:00:01. > :00:11.don't thing the Prime Minister intends to change his strategy
:00:11. > :00:16.
:00:16. > :00:21.Tonight, are you getting the service you want from your GP? Are
:00:21. > :00:27.longer opening hours and better websites the way to improve, or do
:00:27. > :00:33.need a full reform of the system? And we will be chewing over the
:00:33. > :00:38.reshuffle rumours in Westminster and Holyrood.
:00:38. > :00:44.Good evening. It seems how easy it is to see your GP is distinctly hit
:00:44. > :00:46.and miss. A report from the Reform Scotland think tank describes a
:00:46. > :00:48.postcode lottery for getting appointments outside normal working
:00:48. > :00:50.hours and the availability of online information. They prescribe
:00:50. > :00:56.greater competition and allowing private companies to take over
:00:56. > :01:00.surgeries. Technically, the NHS is not our
:01:00. > :01:06.national religion. The foreign views of the Olympic opening
:01:06. > :01:11.ceremony can be excused for thinking it is. Here, politicians
:01:11. > :01:15.know the health service has suspect it -- special status for the public.
:01:15. > :01:20.But that does not mean everything is perfect. When you are patient
:01:20. > :01:24.looking to see your GP, the things you are after are prompt
:01:24. > :01:32.appointment at convenient times. Are we getting that serve as? Some
:01:32. > :01:35.people are saying no and it is a postcode lottery. If iPhone today,
:01:35. > :01:43.the appointment will be for the following week. It is not that
:01:43. > :01:50.quick. -- If I call my GP today. The appointment times are not that
:01:50. > :01:59.helpful. Not very many places open in the evening. That needs to be
:01:59. > :02:04.done more widespread. My partner phoned this morning and it was 20
:02:04. > :02:10.minutes before the answered the phone. 01 of the regular doctors
:02:10. > :02:16.was in there. It was days off or they were doing house calls. It was
:02:16. > :02:20.a locum that she went to see. Reform Scotland is proposing a
:02:20. > :02:25.number of ways to put patients first. They say catchment areas
:02:25. > :02:30.should be enlarged to give patients more tries. It once practices to
:02:30. > :02:36.provide more and better information, especially online. It wants to
:02:36. > :02:41.allow the private-sector to offer competition. Patients deserve to
:02:41. > :02:45.know what the catchment areas are. That information should be widely
:02:45. > :02:50.available. At the moment, the discretion as with the individual
:02:50. > :02:55.practice. They can choose whether to except those from out with the
:02:55. > :03:00.catchment area. We think that they should be made to accept patients
:03:00. > :03:06.unless they have good grounds, such as they are full. We think the
:03:06. > :03:13.service needs to change to meet the needs of patients. In at Ibrox in
:03:13. > :03:18.Glasgow, there are seven doctors which serve 8,500 people. They have
:03:18. > :03:23.an online presence. It tells you when they are open and what you can
:03:23. > :03:29.expect in terms of services. Reform Scotland also wants private sector
:03:29. > :03:33.companies to run GP practices like this. The Health Secretary, Nicola
:03:33. > :03:38.Sturgeon, said tonight that some of the proposals were interesting. She
:03:38. > :03:42.added, I will not put profits before patients and we are
:03:42. > :03:49.committed to a GP service that remains very much part of the NHS
:03:49. > :03:55.family. Her caution in the run-up to the independence referendum is
:03:55. > :04:01.understandable. Especially when you consider the almost permanent
:04:01. > :04:10.controversy surrounding Andrew Lansley south of the border.
:04:11. > :04:20.need money in order for the private sector to get involved. It will be
:04:21. > :04:24.
:04:24. > :04:29.peering down -- it will be steering -- it will be scaling down the care
:04:29. > :04:36.service involvement. I think we must be more caring as a nation and
:04:36. > :04:44.find a way to do it better. I think doctors ought to try to spread the
:04:44. > :04:51.good practice. In the meantime, some will fall into the gaps. Like
:04:51. > :04:57.this woman trying to speak to her elderly mother's doctor to air her
:04:57. > :05:03.concerns. They said they could phone the next week. I said, you
:05:03. > :05:08.cannot be serious. You cannot get someone to phone me for another
:05:08. > :05:14.week? I am talking about and 92- year-old lady who is not in the
:05:14. > :05:19.best of health. GPs are the first point of contact between patients
:05:19. > :05:24.and the health service. It needs to work. Politicians have the dilemma
:05:24. > :05:27.of leaving well alone or reforming. Both have their dangers.
:05:27. > :05:29.I am joined from Edinburgh by one of the authors of that Reform
:05:30. > :05:32.Scotland report, Geoff Mawdsley and by the Chairman of the BMA's
:05:32. > :05:42.Scottish General Practitioners Committee, Alan McDevitt. Alan
:05:42. > :05:42.
