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The 2018 GP Contract was negotiated on a national basis with the BMA’s Scottish GP Committee which represents all Scottish GPs. The Contract is based on the transfer of some services to Health Board delivery to allow GP practices to focus on what only GPs can do. This means that GP practices are no longer the default providers of vaccinations.

The Scottish Government agreed a process with the GP committee to allow the continued delivery of vaccines, and other services intended for transfer, by GP practices where, due to remoteness and rurality, Health Board delivery would be difficult.

The seven key principles of service design are that any redesigned services should be:

? safe for patients and staff;

? person-centred;

? equitable;

? outcome focussed;

? effective;

? sustainable; and

? affordable

The vast majority of vaccinations are now delivered by Health Board employed staff with a consequent release of capacity for GP practices.

If vaccination rates drop in any Health Board area, the Scottish Government would expect that board to examine its vaccination arrangements and make any necessary adjustments, including the full use of the flexibilities provided under the GP contract, to ensure a proper level of vaccination. This is a continuation of the expectation the Scottish Government would have had of Health Boards when delivery was mostly in the hands of GP contractors; Health Boards were still responsible for ensuring that a proper level of vaccination was met.

The decline in childhood uptake we are seeing nationally is of course a cause for concern. On 16 July, Public Health Scotland published a report on ‘Understanding and addressing declines in childhood immunisations’. This research provides valuable insights into various aspects of childhood immunisation delivery in Scotland.

The Scottish Vaccination and Immunisation Programme are working together to take forward the recommendations in the report. This will ensure that the learning and good practice highlighted in this report is put into action to improve uptake, and ensuring that the delivery of immunisations across all childhood programmes is equitable and accessible.

Director General is a senior grade within the Senior Civil Service (SCS) and pay and terms and conditions of employment are reserved to the UK Government. The Director General for Health and Social Care’s salary remains within the overarching pay range set by Cabinet Office for Directors General, which has a ceiling as at 1 April 2023 of £208,100. The salary for the current Permanent Secretary was also set by Cabinet Office when they were appointed to the Scottish Government and was set to be cognisant of the salaries of other Permanent Secretaries across the UK.

The Director General for Health and Social Care’s salary reflects the fact she serves as both NHS Scotland’s Chief Executive and the Scottish Government’s Director-General Health and Social Care. As such the salary is set in relation to relevant market rates in Scotland and the wider UK, and at a level that ensures the role is attractive to candidates with relevant experience, particularly senior healthcare leaders in the NHS. The Senior Leadership Committee in the Cabinet Office, and the Civil Service Commission both approved the salary approach for this role.

It is not unusual both in the public and private sectors for there to be overlap between salaries and grades where salaries for individual roles need to be set to compete in a specialist market.

It is important to recognise that the dualling of the A9 between Tomatin and Moy and indeed, the whole A9 dualling programme seeks to enhance journey reliability and safety for all road users, including pedestrians, cyclists, and bus and coach passengers, as well as vehicle drivers and passengers. The design of each project builds in these elements, for example, the provision of new bus stops is integral to the contract for the Tomatin to Moy section.

The advance works listed in the response to S6W-28536 on 7 August 2024 include the following elements of work that will make improvements for pedestrians, cyclists, and bus and coach passengers.

? Tomatin Distillery Access and Local Road Improvements Project:

This advance works contract provided new facilities for pedestrians, cyclists, and bus and coach passengers to facilitate more reliable and safer travel in the area. This included footpaths, a new footbridge which replaced an existing footbridge over All na Frithe watercourse, and new bus stops and bus shelters. Public lighting was also provided along the new footpaths. These enhancements were completed in autumn 2022.

? Lynebeg Railway Underbridge:

This advance works contract included the provision of a new bus lay-by and bus shelter, and associated sections of new footpath, to provide better facilities for pedestrians and bus and coach passengers. This enhancement was completed in Spring 2022.

The cost information available does not enable a breakdown of costs to be provided for each of these measures included in these advance works contracts.

These works have been delivered early as part of the advanced works contracts for the A9 Dualling: Tomatin to Moy project, which was the subject of statutory consultation following publication of draft Orders and the Environmental Statement on 18 May 2018. Prior to that date, consultations on developing proposals were undertaken with a number of individuals and organisations and those findings helped to inform the nature of and design of the measures set out above that have been undertaken to improve reliability and safety for pedestrians, cyclists and bus and coach passengers who travel on this section of the A9.

