Primary and Community Health Steering Group minutes: October 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
• Delivery Director for Preventative and Proactive Care and Service Renewal Framework Major Change 1 (Prevention) Lead, 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
• Director of Midwifery, NHS Western Isles
• 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)
• Interim Director of Nursing and Systems Improvement, Healthcare Improvement Scotland (HIS)
• Chief Executive, 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
• Associate Director, Royal College of Nurses (RCN)
• National Director, British Dental Association Scotland (BDA Scotland). Deputy attended: Policy Adviser, BDA
• Chair, Optometry Scotland    
• CEO, Community Pharmacy Scotland
• Director for Scotland, Royal Pharmaceutical Society (RPS)
• Professional Adviser for Scotland, Chartered Society of Physiotherapists (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
• National Coordinator, General Practice Managers Network representative
• Professor of Medical Education, University of Glasgow and Co-Director of the Scottish School of Primary Care
• Chief Executive and Nurse Director, Queen's Nursing Institute Scotland
• Chief Officer of Development, The ALLIANCE 

Apologies

• 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
• Director of National Centre for Remote and Rural Health and Care
• Executive Medical Director, NHS 24
• Chief Executive, NHS Dumfries and Galloway
• NHS Board Digital Leads Group representative
• Chief Officer South Lanarkshire Health and Social Care Partnership (HSCP) and HSCP Chief Officers Representative
• Nurse Director, Angus Health and Social Care Partnership
• Director of Digital, National Education for Scotland (NES)
• Chief Executive, Voluntary Health Scotland
• Head of Digital Services, Practitioner Services Division, National Services Scotland (NSS)

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 government updates

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.

The Co-Chair provided updates on key developments since the last meeting in June:

• reform products: the meeting and its agenda builds on three reform products published earlier in the year, with a focus on developing the Primary Care and Community Health Route Map, a key commitment in the Service Renewal Framework (SRF)
• digital developments: the rollout of the MyCare app and digital prescribing initiatives were highlighted as major steps in digital transformation.
• funding announcements: a significant funding package had been announced to support core general practice, general practitioner (GP) recruitment, premises, and digital improvements
• walk-in Centres: the Scottish Government’s commitment to exploring walk-in centres was noted, with emphasis on ensuring alignment with existing services and policy direction
• community health sub-group: this sub-group met for the first time and discussed principles around person-centred care, relational continuity, and integrated pathways

Overview Presentation - Primary Care Strategy Unit

The Strategy Unit presented the proposed structure and engagement strategy for the Route Map:

• the Route Map will be a delivery plan organised around six key drivers of change (e.g. governance, finance, workforce)
• it will include priority actions, timelines, and measurement indicators aligned with SRF and Population Health Framework (PHF) commitments
• a number of policy areas where work and discussion are ongoing included models of care, governance, population-based planning, and measurement frameworks
• engagement proposals include targeted outreach to workforce, public, and third sector stakeholders

Questions/feedback

Key points raised:

• walk-in centres: need for alignment with person-centred care and wider activity focused on health inequalities. The Co-Chair clarified the policy’s origin and assured that pilots would be carefully tested
• scope and dependencies: questions were raised about the inclusion of social care and third sector roles. Officials confirmed these would be integrated and engagement would be broadened

Feedback from breakout groups

Group 1

Route Map

• overall good but need to see more details
• timeline and sequencing
• what does it mean will be key – make it real and simple (developed later in discussions)

Gaps

• models of care important, consider existing work done (e.g. House of Care model)
• different population groups – equity, rural communities, missingness.  Needs to be a thread rather than a section
• population planning – linking to patient journey and data
• expectation management - managing trade-offs/ tensions in policy development e.g. community

Role you can play

• what does this mean for me? Shaping the outputs in a way that is meaningful for people
• engagement with workforce crucial – both before and after.  Consider sequencing.  Getting people sold on the vision first.  Then more detail on plan.  How socialise the Route Map and ensuring ownership
• engagement with the public – Alliance offer to help test messaging
• engagement with wider health colleagues, crucial for interface, hubs, models of care, data

Future of the Steering Group

• proposals and membership feel like the right direction

Group 2

Skeleton

• why is this change needed, and what has changed so far?
• importance of being clear on what it means for workforce, system, patients
• the use of digital across all services will be a key cross cutting priority
• the importance of NHS identity