:05:43. > :05:45.McDevitt, this all sounds fairly sensible. I think there is a
:05:45. > :05:49.misunderstanding of the problem, particularly surrounding catchment
:05:49. > :05:59.areas. It is in the surgery's interests to accept as many
:05:59. > :06:00.
:06:00. > :06:07.patients as possible. We have to provide home visits if required.
:06:07. > :06:13.You don't want to be travelling for an hour to visit someone. In most
:06:13. > :06:21.city areas, patients will have multiple practices. There are nine
:06:21. > :06:27.in my region, for example. In that sense, you are prescribing a
:06:27. > :06:31.solution which already exists? certainly did not find that in
:06:31. > :06:36.relation to Edinburgh. We did not look at Glasgow, but in Edinburgh
:06:36. > :06:40.it was clear there were plenty of patients who only had one practice
:06:40. > :06:44.to choose from. That has not give them any choice. Otherwise, they
:06:44. > :06:47.would have to go outside the catchment area and that is at the
:06:47. > :06:52.discretion of the individual practice. We think a wider
:06:52. > :06:57.catchment area would give patients more power, the bid have a wider
:06:57. > :07:02.choice and it would not be the discretion of that practice. I
:07:02. > :07:07.think there is a problem in cities as well as rural areas. There is an
:07:07. > :07:11.issue of people not having a choice, surely? One of the things which has
:07:11. > :07:17.been discovered is that if someone chooses to find the internet to
:07:17. > :07:23.find out about this, it seems to be difficult. That is useful for us to
:07:23. > :07:29.reflect upon. People are struggling to find this information on the NHS
:07:29. > :07:37.website. What should they be able to find? The practices in their
:07:37. > :07:41.local area, for example. If you look at D K NHS website -- if you
:07:41. > :07:51.look at the NHS website for England, I said that I lived in Halifax and
:07:51. > :07:52.
:07:52. > :07:59.it gave me choices for five different surgeries. It had
:07:59. > :08:03.information on each of the doctors. There were results of an organised
:08:04. > :08:10.surveys done for the NHS and there were individual comments from users.
:08:10. > :08:18.There is nothing like that in Scotland. There is not, but that
:08:18. > :08:22.costs �100 million to run at. I don't think patients would use that
:08:22. > :08:26.information very much because the do not tend to move practice and
:08:26. > :08:34.very often. You found a stark contrast between Scotland and
:08:34. > :08:42.England? Absolutely. NHS 24 gives you very basic information compared
:08:42. > :08:46.to the English equivalent. In this instance, the English service is
:08:47. > :08:51.much better than at the Scottish service. I think we should strive
:08:51. > :09:01.to be at least as good as if not better than what is on offer down
:09:01. > :09:01.
:09:01. > :09:05.south. What about private companies being allowed to run NHS surgeries?
:09:05. > :09:10.If you can find a system which works better than what we have just
:09:10. > :09:20.now, we should consider introducing that. Private health care
:09:20. > :09:23.
:09:23. > :09:27.throughout the world has not proved to be better than NHS. We are not
:09:27. > :09:34.on an open market and don't have up it -- don't have a free provision
:09:34. > :09:44.of private sectors -- private services. At your peril, you
:09:44. > :09:45.
:09:45. > :09:51.would... Why is it at your peril? The primary health care system in
:09:51. > :09:57.the UK is not being provided by a private companies in other
:09:57. > :10:02.countries. Private companies should be able to bid on the same basis as
:10:02. > :10:07.GP practices. Most people instinctively seek a difference
:10:07. > :10:15.between a group of doctors teaming up to form a private practice who
:10:15. > :10:20.are, rightly or wrongly, there to be doctors and some international
:10:20. > :10:26.healthcare company saying that people will be put in with no local
:10:26. > :10:30.knowledge and they will try to run the surgery. Commercial companies
:10:30. > :10:35.deliver pharmacies, eye tests and other things which are part of the
:10:35. > :10:40.NHS. Some of these companies are very small. This idea it is always
:10:40. > :10:46.bigger business is nonsense. We should be a loving, I think,
:10:46. > :10:54.commercial companies to at least Pender. Health boards can refuse to
:10:54. > :10:58.accept that tender, as happened in Lanarkshire. Patients can vote with
:10:58. > :11:03.their feet. If they do not like the service offered by a commercial
:11:03. > :11:10.company, Bent if you have the choice that we envisage, they can
:11:10. > :11:17.move on. What is your problem with that? It is about what patients and
:11:17. > :11:21.the country want from their service. Let me ask you an acid test
:11:21. > :11:28.question. If we are to take you seriously, if the Government came
:11:28. > :11:32.up with a proposal which said that we propose that all you're general
:11:32. > :11:39.practitioners in your section of the BMA was to make sure that we
:11:39. > :11:43.have social medicine with no hint of the private sector, we will stop
:11:43. > :11:48.being independent contractor has to the NHS and will be NHS employees,
:11:48. > :11:51.you would be in favour of that? think there are enough doctors in
:11:51. > :12:01.the country to represent all different shades of politics. If
:12:01. > :12:03.
