Primary care improvement plans - implementation progress summary: March 2025
Summary of the current progress towards implementation of the Memorandum of Understanding (MoU) between the Scottish Government, the SGPC, Integration Authorities and NHS Boards.
Primary care improvement plans
Summary of implementation progress at March 2025
Introduction
This management information publication provides a national summary of the progress towards implementation of the Memorandum of Understanding (“MoU”: see ‘Background’ for more information). It covers the period up to the end of March 2025 and is based on data provided by Integration Authorities (IAs) in May 2025. It updates the information published in June 2024. The data at IA/NHS Board level is available in the spreadsheet accompanying this publication.
For the first time, this publication includes financial reporting on how the Primary Care Improvement Fund (PCIF) was used. This is broken down by IA, by service, and by staff and non-staff costs.
However, IAs can also use other funding sources to support the implementation of the MoU. Therefore, the financial data in this publication should not be taken to reflect the total that was spent on each service or by each IA.
Data quality
The data included in this report is provided by IAs. Workforce numbers come from local systems. These systems are dynamic and primarily used for operational purposes. As the data can change over time, the figures presented here are the best available estimates. The Scottish Government is working with IAs to improve data quality. Therefore, previously published information may change to reflect these refinements.
The publication contains data on three broad areas: workforce numbers, access to NHS Board provided services, and financial reporting.
Data was collected on the number of whole time equivalent (WTE) of staff working to deliver each MoU service, including whether they are funded by the PCIF or from other non-PCIF sources. This is consistent with the approach taken in previous years, and therefore improves our understanding of how the size and composition of the workforce providing multidisciplinary team services is evolving. This year, the data collected also includes staff funded through the Primary Care Phased Investment Programme (PCPIP) – which began in April 2024, with four sites participating (see 'Primary Care Phased Investment Programme' below for further information).
As with the last two collections, we have asked only if practices have access to health board provided services. As a result, these figures encompass different levels of access from low to full access. Any interpretation of these figures should, therefore, take account of this. Scottish Government continues to work with IAs and other partners to explore how we can improve the evidence base for multidisciplinary team services, including on access to services.
Background
The 2018 GMS Contract Offer (“the Contract Offer”) and its associated Memorandum of Understanding (“MoU”) between the Scottish Government (SG), the Scottish General Practitioners Committee of the British Medical Association (SGPC), Integration Authorities (IAs) and NHS Boards was a landmark in the reform of primary care in Scotland.
Its key aims are to refocus the role of the General Practitioner (GP) as expert medical generalists, enabling GPs to do the job they trained to do and deliver better care. In tandem, the contract aims to establish multi-disciplinary teams of different healthcare professionals who come together to provide a range of services in communities for those people in need of care.
The contract recognises the statutory role of IAs in commissioning primary care services and service redesign to support the role of the GP as an expert medical generalist. It also recognises the role of NHS Boards in service delivery and as NHS staff employers, and parties to General Medical Services (GMS) contract.
The MoU set out the six priority service areas where IAs, in partnership with Health Boards and GPs, would focus for service redesign and expansion of the MDT:
- Vaccination Transformation Programme (VTP)
- Pharmacotherapy
- Community Treatment and Care Services (CTAC)
- Urgent Care
- Additional Professional Roles
- Community Link Workers (CLW)
The revised Memorandum of Understanding for the period 2021-23 (MoU2) between the Scottish Government, the SGPC, Integration Authorities and NHS Boards refreshed the previous MoU between these parties.
MoU2 reaffirmed the commitment to expanding and enhancing the MDT and placed a focus on three service areas – Vaccination Transformation Programme, Pharmacotherapy and CTAC. Regulations were amended to place a legal responsibility on Health Boards to provide Pharmacotherapy and CTAC services to General Practices and their patients, alongside their responsibility for the provision of Vaccination services.
Funding to support the implementation of the MoU has been allocated to IAs through the Primary Care Improvement Fund (PCIF). Locally agreed Primary Care Improvement Plans (PCIPs) covering all 31 IAs in Scotland have been developed and implemented since July 2018. The PCIPs set out in more detail how implementation of the six priority service areas will be achieved. IAs are required to provide annual updates on their PCIPs. These updates are supplied via an agreed standard tracker template, with a focus on workforce, access and finance data. It is this data collected through the trackers that is presented in this publication
The delivery of primary care transformation is occurring within a complex local landscape. IAs must work closely with local communities and stakeholders to ensure that PCIPs address specific local challenges and population need. They must also agree where the local priorities lie for the services being reformed. As a result of this, there is geographical variation in service design and delivery models.
Primary Care Phased Investment Programme
From January 2024, the Scottish Government established the Primary Care Phased Investment Programme, (PCPIP) to help further develop the evidence base on MDT working.