Gaps

• models of care will be key and fundamental, linked to strategic workforce planning
• models of care lessons learned from district & mental health nursing. Need be conscious of inclusion of maternity services (currently acute)
• patient education – teaching people about new pathways and access care needs to be considered for inclusion. Bring people with us.  (connected – PHF)
• what is the role community appointment days and covering a wide range of service including non-health related (connected – PHF)

Role you can play

• importance of all organisations rising to the occasion to deliver this change. Need to find a formula that supports us to do that cohesively across the sector (good governance)
• members that sit on multiple groups can create links: Area Clinical Forums and Area Optometry Committee have representation on group so can engage
• bespoke comms to organisations: central distribution of key messages and asks to ensure consistent narrative and ease of distribution 
• link in with national initiatives (internally in SG and external) - embedding community first principles early on

Future of the Steering Group

• linking intent to reality
• assurance role – how can we work collectively, and collaborate to ensure support around any delivery challenges
• clarification on metrics and measurements needed to ensure collective ownership on delivery
• ensuring subgroups have relevant and accurate representation to contribute

Group 3

Skeleton

• how are we going to do things in practice.  Need to be clear on what we are trying to “fix” to guide activity
• need to think about patient safety and patient engagement
• who is this document for? And can we have visuals to aid with accessibility?
• sustainability – environment as well as financial
• prevention needs to be included but also aware that not everything can be prevented

Gaps

• discussed role and membership of sub-group
• need to link into full health and social system
• urgent care
• health inequalities
• evaluation – need to drive change through measurements and evaluation
  • need to focus on outcomes not just activity
  • can we make HACE more “live” and not from last year

Next steps

• Scottish Government primary care officials will refine the Route Map structure and engagement plan based on feedback
• future meetings will focus on addressing identified gaps and shaping the Route Map content
• members are encouraged to submit additional written feedback to the secretariat
• invitations for the next meeting will be circulated shortly

Annex 1: Breakout groups discussion summary

Group 1

Question 1: Are you content with the draft skeleton Route Map? Are any critical areas missing?

• there was general agreement on the overall structure of the route map but clarity on details and providing, clear timelines and sequencing of actions, and the anticipated impacts across different populations and the workforce (including links with local authority employed social care) is crucial
• risk that the  route map may be too high-level. It needs to be accessible to a range of audiences e.g. GPs, practice partners, or community nursing teams. Noted that others found the description of the route map and scope helpful as it aligns with previous discussions and expectations
• there was discussion and feedback around the GP Walk-In Centres policy announced by Scottish Ministers, including frustration that members were not given prior notice of the announcement despite being members of this group
• a member noted that Annex 3 of the cover paper, which covers subgroup creation for community health, does not include a pharmacy representative. If models of care are being considered then pharmacy representation is essential on that group, pharmacists work in all areas and in the past when not consulted on evolving models of care challenges have then arisen when the service is implemented
• there was a critique of the reasoning for governance and planning (Chapter 12) being separated from infrastructure (Chapter 10). A reflection that infrastructure sits with digital and data, but large IT projects are closely tied to governance and that it was unclear why these are split
• there is a concern with increasing the expectation on primary care when there are fundamental issues in primary care which need to be addressed.  There is a risk of not building on the key elements that are good about primary care
• consider a separate chapter on the governance of the route map itself, separate from governance of primary care and community health more generally
• there is a reference in page two to the 'interaction between the NHS and NCS', when we don't yet have the full structure of a National Care Service in Scotland

Question 2: Are the areas identified as priority gaps the right ones? What are your thoughts on the plan to fill the gaps?

• there is a lot of duplication around the system, therefore we should be more consistent around data collection and use, and clearer about the ways that we are sharing information to help us plan. Data collection is episodic and transactional and does not follow patient care and there is no easy way of tracking people through the system. Improvements here would help us see where the high contact patients are
• the Care Reform Act put a duty on ministers to introduce an integrated health care record. This will hopefully address some of the issues around the digital front door
• beneficial to have research around models of care to see how these could meet the gaps
• there needs to be a workforce plan about how we meet current gaps in workforce provision (such as primary care psychologists) without disadvantaging current provision

Question 3: What role can you/your organisation/your wider networks play in helping to engage and bring the Route Map to finalisation?

