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What are you doing to ensure that committees such as the Public Audit Committee, as well as Audit Scotland and other independent bodies, have access to information for the purposes of transparency and accountability, so that we can evaluate value for public money and not be presented with lots of black pages?

Presumably, on top of the £35 million, there will still be the on-going monthly operational costs to keep the yard running, which include staffing costs and so on. Is that in addition to the extra capital that has been asked for? How much is that?

One thing that we have not gone into great detail on is satisfaction. You talked earlier about the health and care experience survey for 2023-24, which is detailed in exhibit 5. I found that to be one of the more shocking graphs in your report. Every single metric on which people were questioned in 2017-18 and again six years later—with the same set of questions—saw a decline in satisfaction, and some of those declines were quite stark. The starkest decline was in people’s overall rating of their care experience as good or excellent. It was at 69 per cent in 2023-24, having gone down by 14 percentage points in just six years. Two thirds of people believe that they are getting a good service, but the other third do not. That is pretty shocking.

Did anything that came out of that survey jump out at you as being an area of concern?

I will ask a question that may be more controversial. Do you think that there should be a top-down complete change to the system—in other words, to the GMS contract? BMA Scotland and those who represent GP practitioners believe that GPs are not getting paid enough for the work that they do. Their workload is increasing and they are having to take on ever more patients. On the other side of the phone, patient satisfaction is decreasing, and the public are not happy with the output. Is the whole system broken? Is the private practice model actually working in Scotland?

Is that good or bad, though? Is it a consolidation—is it better to have fewer, bigger practices? It is quite hard to tell what that number means. On the face of it, it looks like it is poor, because it means that there are fewer practices, and therefore there is much less local access to a GP.

We have talked about data and the lack of it, but there are things that we know and that have been made clear to us. I would like to look at two pieces of data: one is the ratio of GPs to population and the other is the number of GP practices in Scotland.

Please correct me if I am wrong, but my understanding is that the number of practices has fallen considerably over the past 10 years. On the patient per whole-time equivalent GP ratio—perhaps we can clarify for the benefit of people watching that that ratio is different from the GP head count; it is the number of patients that a GP has on average—the Scottish Government often claims that WTE GP to patient ratio is smaller in Scotland than elsewhere and that therefore people have easier access to a GP in Scotland than in other parts of the UK. However, your analysis seems to suggest that the WTE GP to patient ratio has decreased over many years, by some margin. It used to be 1,515 patients per WTE GP and it is now 1,735 patients per WTE GP. It is no wonder that people cannot get an appointment at 8 o’clock to see their GP; far more people are registered with GPs.

We do not have a huge amount of time left to consider this issue, but I have a final question on the fact that there is no specific target or commitment to increase the number of GP nurses. We are looking at a multidisciplinary team-type model or one in which primary care can be provided by nurses rather than GPs to ensure that it is easier and quicker for people to get an appointment, and there are some good examples of where that is working well. That requires an increase in the number of GP nurses, but my understanding is that the number has decreased in recent years. I think that your report says that it has flatlined, but I will check that. In any case, there is no clear target to increase the number.

If we cannot increase GP numbers by 800—the Royal College of General Practitioners and the British Medical Association say that there should be an increase of 1,500, but we are going in the wrong direction—that is a worry, and the lack of an increase in GP nurse numbers is another worry. Who on earth will deliver for all the increased demand?

A good example of that is the ScotGEM project to try to recruit rural GPs—that was when the Government had a strategy. I read a news report about that recently. In one year, there were 52 graduates, of whom only 10 went on to become GPs, and only two of those went to the north of Scotland to fulfil GP vacancies in rural areas. That is a drop in the ocean compared with what is required in rural and island communities, where there are generally huge issues in recruiting, retaining and attracting GPs. Despite the incentives to get GPs into rural areas—such as golden handshakes, fast-track schemes and specialist four-year programmes with specific rural medical training—we still cannot fill those gaps, as a result of which those regional inequalities are surely exacerbated.

That is grand. Good morning, Auditor General and esteemed colleagues. I have a few areas to cover. I will start by going back to an issue that came up earlier in relation to multidisciplinary teams. It sounds like a fairly positive move—the idea that care can be delivered by the person in the GP practice who is best able to offer the care, which goes back to the point about people’s perception that they must speak to a GP when, actually, if the care can be delivered by someone else, that is better. However, your report seems to allude to the fact that your researchers uncovered some dissatisfaction among the GP fraternity because some GPs think that the approach might actually be adding to their workload, not reducing it. Can you explain that?

Is the tension actually a result of the fact that the Government is putting money into health boards to deliver MDT personnel rather than increasing the money that is going through the GMS contracts directly to GPs? Do GPs just want the money directly in order to do the work that they have got to do rather than see people who are coming in at a more junior level being funded differently? It is the same pot of cash overall. Is that where the tension really lies, given that these are private practices?