In at the deep end: Q&A with Humza Yousaf

Humza Yousaf is Cabinet Secretary for Health and Social Care in Scotland and recently visited the Perth practice of RCGP Joint Chair David Shackles. As he approaches his first year in the role, here are his reflections.

WHAT HAVE BEEN YOUR BIGGEST REFLECTIONS FROM YOUR VISIT TODAY?

General practice is undoubtedly under considerable pressure. I could see that as soon as I walked in, how many people were in the waiting room and how many people were coming in. I was struck by the collaborative, multidisciplinary team working, that clearly works really well.

Humza Yousaf visits RCGP Scotland joint-chair David Shackles' practice in Perth, with practice manager Lynn Williamson

Lizzie Edwards

HOW WILL THE NEW HEALTH AND SOCIAL CARE WORKFORCE STRATEGY BENEFIT GPs, THEIR TEAMS AND PATIENTS?

Every person working in a GP practice I’ve spoken to tells me that the last two years have been exhausting. The receptionist staff have told me that they’ve never received as much abuse as over the last two years. That’s unacceptable. A key focus of the strategy is looking after staff wellbeing. We’ve got ambitious targets to grow GP numbers over the next five years and this strategy cements that commitment, but also looks towards how we can deploy our staff even more effectively, so we’re investing in our allied health professional workforce too.

WHAT NEEDS TO HAPPEN TO ENSURE GPs FEEL ABLE TO REMAIN IN THEIR ROLES?

It’s not just about recruitment, which is important, it’s about retention. We have to ensure that being a GP remains a really attractive career choice. GPs I speak to tell me that the last two years have felt like the worst of the winter pressures, they’ve had no respite. There will always be busy periods, but we’ve got to ensure that workload is more evenly balanced over the course of the year. Key to that is ensuring there is a hybrid model in how patients are seen. Keeping face to face where needed, we've got to have telephone consultations and video consultations because a lot of people benefit from that, I know I prefer it because it takes less time out of my day, quite frankly.

We also need to ensure medical graduates are coming through the training pipeline and view general practice as really attractive. We’ve done well, 98% of GP training posts were filled last year. We’ve met our commitment to increase training places and available medical school places.

WHAT ARE YOUR REFLECTIONS ON HOW GENERAL PRACTICE HAS RESPONDED TO THE PANDEMIC?

I’ve been doing this for 10 months and it’s really challenging. People on the frontline have been working day in day out with all the associated pressures and health impact for two years. Many have told me that they haven’t had a moment to breathe. That’s my first reflection – my genuine worry about the mental wellbeing of our NHS staff.

My second is that I get quite upset if I get a hint of anybody trying to blame any part of the workforce and there’s been a temptation by some, in politics and the media, to point a finger at GPs. I think that’s deeply unfair, I’ve not met a GP who’s sitting on their hands or twiddling their thumbs. They are working absolutely flat out and it must be really demoralising to have the finger of blame pointed at you when all you’ve done is work exceptionally hard. We’ve got to guard against that blame culture. We’ve been hit by the biggest shock our NHS has faced in its 73 years. That’s not the fault of GPs, or any health worker – they are doing their best and I think we need to remember how valuable GPs and all general practice staff are to our communities.

WHAT ROLE DOES GENERAL PRACTICE HAVE IN NHS SCOTLAND'S DRIVE TOWARDS NET ZERO AND HOW DO YOU PLAN TO SUPPORT THE PROFESSION IN ACHIEVING THIS?

Our health service has significant footprint in terms of employment, estates and treatments. I think about inhalers: how can we reduce, where clinically appropriate the use of reliever inhalers and switch to dry powder inhalers? It may seem small, but actually the accumulative impact will be significant. We want GPs to work closely with our pharmacists to reduce the environmental impact of other areas of prescribing and we’ll publish our Scottish Quality Respiratory Prescribing Guidance, hopefully this year, to help clinicians with this.

Estates is important too. With new builds it’s relatively easy to make them more environmentally friendly, for estate that already exists, it’s more difficult, but there are things such as boiler schemes, or solar panelling we could look at, and there’s a whole host of possible initiatives that are focussed on GP practices.

We’ll be publishing our NHS Climate Emergency and Sustainability plan in the Summer.

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RCGP SCOTLAND HAS BEEN ACTIVELY INVOLVED IN FINDING SOLUTIONS TO THE APPALLINGLY HIGH LEVELS OF DRUG RELATED DEATHS IN SCOTLAND. WHAT PROGRESS IS BEING MADE IN REDUCING DRUG RELATED DEATHS AND WHAT MORE NEEDS TO BE DONE TO SUPPORT THOSE WHO ARE SUFFERING FROM DRUG RELATED HARMS?

I agree, it’s appalling but we are making progress. I think the MAT [Medication Assisted Treatment] standards are vital to that, so embedding and implementing them will be key to ensuring that people who need it get treatment in a timely manner, and vitally get the wrap around support that is needed. There’s a critical role here for primary care.

WHAT DO YOU SEE AS THE ROLE OF GENERAL PRACTICE IN HELPING TO REDUCE HEALTH INEQUALITIES IN SCOTLAND, WHICH HAVE WORSENED OVER THE PANDEMIC?

I’m a great supporter of the work of the Deep End, they do an incredible amount of good work and are an important voice in the discussion about how we reduce health inequalities in Scotland. The Short Life Working Group looking at health inequalities in primary care published their findings recently and I’m very enthusiastic about a lot of their recommendations. Primary care has such an important role to play in reducing health inequalities. You are the front door, you will see whole families so you will understand them better than I think just about anyone else. But it’s not just GPs, it’s Community Link Workers, I’ve got a fantastic one in my own constituency, it’s the thousand additional mental health and wellbeing workers that we committed to by 2026. All of these individuals working together are going to play a really important role in all of this.

FINALLY, DO YOU HAVE A MESSAGE FOR GPs AND THEIR TEAMS?

Genuinely, whole heartedly and sincerely: thank you. I don’t think we can truly repay those who have worked and continue to work in our health service for what they’ve done during Covid. I want GPs and their practice staff, everyone involved in a GP practice, to know that this Government really supports your efforts and are grateful for your efforts. Sometimes my conversations with the RCGP and the BMA can be quite robust but where we have disagreements we’ll be constructive about it. I’m committed to doing my best to ease the workload pressures you are facing. I can’t promise I’ll be able to do that overnight and I’ll be upfront and honest about that. •