Through this programme, Healthcare Improvement Scotland (HIS) is providing bespoke quality improvement support to four demonstrator sites to more fully implement two priority service areas within the 2018 GP contract – Pharmacotherapy and CTAC services – and to collect data to understand the impact for people, the workforce and the wider system. Ultimately, the programme aims to strengthen the evidence base on the national context for the implementation of multidisciplinary teams and inform future long term Scottish Government investment.
Additionally, HIS have established the national ‘Primary Care Improvement Collaborative’ which offers support for local teams to implement quality improvement approaches in Pharmacotherapy and CTAC services and in access to primary care services.
Workforce numbers
Table 1 shows the number of whole time equivalent (WTE) staff working to support implementation of the six MOU agreed priority services.
The data shows 5,019.5 WTE staff working in the MOU services in March 2025. Of these, 3571.0 were funded by the Primary Care Improvement Fund (PCIF), 1,313.4 were funded through other sources, and 135.1 were funded through the Primary Care Phased Investment Programme (PCPIP).
There was an overall increase of 173.4 WTE staff between March 2024 and March 2025. This represents an increase of 91.6 funded through the Primary Care Improvement Fund, a fall of 53.3 funded through other sources, and the 135.1 staff funded through the PCPIP.
Increases in workforce may represent progress towards delivery of the MoU. However, there is no agreed target for specific service or total workforce levels required across Scotland.
It should also be recognised that there may be variation in appropriate staffing numbers depending on the clinical model developed, the skill mix of the workforce and local population needs.
Table 1: Number of Staff: Scotland - Whole time equivalent at 31 March
| PCIF funded | Other funded | PCPIP funded | Total | PCIF funded | Other funded | PCPIP funded | Total | ||
|---|---|---|---|---|---|---|---|---|---|
| Mar-24 | Mar-24 | Mar-24 | Mar-24 | Mar-25 | Mar-25 | Mar-25 | Mar-25 | ||
| Pharmaco-therapy | Pharmacist | 548.8 | 106.4 | 0.0 | 655.3 | 560.2 | 89.6 | 12.2 | 662.0 |
| Pharmacy Technician | 406.6 | 41.0 | 0.0 | 447.6 | 429.9 | 32.1 | 9.0 | 471.0 | |
| Assistant/Other Pharmacy Support Staff | 139.9 | 15.6 | 0.0 | 155.4 | 187.4 | 12.0 | 22.5 | 221.9 | |
| VTP | Nursing | 262.0 | 289.4 | NA | 551.4 | 249.9 | 315.9 | NA | 565.8 |
| Healthcare Assistants | 62.7 | 203.1 | NA | 265.8 | 58.4 | 211.5 | NA | 269.9 | |
| Other | 65.8 | 94.8 | NA | 160.7 | 57.7 | 85.8 | NA | 143.5 | |
| CTAC | Nursing | 410.8 | 148.6 | 0.0 | 559.5 | 427.8 | 137.5 | 30.1 | 595.3 |
| Healthcare Assistants | 467.2 | 70.3 | 0.0 | 537.5 | 485.1 | 62.1 | 43.7 | 590.9 | |
| Other | 114.3 | 3.7 | 0.0 | 118.0 | 89.6 | 3.3 | 17.6 | 110.5 | |
| Urgent Care | Advanced Nurse Practitioners | 193.8 | 26.7 | NA | 220.4 | 204.9 | 19.7 | NA | 224.6 |
| Advanced Paramedics | 12.0 | 1.0 | NA | 13.0 | 14.7 | 1.0 | NA | 15.7 | |
| Other | 37.5 | 32.6 | NA | 70.0 | 31.7 | 25.3 | NA | 57.0 | |
| Additional professional roles | Mental Health workers | 175.4 | 222.4 | NA | 397.8 | 179.7 | 213.2 | NA | 392.9 |
| MSK Physios | 230.9 | 22.8 | NA | 253.7 | 253.3 | 21.9 | NA | 275.2 | |
| Occupational Therapists | 28.1 | 2.7 | NA | 30.8 | 36.5 | 2.7 | NA | 39.2 | |
| Other | 60.5 | 20.0 | NA | 80.5 | 27.8 | 14.0 | NA | 41.8 | |
| Community Link Workers | 263.2 | 65.6 | NA | 328.9 | 276.5 | 65.8 | NA | 342.3 | |
| TOTAL | 3479.5 | 1366.7 | 0.0 | 4846.1 | 3571.0 | 1313.4 | 135.1 | 5019.5 | |
Note: Community Link Workers includes a small number of admin staff funded through PCIF, employed to support the delivery of the programme.