:12:03. > :12:08.that was what the Government wanted Why not go the opposite direction?
:12:08. > :12:12.Well, the flexibility his not better in the current situation, we
:12:12. > :12:15.just think it should be better and should not discriminate on
:12:15. > :12:22.perceived motivation which seems to be the logic behind the
:12:22. > :12:27.Government's legislation. The basic point is, what are you suggesting?
:12:27. > :12:32.It may are not turn out to give a better service to the patient, but
:12:32. > :12:36.people want with a minimum of fuss to have a doctor they feel they can
:12:36. > :12:40.trust and get a decent service from the doctor. They are not interested
:12:40. > :12:46.in choosing to have an operation somewhere or choosing between
:12:46. > :12:53.doctors, they just want to trust the health service. Yes, but
:12:53. > :12:58.tressed is how we improve standards. -- Trust is how we improve. The
:12:58. > :13:02.issue is, is the service responsive to the needs of the patient?
:13:02. > :13:07.Briefly, Alan, you are keen to dig up the intranet stuff, is there
:13:07. > :13:11.anything else in this? One of the things that is consistently shown
:13:11. > :13:15.is that the patient wants to book appointments online and get a
:13:15. > :13:21.prescription and we're looking at this at the moment in Scotland.
:13:21. > :13:24.and or opening hours? Yes, we have extended hours and some of the
:13:24. > :13:27.practices can provide this. changes are afoot as politicians
:13:27. > :13:29.get back to the grind at Westminster and Holyrood. David
:13:29. > :13:32.Cameron is under pressure to respond more decisively to the
:13:32. > :13:35.economic crisis and has already been floating a whole range of
:13:35. > :13:39.changes to business banking and planning laws. They're to go with
:13:39. > :13:42.his first big reshuffle since the coalition was formed in 2010. Alex
:13:42. > :13:44.Salmond may be enjoying a more comfortable time at Bute House, but
:13:44. > :13:54.he's under pressure to inject some vitality into his campaign for
:13:54. > :13:57.
:13:57. > :14:03.First step for the First Minister, setting out what he plans to do in
:14:03. > :14:08.the Scottish Parliament. Of the 15 bills being introduced, most
:14:08. > :14:11.political attention will be on the referendum Bill. This is where a
:14:11. > :14:16.deal has to be done with Westminster on a section 30 order
:14:16. > :14:20.to enable a referendum without illegal challenge. The aim is to
:14:20. > :14:26.introduce a referendum Bill Lawry next year and for it to become law
:14:26. > :14:29.by late 2013. And the expectation is that would be a bill on same-sex
:14:29. > :14:35.marriage, contentious among many religious groups and politicians.
:14:35. > :14:38.The annual budget bell will be another big challenge. The Finance
:14:38. > :14:44.Secretary has hinted there may be some relief for people on public
:14:44. > :14:50.sector and wages. Down at Westminster, the focus is on an
:14:50. > :14:54.economic relaunch and a reshuffle. Fresh back from the euphoria of the
:14:54. > :14:58.summer holidays, some Tory MPs are waiting to see if they will be
:14:58. > :15:01.appointed Ministers. Others are ganging up on the Government's
:15:01. > :15:06.demanding it do better. The betting is that David Cameron will keep
:15:06. > :15:10.George Osborne, despite criticism of his performance as Chancellor.
:15:10. > :15:16.There are no such guarantees of safety are many others on the
:15:16. > :15:18.Government. -- safety of many others.
:15:18. > :15:21.I'm joined now from London by The Record's Westminster editor,
:15:21. > :15:27.Torcuil Crichton and from Edinburgh by the deputy editor of The
:15:28. > :15:32.Scotsman, Peter MacMahon. There is some speculation about the Cabinet
:15:32. > :15:37.reshuffle, speculator. We think Andrew Mitchell will be the new
:15:37. > :15:41.Chief Whip, but from here on how it, there is all speculation. It looks
:15:41. > :15:47.like Andrew Lansley has gone from bad Department of Health and
:15:47. > :15:50.Caroline Spelman will go from environment. Jeremy Hunt was burnt
:15:50. > :15:54.by the Murdochs and will now be burned by David Cameron. Ken Clarke
:15:54. > :15:59.is off, we do not know what he would be Justice Secretary. There
:15:59. > :16:02.are people like Grant Shapps on the way up, he is to be moved from
:16:02. > :16:12.housing to education, so Michael Gove has to go somewhere and he
:16:12. > :16:14.
