Radical overhaul of Scottish NHS needed for ‘21st-century system’

A radical overhaul of health services in Scotland is needed with the traditional 9-5, five-days-a-week approach "consigned to history", MSPs have found.

A new 21st-century system that embraces technology and is shaped around the needs of patients is called for in a report by Holyrood's health committee.

This should include a shift away from GPs being the "deliverer of all services" and a greater role for other professionals like nurses, occupational therapists and physiotherapists, as well as dieticians and language therapists.

There must also be greater emphasis on prevention with Scots taking a greater role in their own care, the report says.

Scots GPs can no longer be the "deliverer of all services"

The health and social care budget in Scotland in topped £15 billion this year, exceeding 50 per cent of the entire Scottish budget for the first time. But demands are expected to grow as the population ages.

Committee convener Lewis Macdonald said: “It is clear that when it comes to primary care, the status quo is no longer an option. Existing ways of delivering care are not only financially unsustainable, but have failed to keep pace with modern life.

“We need to radically rethink primary care so that we can ensure our citizens receive the best possible care for generations to come.

“We must move away from the automatic provision of prescriptions and towards social prescribing. There must be widespread adoption of a preventative model of delivering care and the health service must fully embrace new technology."

The committee’s report is entitled What should Primary Care look like for the next generation? It is the culmination of a two-year inquiry into the future of primary care.

Health services have not kept pace with "modern living”, it finds, and must fully embrace technology.

"Primary care requires radical revision to ensure our citizens receive the primary care they want, need and require for the next generation and beyond," the report says.

There also needs to be a shift towards "prevention" in the way patients are treated – and away from simply handing out prescriptions.

Scots will be expected to take greater responsibility for their own health, with "social prescribing" also becoming much more of the norm across the board.

The MSPs say more of a "cross government" approach is needed to successfully implement a preventative approach.

In schools, this should see the introduction of healthy lifestyle strategies and knowledge of food and nutrition into the curriculum.

Local councils would also have a role to play in allowing planning for cycle tracks in towns and cities, as well as allowing communities to use schools, churches and community centres for exercise.

Green spaces should also be protected from new buildings, the report adds.

The Scottish Government has committed to increase GP numbers by 800 by 2030, which the report says should also be "recast" to ensure there is instead a proportionate rise across "multi-disciplinary teams".

These include nurses, physios, occupational therapists, who will play an increasing role in providing services where appropriate, shifting away from the current situation where GPs do it all.

Dr Andrew Buist, chair of the BMA’s Scottish GP Committee, said: "We completely agree that GP services need to be patient focussed – but suggesting this is simply about GP surgery opening hours reflects neither the complexity of the system, or the huge pressures already on the GPs themselves.”

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