All answers to written Parliamentary Questions are available on the Parliament's website, the search facility for which can be found at https://www.parliament.scot/chamber-and-committees/written-questions-and-answers .

Following the conclusion of the procurement process and contract award for the A9 Dualling Tomatin to Moy project, I recently wrote to the Net Zero Energy and Transport Committee to disclose this information which I am aware is of great interest. An extract of this letter containing this information is provided below:

'Having considered carefully our obligations around confidentiality and transparency, and following consultation with the contractor involved, I can advise that the contract value for the single bid received in October 2022 in relation to the previous procurement for the A9 Dualling: Tomatin to Moy project was £169,986,287.00 at October 2022 prices.

At the time of receipt of this tender, which was the first procurement of a major roads project undertaken by Transport Scotland following the occurrence of the COVID-19 pandemic, the Scottish Ministers were unable to conclude that the tender submission represented best value for the taxpayer. As only a single tender was received on that procurement, no direct market comparator cost was available at that time. The cost of the tender received was significantly higher than both the original £115 million cost estimate for this project, even after allowing for significant inflationary effects, and a cost comparator bid of £136,945,150 compiled by Transport Scotland’s technical advisors.

I am delighted that the recent procurement process has led to a successful contract award and I am pleased to see progress with the delivery of the dualling. I am strongly of the view that the conclusion reached in respect of the previous procurement was appropriate based on the information available at that time. It is imperative that the Government ensures appropriate use of public funds and as best value for the taxpayer could not be demonstrated as outlined above, it was clearly not appropriate for the Government to proceed with a contract award at that time.'

Following careful consideration of the single tender received in 2022, the price of which was significantly higher than expected, Ministers concluded that award of the contract at that time would not represent best value for the taxpayer. Further background on this decision is set out in my response to S6W-28531 on 7 August 2024.

All answers to written Parliamentary Questions are available on the Parliament's website, the search facility for which can be found at https://www.parliament.scot/chamber-and-committees/written-questions-and-answers .

Advance works to a cost of £22.6 million have been undertaken for the A9 Dualling: Tomatin to Moy project, to de-risk the main construction works contract.

This cost is broken down as follows:

The Scottish Government expects Health Boards to reach the World Health Organisation (WHO) target of 95% uptake of childhood vaccinations.

The most recent childhood data for NHS Highland, which includes quarterly data since 2015, is published by Public Health Scotland: Childhood immunisation statistics Scotland - Quarter and year ending 31 March 2024 - Childhood immunisation statistics Scotland - Publications - Public Health Scotland

The trend data for NHS Highland shows that as of March 2024, the uptake rate of children who have received the 3-dose full primary course of the 6-in-1 vaccine by 12 months of age is 90.2% and by 24 months of age it is 94.4%. Since March 2023 this shows a decline of 3.2% uptake by 12 months of age and an increase of 0.4% uptake by 24 months of age.

NHS Highland was escalated to stage 2 of the NHS Scotland Support and Intervention Framework for their vaccination services in late 2023 and since then Scottish Government officials have been engaging closely in an improvement and assurance process which includes the Board Chief Executive and Director of Public Health. As part of this process, the Scottish Government receives a wide range of management information from NHS Highland. The best available information on comparative uptake rates of childhood immunisation through GP practice-delivered and NHS board-delivered vaccination services in Argyll and Bute was shared by NHS Highland with the chair of the GP committee in Highland on 2 July.

Quarterly data for the percentage of children who have received their full primary course of the 6-in-1 vaccine, which protects children against pertussis, and other diseases, by 12 months and 24 months of age, is published by Public Health Scotland: Childhood immunisation statistics Scotland - Quarter and year ending 31 March 2024 - Childhood immunisation statistics Scotland - Publications - Public Health Scotland

This includes the national uptake and uptake for NHS Highland since June 2015.

Maternal pertussis immunisation is offered to pregnant women between 16 and 32 weeks of pregnancy. This provides protection to infants in the first weeks of their life, before they are offered vaccination as part of the Childhood Immunisation Schedule. Uptake data is held within the individual NHS Health Boards.