03/09/2012 Newsnight Scotland

don't thing the Prime Minister intends to change his strategy

Tonight, are you getting the service you want from your GP? Are

longer opening hours and better websites the way to improve, or do

need a full reform of the system? And we will be chewing over the

reshuffle rumours in Westminster and Holyrood.

Good evening. It seems how easy it is to see your GP is distinctly hit

and miss. A report from the Reform Scotland think tank describes a

postcode lottery for getting appointments outside normal working

hours and the availability of online information. They prescribe

greater competition and allowing private companies to take over

surgeries. Technically, the NHS is not our

national religion. The foreign views of the Olympic opening

ceremony can be excused for thinking it is. Here, politicians

know the health service has suspect it -- special status for the public.

But that does not mean everything is perfect. When you are patient

looking to see your GP, the things you are after are prompt

appointment at convenient times. Are we getting that serve as? Some

people are saying no and it is a postcode lottery. If iPhone today,

the appointment will be for the following week. It is not that

quick. -- If I call my GP today. The appointment times are not that

helpful. Not very many places open in the evening. That needs to be

done more widespread. My partner phoned this morning and it was 20

minutes before the answered the phone. 01 of the regular doctors

was in there. It was days off or they were doing house calls. It was

a locum that she went to see. Reform Scotland is proposing a

number of ways to put patients first. They say catchment areas

should be enlarged to give patients more tries. It once practices to

provide more and better information, especially online. It wants to

allow the private-sector to offer competition. Patients deserve to

know what the catchment areas are. That information should be widely

available. At the moment, the discretion as with the individual

practice. They can choose whether to except those from out with the

catchment area. We think that they should be made to accept patients

unless they have good grounds, such as they are full. We think the

service needs to change to meet the needs of patients. In at Ibrox in

Glasgow, there are seven doctors which serve 8,500 people. They have

an online presence. It tells you when they are open and what you can

expect in terms of services. Reform Scotland also wants private sector

companies to run GP practices like this. The Health Secretary, Nicola

Sturgeon, said tonight that some of the proposals were interesting. She

added, I will not put profits before patients and we are

committed to a GP service that remains very much part of the NHS

family. Her caution in the run-up to the independence referendum is

understandable. Especially when you consider the almost permanent

controversy surrounding Andrew Lansley south of the border.

need money in order for the private sector to get involved. It will be

peering down -- it will be steering -- it will be scaling down the care

service involvement. I think we must be more caring as a nation and

find a way to do it better. I think doctors ought to try to spread the

good practice. In the meantime, some will fall into the gaps. Like

this woman trying to speak to her elderly mother's doctor to air her

concerns. They said they could phone the next week. I said, you

cannot be serious. You cannot get someone to phone me for another

week? I am talking about and 92- year-old lady who is not in the

best of health. GPs are the first point of contact between patients

and the health service. It needs to work. Politicians have the dilemma

of leaving well alone or reforming. Both have their dangers.

I am joined from Edinburgh by one of the authors of that Reform

Scotland report, Geoff Mawdsley and by the Chairman of the BMA's

Scottish General Practitioners Committee, Alan McDevitt. Alan

McDevitt, this all sounds fairly sensible. I think there is a

misunderstanding of the problem, particularly surrounding catchment

areas. It is in the surgery's interests to accept as many

patients as possible. We have to provide home visits if required.

You don't want to be travelling for an hour to visit someone. In most

city areas, patients will have multiple practices. There are nine

in my region, for example. In that sense, you are prescribing a

solution which already exists? certainly did not find that in

relation to Edinburgh. We did not look at Glasgow, but in Edinburgh

it was clear there were plenty of patients who only had one practice

to choose from. That has not give them any choice. Otherwise, they

would have to go outside the catchment area and that is at the

discretion of the individual practice. We think a wider

catchment area would give patients more power, the bid have a wider

choice and it would not be the discretion of that practice. I

think there is a problem in cities as well as rural areas. There is an

issue of people not having a choice, surely? One of the things which has

been discovered is that if someone chooses to find the internet to

find out about this, it seems to be difficult. That is useful for us to

reflect upon. People are struggling to find this information on the NHS

website. What should they be able to find? The practices in their

local area, for example. If you look at D K NHS website -- if you

look at the NHS website for England, I said that I lived in Halifax and

it gave me choices for five different surgeries. It had

information on each of the doctors. There were results of an organised

surveys done for the NHS and there were individual comments from users.