• the Primary Care Occupational Therapy Network which exists already in Scotland and are very well established and have over 150 members who work across a majority of the health boards in Scotland and across different sorts of models of funding. This is a key group that should be consulted
• Optometry Scotland - Scottish Government did a series of workshops and roadshows. Usually flooded with enquiries coming in after these things once the announcement occurs. However, some separate documentation for each of the groups could be useful. Highlights for each of the groups would be useful.
• The ALLIANCE and Voluntary Health Scotland could coordinate some engagement with third sector. Their members deliver a range of community health and support, and VHS also coordinates the Community Link Worker network. The ALLIANCE could also host some sessions with its individual members (people living with long term conditions, disabled people, unpaid carers).
• Heads of Psychology Services (HOPS) group and local Directors of Psychology
• A member highlighted work underway on the National Digital Platform for health and social care
• Question raised on what the plans are for public engagement

Question 4: What are your views on the proposals for the future role of the Steering Group Set out in Annex 2 of the cover paper: Specifically, the role of the Steering Group in providing strategic assurance on progress against SRF and formally bringing together providing collective sector views on wider reform. In the context of this expanded future role for the Steering Group, are there any gaps in its current membership?

• members were content with the plans and membership

Group 2 

Question 1: Are you content with the draft skeleton Route Map? Are any critical areas missing?

• need to clearly articulate the case for change (why it’s needed right now) and how the context in the country has changed from 2014 and 2018 (with respect to different contracts for example)
• the experiences, views, and contributions of service users needs to be included, especially to understand existing behaviours and how to accommodate that
• a question around about the importance of NHS identity especially considering independent contractor employed staff don’t have a direct connection with the NHS necessarily
• we have made good progress to get to this point and the announcement of more funding for general practice demonstrates a shift in the right direction
• we haven’t managed to deliver change effectively in the past for several reasons: we haven’t got the governance right before; we haven’t had the mechanisms in place to support change before; and, We haven’t had the cohesion of all of the players before to effect change
• there is a very cluttered landscape that needs to be de-siloed and needs to be done cohesively rather than in a random fashion
• document needs to be wider and more deliberate than a strategic document
• much of the work is about building the capability within wide teams to ensure that the intent can be delivered The Route Map is about ensuring that all of the different elements are coming together in a deliberate way. It’s an opportunity to signpost the change that is already happening and including the data to evidence the shift
• models of are will be interesting to be expanded upon, does this include something about Dying Well? Who are we consulting to ensure models of care to ensure they are practical and fit for purpose? What group will be responsible to decide on Models of Care, and how do we ensure wide support and buy-in? The Steering Group probably isn’t sufficiently broad for that work
• workforce and focus groups are important given that the steering group cannot fill all the component parts
• need to look at the 24/7 dimension
• need to ensure that everything is interlinked so that any changes to models of care has the appropriate workforce planned for and in place. Variety of different professions need to be brought together requiring a strategic long-term plan for workforce. For workforce, what is the operating model for Primary Care within a wider H&SC system?
• to inform a workforce plan we must start with a workforce analysis considering: What have we got? What do we need? How do you deliver on that? It's crucial that the policies shape the services and the workforce needed rather than that they are shaped by the workforce we have
• delivering a large number of additional professionals (in any field) will take time, so need to start early on that
• the more clarity that we can provide on intent of how component parts of workforce can and will be deployed makes easier the role of training, supporting and delivering that workforce. Too much strategic planning in Scotland currently is done year-to-year. Where are the current deficiencies in training and development?
• will walk-in centres replicate the model where a physio works within a GP on the MSK caseload? Where will the workforce come from to staff these walk-in centres, and how will that be sourced across the different professions?
• creating additional avenues of care usually doesn’t work and instead often fuels health inequalities and punishes those with poor health literacy. If introducing new pathways and frameworks, it’s better that these flow from a known and established first point of contact. Until a framework and pathways have been developed, you don’t know what workforce you will then need to support it
• we need to consider how people currently access services and what their health literacy is. There will need to be an effective patient education campaign to embed any change

Question 2: Are the areas identified as priority gaps the right ones? What are your thoughts on the plan to fill the gaps?

• what was pointed out in CMO report on community appointment days needs highlighting and provides information to support of the a case for investing in and expanding the model:
  • they bring together a range of different health and other professions, including 3rd sector – Citizen Advice Bureau, benefits, housing etc.
  • provides more of a wraparound support service and a single point for people to link up with wide range of support services, and have been very popular with public, especially in more deprived areas
• question of whether Social Security Scotland and benefits support be included in the offer around Community Appointment Days
• district nursing, mental health nursing, and maternity services and how these are currently intersect with primary care
• rehabilitation model as well as prehabilitation working to try and keep people as well as they can be, as well as the preventative and early intervention aspects around this

Question 3: What role can you/ your organisation/your wider networks play in helping to engage and bring the Route Map to finalisation, between now and early 2026?