NHS Board provided services
NHS Boards are placing the additional primary care staff described in ‘Workforce numbers’ in general practices and the community. Here they can work alongside GPs and practice teams to deliver an increased range of services, in accordance with the MoU. In doing so, they can support the expert medical generalist model and improve patient care. While some of these services and sub-services represent new areas of activity, in most cases, these had historically been provided by individual general practices. Chart 1 illustrates the percentage of general practices whose patients can now access, in some capacity, these services directly from their NHS Board. As noted in the Data quality section of this report though, these figures encompass different levels of access from low to full access. Any interpretation of these figures should, therefore, take account of this. The data relating to this chart can be found in the spreadsheet which accompanies this publication.
It is not expected that all general practices in Scotland will take up these NHS Board provided services. Since service delivery models are designed specifically according to local population needs, there are variations in approach across the country. For example, there may be some general practices where there is no defined need for a particular professional role. These services may therefore never reach 100 percent coverage. There may also be local circumstances where local Primary Care Improvement Programme Boards determine it is necessary for one or more local general practices to continue delivering one or more services intended to transfer to board-employed MDT under the MoU.
Between 84 and 98 percent of practices have access to different level 1 pharmacotherapy subservices as at March 2025. Between 71 and 94 percent of practices have access to level 2 pharmacotherapy subservices, and between 53 and 82 percent of practices have access to level 3 pharmacotherapy subservices.
For CTAC services as at March 2025, 88 percent of practices have access to Phlebotomy, 61 percent of practices have access to Chronic Disease Monitoring, and 89 percent of practices had access to Other CTAC services.
The roll out of the Vaccination Transformation Programme is well advanced. Ninety-nine percent of practices have access to pre-school, out of schedule, adult immunisations and adult flu vaccinations. Travel vaccinations are accessed by 98 percent of practices and school age and pregnancy vaccinations are accessed by 96 percent of practices.
Of NHS Board-provided urgent care services, 24 percent of practices have access to services delivered in-practice and 51 percent of practices have access to external services.
Eighty-three percent of practices have access to a Community Link Worker (CLW). However, CLW services are not intended to be universal but should, primarily, be targeted where there is greatest need, in line with deprivation and health inequalities.
Additional professional services include physiotherapy, mental health workers, and occupational therapists. Sixty-two percent of practices have access to a musculoskeletal physiotherapist, 83 percent of practices have access to a mental health worker, and 14 percent of practices have access to an occupational therapist.
Finance
In 2024-25, £190.8 million was allocated to IAs to support the PCIF. Funding allocations were based on 2023-24 NHS Scotland Resource Allocation Committee (NRAC) shares and it was agreed with CFO representatives that these shares will be the basis for future allocations.
The 2024-25 PCIF was increased beyond the initial £190.8 million allocation through the 2024-25 Agenda for Change uplift, bringing total spend to approximately £200 million. The 2024-25 PCIF allocation is inclusive of previous years’ Agenda for Change uplift costs.
The allocation was reduced to account for baselined pharmacy funding. Please note that Pharmacy funding of £7.8 million has been allocated separately but must be considered as part of the PCIF.
Table 2 shows that in 2024-25 £185m was spent on staff costs and £14.9m was spent on non-staff costs. Pharmacotherapy had the highest staff costs (£64.2m) and highest overall costs (£65.1m). Community treatment and care services (CTAC) had the highest non-staff costs (£5.4m). Non-staff costs can include costs for accommodation, costs for pharmacy hubs, premise works and preparation for works, IT equipment, and the provision of training.
Table 2: Total PCIF spend on staff and non-staff costs rounded to millions: Scotland – 2024-25
| PCIF staff costs total spend | PCIF non-staff costs total spend | Total | |
|---|---|---|---|
| Pharmacotherapy | £64.2 | £0.8 | £65.1 |
| VTP | £16.9 | £1.9 | £18.8 |
| CTAC | £44.3 | £5.4 | £49.6 |
| Urgent Care | £17.1 | £0.5 | £17.6 |
| Additional profession roles | £30.7 | £0.3 | £31.0 |
| Community Link Workers | £8.6 | £2.8 | £11.4 |
| Other | £3.2 | £3.4 | £6.5 |
| TOTAL | £185.0 | £14.9 | £200.0 |
In addition to funding available through the PCIF, the Scottish Government has also made £15 million available to Healthcare Improvement Scotland and the four demonstrator sites (NHS Ayrshire & Arran; NHS Scottish Borders; Edinburgh City HSCP; NHS Shetland) over 2024/25 and 2025/26 to recruit additional workforce to support participation in the PCPIP. Expenditure on staff and non-staff costs from the PCPIP can be seen in Table 3 below.