There is nothing like that in Scotland. There is not, but that

costs �100 million to run at. I don't think patients would use that

information very much because the do not tend to move practice and

very often. You found a stark contrast between Scotland and

England? Absolutely. NHS 24 gives you very basic information compared

to the English equivalent. In this instance, the English service is

much better than at the Scottish service. I think we should strive

to be at least as good as if not better than what is on offer down

south. What about private companies being allowed to run NHS surgeries?

If you can find a system which works better than what we have just

now, we should consider introducing that. Private health care

throughout the world has not proved to be better than NHS. We are not

on an open market and don't have up it -- don't have a free provision

of private sectors -- private services. At your peril, you

would... Why is it at your peril? The primary health care system in

the UK is not being provided by a private companies in other

countries. Private companies should be able to bid on the same basis as

GP practices. Most people instinctively seek a difference

between a group of doctors teaming up to form a private practice who

are, rightly or wrongly, there to be doctors and some international

healthcare company saying that people will be put in with no local

knowledge and they will try to run the surgery. Commercial companies

deliver pharmacies, eye tests and other things which are part of the

NHS. Some of these companies are very small. This idea it is always

bigger business is nonsense. We should be a loving, I think,

commercial companies to at least Pender. Health boards can refuse to

accept that tender, as happened in Lanarkshire. Patients can vote with

their feet. If they do not like the service offered by a commercial

company, Bent if you have the choice that we envisage, they can

move on. What is your problem with that? It is about what patients and

the country want from their service. Let me ask you an acid test

question. If we are to take you seriously, if the Government came

up with a proposal which said that we propose that all you're general

practitioners in your section of the BMA was to make sure that we

have social medicine with no hint of the private sector, we will stop

being independent contractor has to the NHS and will be NHS employees,

you would be in favour of that? think there are enough doctors in

the country to represent all different shades of politics. If

that was what the Government wanted Why not go the opposite direction?

Well, the flexibility his not better in the current situation, we

just think it should be better and should not discriminate on

perceived motivation which seems to be the logic behind the

Government's legislation. The basic point is, what are you suggesting?

It may are not turn out to give a better service to the patient, but

people want with a minimum of fuss to have a doctor they feel they can

trust and get a decent service from the doctor. They are not interested

in choosing to have an operation somewhere or choosing between

doctors, they just want to trust the health service. Yes, but

tressed is how we improve standards. -- Trust is how we improve. The

issue is, is the service responsive to the needs of the patient?

Briefly, Alan, you are keen to dig up the intranet stuff, is there

anything else in this? One of the things that is consistently shown

is that the patient wants to book appointments online and get a

prescription and we're looking at this at the moment in Scotland.

and or opening hours? Yes, we have extended hours and some of the

practices can provide this. changes are afoot as politicians

get back to the grind at Westminster and Holyrood. David

Cameron is under pressure to respond more decisively to the

economic crisis and has already been floating a whole range of

changes to business banking and planning laws. They're to go with

his first big reshuffle since the coalition was formed in 2010. Alex

Salmond may be enjoying a more comfortable time at Bute House, but

he's under pressure to inject some vitality into his campaign for

First step for the First Minister, setting out what he plans to do in

the Scottish Parliament. Of the 15 bills being introduced, most

political attention will be on the referendum Bill. This is where a

deal has to be done with Westminster on a section 30 order

to enable a referendum without illegal challenge. The aim is to

introduce a referendum Bill Lawry next year and for it to become law

by late 2013. And the expectation is that would be a bill on same-sex

marriage, contentious among many religious groups and politicians.