:16:14. > :16:21.might become the party chairman. Michael Gove is a Scotsman, so it
:16:21. > :16:25.adds extra fuel to the debate. Step they were making was that most
:16:25. > :16:30.people with a few exceptions, they have never heard other people going
:16:30. > :16:34.never mind the people being replaced. The yes, and particularly
:16:34. > :16:37.in Scotland when there are different Ministers responsible for
:16:37. > :16:41.health and education and people like the English Education Minister
:16:41. > :16:46.who will not feature very heavily. It is not important for the punters,
:16:46. > :16:51.what is important is were the economic ideas for growth will be
:16:51. > :16:56.and having good people back into work, and the dawning realisation
:16:56. > :17:01.that will come in Scotland and the rest of the UK that 80 % of the
:17:01. > :17:07.Government's cuts are still to come. You will see that tomorrow, in
:17:07. > :17:13.tomorrow's paper, over we focus on the poverty time bomb. Something
:17:13. > :17:18.like 45,000 kids getting food parcels in Britain, thousands of
:17:18. > :17:22.people in fuel poverty in Scotland. The pressure on the Scottish
:17:22. > :17:25.government is slightly different, Pete, the commentary seems to have
:17:25. > :17:30.decided that the independence campaign is going over so they have
:17:30. > :17:35.to get back on the road. How do they do that with a new legislative
:17:35. > :17:39.programme? I am not sure that the legislator programme will get to
:17:39. > :17:43.the campaign that they want back on track. There will be a referendum
:17:43. > :17:48.bill, but I am not sure how much detail we will see tomorrow,
:17:48. > :17:52.because, of course, the big thing is the question, and they have not
:17:52. > :17:58.sold the differences between Westminster and Holyrood on whether
:17:58. > :18:03.it will be one or two and what the question will be. They hope to
:18:03. > :18:10.present themselves as a competent government, meanwhile, offstage,
:18:10. > :18:13.outside the Government, they will be disappointed that the Yes team,
:18:13. > :18:21.the high-powered team running the campaign, they will hope that these
:18:21. > :18:26.teams will run in tandem. One of the things the SNP's critics have
:18:26. > :18:29.said, if you elect them to win majority government, they will
:18:29. > :18:33.spend years talking about independence and nothing else will
:18:33. > :18:39.happen, and there is a danger Ellesse they come up with some kind
:18:39. > :18:45.of legislation or legislative programme. -- unless they came up.
:18:45. > :18:51.People will say we told you so. They well. A but do they have any
:18:51. > :18:55.plans to do anything? There is the same sex marriage legislation,
:18:55. > :18:59.there is a majority of SNP's in favour of changing the legislation,
:18:59. > :19:02.but none the less, that his controversial and has attracted the
:19:02. > :19:06.opposition of the Catholic Church and the Church of Scotland which
:19:06. > :19:11.the Government will have to pilot through. We could not be saying
:19:11. > :19:15.that they have to legislate the Kaiser in government. You do not
:19:15. > :19:19.have to have hundreds of bills just because you are in government. I am
:19:19. > :19:29.at a loss to see how they get to 15 bills and what they will be made up
:19:29. > :19:33.of. Basically, the coalition well be, as you said, they will be
:19:33. > :19:35.hoping that these are more competent than the people they had
:19:35. > :19:42.before her and will start delivering real impact on the
:19:43. > :19:46.economy? Better, stronger, fresher, they want to new ideas and want to
:19:46. > :19:51.show that Eric government focused on the business of getting Britain
:19:51. > :19:56.back to business. -- that they array government. By that time the
:19:56. > :19:59.dust settles on this reshuffle by Wednesday morning, by Prime
:19:59. > :20:04.Minister's questions that Wednesday, on Thursday, we will be asking
:20:04. > :20:07.about the economy. George Osborne, a live issue must will be
:20:07. > :20:11.Chancellor, will be in Scotland later this week making a speech on
:20:11. > :20:17.the economy. I am sure he will have something to say about the
:20:17. > :20:22.constitution as well. And on the referendum Bill, I would expect
:20:22. > :20:26.that at MichaelWill still be speculation for Scotland. --
:20:26. > :20:30.secretary for Scotland. He is asking Alex Salmond to sit down and
:20:30. > :20:35.discuss the terms of the question and Westminster is determined that
:20:35. > :20:39.it will be one question, not to questions. He may continue being Mr
:20:39. > :20:42.reasonable and it would be up to Alex Salmond to look equally
:20:42. > :20:47.reasonable or we will know when the next few weeks if you serious or
:20:47. > :20:57.not about to referendum or if he will run away from one. Whether be
:20:57. > :20:58.
:20:58. > :21:08.a referendum, Pete? Yes. One yes, one no. We have to leave it there.
:21:08. > :21:19.
:21:19. > :21:29.This is the fact that the West Coast Main Line contract is still
:21:29. > :21:30.