting ongoing challenges affecting primary care and wider HSC in Scotland.

Anticipated that SRF will set out a series of  renewal design and delivery principles – potentially covering prevention first, people first, community first, digital first and population first.

Discussed what the intended changes will mean for people, including a shift from acute to primary and community care, more support for growth of self-care and more support for rural and island communities.

Highlighted the link between the work of the steering group, the development of new vision and outcomes for PC, and how this work is contributing to the SRF.

Updated the group on next steps, planned engagements around the SRF, and shared the prompt questions to facilitate the group’s discussion to follow.

The Co-Chair concluded this opening section, noting the overall purpose of the SRF as  provide a clearer, less-congested ‘handrail’ which can support development of the type of health and social care system we need and want to see.

Plenary discussion

The discussion and members views has been summarised and grouped thematically.

General

• the overview of SRF in development was generally warmly received. A number of members indicated that this was taking the system in the right direction, citing specific examples including the anticipated focus on improving population health and recognition of the importance of primary care and community care

Shifting the balance of care and resource allocation

• member asked what is different now? Why has this change not been delivered in the past 14 years? Co-Chair noting a difference is that while governments have been very clear about ‘we would like a shift in care’ previously,  there has not  necessarily  been the accompanying clarity, purpose on what needs to be done to enable that change.  The SRF and the subsequent Primary Care Route Map
• member welcomed the direction of travel in recognising the contribution of primary care to the system. Sought more detail on  ‘methodology for prioritisation of resource use’, How do we continue to prioritise our strategic plan when ‘the going gets tough?
• member raised that we need to answer the following questions: ‘What do we stop investing in elsewhere, and what resources do we need to shift?’. This is taking place within a context of a difficult financial position and reform discussion needs to be grounded in that context. If there is work, we can pinpoint and accelerate cited was shared patient record), that could make this attempt at reform more credible with stakeholders

Engagement

• member asked what level of public engagement is intended on this. Is there a consultation process?
• member suggested an engagement working group could be established
• Co-Chair stated this represents a signal of intent from government and a recognition of the difficulties of delivery. We recognise that we can  produce plans that don’t always meet the availability of resources. This is setting out the evidence and framework for what change can look like in practice

Terminology

• several members agreed that  terminology around "local hubs" needs to be reconsidered and changed to something different, suggesting "Local community". Hubs can imply a single building or centralised site which might house range of services, whereas the model described represents care across multiple settings in the community. Noted that the term ‘hubs’ is used across different policies and delivery partners to refer to different things
• a member was concerned that the SRF may be ‘health-heavy’ and social care and unpaid carers may not be as prominent as they should be. Additionally, they felt that certain fragile services (e.g. chronic pain service) need to be adequately represented in plans
• further feedback that equalities and rights need to be embed in the plans and positive reaction to anticipated narrative on system leaders and the representation of the third sector. ‘Self-care’ may not a term frequently used or familiar in Scotland, compared to ‘supported self-management’

Workforce, training and education

• members generally welcomed the idea of moving more services into the community, but highlighted the time required and the limited capacity  (including physical accommodation) available in community settings
• on workforce planning, reflections around this being more dynamic, considering ‘who will we need in future and who is doing current training for our future requirements?’. A sufficient workforce to meet future needs and models of care is required and that all of this change needs to be measured
• members agreed that we need to look at MDT models, to reintegrate fragmented ways of working and optimise relational care and practice. MDT working requires significant investment in time to develop trusting relationships and partnerships and time remains a very precious commodity
• specific feedback that multidisciplinary team (MDT) development could sit at odds with other elements of the framework, and a disparate MDT first point of contact makes relational care more difficult
• member reflects that a focus on continuity of care, relationship-based care, generalism and development of more generalist skills across workforce and education is required
• further reflections on how better integrated MDT working can support this and developing staff skills in a safe way, and could be expanded to include other professionals including paramedics
• we need to reflect on how we integrate education into these frameworks and also consider points of entry for the workforce into the system. Education system is currently very fragmented. Primary care and wider workforce need to have opportunities to learn together, so that they can grow, develop and work better together
• we have a finite opportunity to boost GP numbers in the community thanks to record levels of medical students and underemployment within sessional GPs. Government should be bold in its commitment to boost whole time equivalent (WTE). Without capacity, very little of the ambitions will be achieved.  A shift to match previous historic proportional funding would fund this

Delivery of Care

• if the vast majority of a patient’s journey is guaranteed to be close to their home, a specific intervention being carried out further from home at a specialist centre will be more palatable for the public. Services need to be seamlessly integrated
• we need people looking after people at home, otherwise Hospital at Home will collapse, so social care must be appropriately represented in this work
• maternity sits across acute and primary care, so it mustn’t be overlooked in these discussions

• self-care aspects within this could be strengthened

Digital and data

• digital exclusion and missingness must not be overlooked
• Nursing and Midwifery Task Force report highlighted duplication and inefficiency of existing digital infrastructure. If we want to get nurses and midwives to support this, some of those recommendations will require to be implemented

Planning

• SRF and reform can helps understand and validate the problems, priorities, and solutions in front of us against a set of outcomes we want to achieve for people. The framework should include next steps towards prioritisation, planning, and delivery and support  accountability and delivery across the whole system. We need to communicate what autonomy and alignment should sit at local and national levels to deliver the objectives