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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.

Thank you, convener. How long would you like me to go on for? I have lots of questions.

That is interesting. Your exhibit 4 points to an overall increase, albeit under inflation, in the primary care budget. However, the BMA has quite stark views on that. Its letter calls the situation “shocking” and talks about the erosion of funding meaning that there is

“a shortfall in practice funding of 22.8 per cent”.

The letter goes on to say that

“£290 million will be required to close that gap”.

The BMA’s perception that GPs are not properly funded seems not to marry up with what the Government is spending on primary practice. Our job is to audit Government spending in that respect, but the feedback from the front line seems to suggest that they are being massively underfunded. Presumably, those views cannot both be correct.

Will you talk me through the areas of your report where you look at the Government’s plans for recruitment and the increase in GP numbers? A commitment has been made to increase the number of GPs by 800, but the RCGP’s initial feedback was that that is nowhere near what is required. It said that having 800 more GPs would still leave a deficit of 700 GPs by 2027. Was the 800 figure plucked out of thin air or does some form of analysis inform it? Is that how many we think that we need, or is it just how many we can afford? Those are two very different things.

We might equally look at what is happening in the dental sector. That is effectively a private sector, albeit that the NHS is free at the point of use, so we do not have a privatised health service in Scotland—I am sure that the Government would be quite keen to stress that. The reality is that a lot of the services are provided through private contracts so, in other words, they are privatised in some way, shape or form.

Do you think that there is just no political appetite for any sort of sweeping reforms? If we sought to bring the whole of primary care into NHS boards under a single budget, do you think that there would be so much pushback from GPs that the change would never be able to happen? If the Government could not introduce such a sweeping change, does it mean that the system will never change? All that will happen is that GPs will ask for more money to deal with the increased demand.

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?

Did Audit Scotland do any analysis on section 2C practices—in other words, those practices that were private partnerships but which decided, for whatever reason, to hand their licence back to the local health board? It is quite difficult to get numbers on them, but the numbers that we were able to pull out of the BMA suggest that there has been a marked increase in the number of section 2C practices. That is more obvious in certain regions than in others. For example, in the Lothians, Shetland, Tayside and Highland, double, treble or even quadruple the number of practices have been handed back to local health boards. Has any work been undertaken on why that is happening so much and why the frequency and volume are increasing?

No, that was helpful—thank you.

The point that I will go on to make in my line of questioning is that many issues that are categorised as additional support needs are non-educational. They might be related to health or wider society, or they might be domestic or related to substance abuse, family or bereavement. Teachers can do nothing or very little about many of those things, in the sense that what happens inside the classroom will not affect what happens outside the classroom.

Is that a scenario in which you will never be able to crack the nut? Given that so many other public agencies and bodies are involved in tackling those wider societal issues that are resulting in poor outcomes for young people, what happens in the classroom will never be able to fix that.