Table 3: Total PCPIP spend on staff and non-staff costs rounded to millions: Scotland – 2024-25
| PCPIP staff costs total spend | PCPIP non-staff costs total spend | Total | |
|---|---|---|---|
| Pharmacotherapy | £0.4 | £0.0 | £0.5 |
| CTAC | £1.6 | £0.2 | £1.8 |
| PCPIP support | £0.4 | £0.0 | £0.5 |
| TOTAL | £2.5 | £0.2 | £2.7 |
Background notes: Definitions
There may be geographical and other limitations to the extent of any service redesign and local needs which need to be determined as part of the PCIP. The services included in the MoU are defined as follows:
Vaccination Transformation Programme (VTP) - VTP was announced in March 2017. It reviewed and transformed vaccine delivery in light of the increasing complexity of vaccination programmes in recent years. It also reflected the changing roles of those historically tasked with delivering vaccinations. The financial and workforce contribution of the VTP element of PCIP represents a portion of overall spend on vaccinations in Scotland. It does not represent the full costs of immunisation programmes in Scotland.
IAs have delivered phased service change based on locally agreed plans as part of the PCIP. These meet a number of nationally determined outcomes including redistributing work from GPs to other appropriate professionals. In October 2021, regulation change removed vaccinations from the GMS contract. This was supplemented by legal directions which were issued in August 2022. These provided a framework to conclude the role of most general practices in providing vaccinations. The Vaccination Transformation Programme provides the current position on the programme.
Pharmacotherapy – There are three levels of service provision covering core and additional activities.
The level one (core) pharmacotherapy service includes activities at a general level of pharmacy practice including actioning acute and repeat prescribing requests and medicines reconciliation activities.
Level two (advanced) and three (specialist) are additional services. They describe a progressively advanced specialist clinical pharmacist role with a focus on high-risk medicines and working with patients to undertake medication and polypharmacy reviews.
The MoU2 recognised the interdependencies between all three levels of pharmacotherapy and the need to focus on the delivery of the pharmacotherapy service, as a whole.
Regulations have now been amended by Scottish Government so that NHS Boards are responsible for providing a pharmacotherapy service to patients and practices.
Community Treatment and Care (CTAC) Services - These services include, but are not limited to, basic disease data collection and biometrics (such as blood pressure), chronic disease monitoring, the management of minor injuries and dressings, phlebotomy, ear care, suture removal, and some types of minor surgery as locally determined as being appropriate.
Scottish Government have amended regulations for the delivery of CTAC Services. Boards are now responsible for providing a CTAC service. These services will be designed locally, taking into account local population health needs, existing community services, and optimising benefit to practices and patients.
Urgent Care - These services provide support for urgent unscheduled care within daytime primary care. For example, providing advance nurse or paramedic practitioner resource for general practice clusters and practices to respond to a range of ill health need which requires senior clinical decision making capacity. Activities range from house calls, demand from care homes, or on the day urgent care response in practice. This creates capacity to enable GPs to better manage their time for more complex cases.
Additional Professional Roles - Additional professional roles provide services for groups of patients with specific needs that can be delivered by other professionals as first point of contact in the practice and/or community setting (as part of the wider MDT or in an advance practitioner capacity). These roles could include, but are not limited to:
• Musculoskeletal focused physiotherapy services
• Community clinical mental health professionals (e.g. nurses, occupational therapists) based in general practice.
Specialist professionals will work within the local MDT to see patients at the first point of contact. They will assess, diagnose and deliver treatment, as agreed with GPs and within an agreed model or system of care. Service configuration may vary dependent upon local geography, demographics and demand.
MoU Parties will consider how best to develop the additional professional roles element of the MoU.
Scottish Government continues to work with local areas on how we best align funding and reporting arrangements across different mental health funding streams. This aims to ensure better co-ordination and integration across the wider system.
Occupational therapists are dual trained in providing assessment, self-management advice and therapy to people with both physical and mental health conditions. They support people with environmental adaptation and rehabilitation, to access or return to work, education and social activities. Variation in the development of services comprising additional professional roles reflects a number of factors including local needs and existing community services.
Community Link Worker (CLW) - Non-clinical, generalist practitioner, based in or aligned to a general practice or cluster, often in more deprived communities. They work directly with patients to help them deal with socio-economic challenges associated with poor health which cannot be addressed clinically. CLWs help people navigate and engage with a wide range of health and social statutory and voluntary services. They may also work with patients who need support because of the complexity of their care and support needs, rurality, or a specific status (e.g. asylum seeker/refugee or homeless). CLW services should be targeted to local need and provide connection between general practice and wider community resources.
Access data - reflects how many general practices have access to a given service or sub-service. There is no additional data provided on levels of access. The access data therefore represents a range of access levels from low to full access and should be interpreted as such.
Contact
For more information or queries on the information presented here please contact the Primary Care Policy Team at PCImplementation@gov.scot.