The annual budget bell will be another big challenge. The Finance

Secretary has hinted there may be some relief for people on public

sector and wages. Down at Westminster, the focus is on an

economic relaunch and a reshuffle. Fresh back from the euphoria of the

summer holidays, some Tory MPs are waiting to see if they will be

appointed Ministers. Others are ganging up on the Government's

demanding it do better. The betting is that David Cameron will keep

George Osborne, despite criticism of his performance as Chancellor.

There are no such guarantees of safety are many others on the

Government. -- safety of many others.

I'm joined now from London by The Record's Westminster editor,

Torcuil Crichton and from Edinburgh by the deputy editor of The

Scotsman, Peter MacMahon. There is some speculation about the Cabinet

reshuffle, speculator. We think Andrew Mitchell will be the new

Chief Whip, but from here on how it, there is all speculation. It looks

like Andrew Lansley has gone from bad Department of Health and

Caroline Spelman will go from environment. Jeremy Hunt was burnt

by the Murdochs and will now be burned by David Cameron. Ken Clarke

is off, we do not know what he would be Justice Secretary. There

are people like Grant Shapps on the way up, he is to be moved from

housing to education, so Michael Gove has to go somewhere and he

might become the party chairman. Michael Gove is a Scotsman, so it

adds extra fuel to the debate. Step they were making was that most

people with a few exceptions, they have never heard other people going

never mind the people being replaced. The yes, and particularly

in Scotland when there are different Ministers responsible for

health and education and people like the English Education Minister

who will not feature very heavily. It is not important for the punters,

what is important is were the economic ideas for growth will be

and having good people back into work, and the dawning realisation

that will come in Scotland and the rest of the UK that 80 % of the

Government's cuts are still to come. You will see that tomorrow, in

tomorrow's paper, over we focus on the poverty time bomb. Something

like 45,000 kids getting food parcels in Britain, thousands of

people in fuel poverty in Scotland. The pressure on the Scottish

government is slightly different, Pete, the commentary seems to have

decided that the independence campaign is going over so they have

to get back on the road. How do they do that with a new legislative

programme? I am not sure that the legislator programme will get to

the campaign that they want back on track. There will be a referendum

bill, but I am not sure how much detail we will see tomorrow,

because, of course, the big thing is the question, and they have not

sold the differences between Westminster and Holyrood on whether

it will be one or two and what the question will be. They hope to

present themselves as a competent government, meanwhile, offstage,

outside the Government, they will be disappointed that the Yes team,

the high-powered team running the campaign, they will hope that these

teams will run in tandem. One of the things the SNP's critics have

said, if you elect them to win majority government, they will

spend years talking about independence and nothing else will

happen, and there is a danger Ellesse they come up with some kind

of legislation or legislative programme. -- unless they came up.

People will say we told you so. They well. A but do they have any

plans to do anything? There is the same sex marriage legislation,

there is a majority of SNP's in favour of changing the legislation,

but none the less, that his controversial and has attracted the

opposition of the Catholic Church and the Church of Scotland which

the Government will have to pilot through. We could not be saying

that they have to legislate the Kaiser in government. You do not

have to have hundreds of bills just because you are in government. I am

at a loss to see how they get to 15 bills and what they will be made up

of. Basically, the coalition well be, as you said, they will be

hoping that these are more competent than the people they had

before her and will start delivering real impact on the

economy? Better, stronger, fresher, they want to new ideas and want to

show that Eric government focused on the business of getting Britain

back to business. -- that they array government. By that time the

dust settles on this reshuffle by Wednesday morning, by Prime

Minister's questions that Wednesday, on Thursday, we will be asking

about the economy. George Osborne, a live issue must will be

Chancellor, will be in Scotland later this week making a speech on

the economy. I am sure he will have something to say about the

constitution as well. And on the referendum Bill, I would expect

that at MichaelWill still be speculation for Scotland. --

secretary for Scotland. He is asking Alex Salmond to sit down and

discuss the terms of the question and Westminster is determined that

it will be one question, not to questions. He may continue being Mr

reasonable and it would be up to Alex Salmond to look equally

reasonable or we will know when the next few weeks if you serious or

not about to referendum or if he will run away from one. Whether be

a referendum, Pete? Yes. One yes, one no. We have to leave it there.

This is the fact that the West Coast Main Line contract is still