• need to achieve greater awareness of the SRF more generally. BMA have been embedded into their news release that was sent to GPs regarding the funding offer for general practice, and have referring to it in discussions with members
• Area Clinical Forums have broad range of professions represented on them, and ADO optometry committees can be consulted too
• all need to rise to the occasion here (as organisations), but together and in a de-siloed manner – as one
• bespoke communications to organisations would be helpful. If organisations could copy/paste these, rather than have to interpret or distil, that would: improve the chances of the message being communicated further and help ensure a consistent message across all organisations. Additionally, 'Please share with your networks' style communications
• other national initiatives ongoing with alignment on Route Map themes for example, the Nursing and Midwifery Task Force oversight group has actions around recruitment and workforce
• Healthcare Improvement Scotland Communications Engagement Unit could assist with communication to patients

Question 4: What are your views on the proposals for the future role of the Steering Group Set out in Annex 2 of the cover paper

• a view that this should be ‘soft’ rather than ‘hard’ assurance – not delivery assurance per se. Clarify, test, and assure what has been done and help keep Scottish Government sighted on the bigger picture
• assurance on overall milestones and components is sensible - but direct accountability for components will sit in delivery space (just trying to make sure best of public sector accountability built in rather than pushing back unduly). An assurance framework for the group will be important, and the 'so what 'being answered
• this group is a good forum to highlight hurdles and blockages and how to go about resolving these collectively and collaboratively. If we believe that this is the right route map, the right direction of travel, we should hold ourselves accountable to deliver on it
• what will this then look like visually for the Steering Group to allow it to provide that overview and assurance, and be able to take ownership where delivery isn’t happening and look to resolve, or alternatively to demonstrate positive delivery?
• consideration needs to be given to the data that will be used to measure improvement. What are the metrics, how do we set them, and what will success look like and how will we measure that?
• regarding membership of community health sub-group question over how the GP was selected, that the membership has a weighting towards NHS Lothian, light on rural representation, and lack of a pharmacy representative

Group 3 

Question 1: Are you content with the draft skeleton Route Map? Are any critical areas missing?​

• over the coming months, want to look at the how will this be delivered at such a scale over a period of time
• prevention and inequality, patient and public engagement, quality and safety, and sustainability seem to be missing
• a lot of funding going into Primary Care but the public may not understand? A plea to sense check what linguistic balances we’re putting in. Who is the intended audience for the route map
• need to be careful with the language so it’s accessible for colleagues and public. Important to reflect that primary care and general practice is 24/7
• discuss implementing models. How do we get held to account for this. Show where data and measurement situated in this doc and how approach is driven by an accountability approach may need to come back for clarity on this
• it will need a summary page considering it will be 40 pages long
• what is the goal and how will we get there? Hope that the route map can articulate that clearly and be accessible as said earlier
• evaluation so important as a check to ensure what we do provides the person receiving care the benefits we are intending
• shared definition of what urgent care is would be beneficial first, the definition of all of this varies between stakeholder
• is 'Assurance' not part of 'Governance'? If not - how are we defining the two? 
• why is there a topic on 'Policy' - I see the SRF and PHS (OIP) as the policy approach, so what is intended by a 'policy' heading?
• it would be really helpful to see inequalities highlighted in a) piloting of walk-ins (are they helping to reduce inequalities in access to PC?), b) access to care more generally in the route map, and c) equality of outcomes in the indicators being developed

Question 2: Are the areas identified as priority gaps the right ones? What are your thoughts on the plan to fill the gaps?​

• pharmacy and Scottish Ambulance Service gaps, and question over health improvement involvement
• there are gaps around measurement and indicators but good to be clear about these so we can work out how best to fill them. So gaps in what we measure (including expanding current work on PC indicators to include CH and shifting the balance indicators) and how we measure these things  (including data gaps around e.g. capacity, demand)
• there is data there looking at touch points. When we redesign the system, how do we measure how these touch points have reduced?
• finances are a certain type of measure of the economic 'value' of care that can tell us something about balance of care. What it perhaps doesn't give you is the balance in terms of value to health (e.g. cost-per-quality-adjusted life year gained) and perceived value (which is relevant to the care element - inc. when there is no health 'gain'). So a few ways of thinking about it that could do with more discussion