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Tackling health inequalities and improving life expectancy remain clear aims of the Scottish Government. To achieve this, we are taking forward wide-ranging action targeted to support communities most in need and address the root causes of inequality; which have been exacerbated by the COVID-19 Pandemic and other recent economic shocks.

This includes allocating around £3 billion a year since 2022-23 to tackle poverty and protect people during the ongoing cost-of-living crisis - as well as initiatives to promote healthy lifestyles through tobacco control, preventing alcohol related harm, promoting healthy eating and physical activity. Reinforced by targeted action through our Women’s Health Plan, which clearly sets out actions which aim to address women’s health inequalities by raising awareness across women’s health, improving access to healthcare for women across their lives and tackling inequalities in health outcomes for women and girls.

We are also working with our partners to develop a Population Health Framework, to take a cross-government and cross-sector approach to improve the key building blocks of health including: good early years and education; good work and income; healthy places; and equitable health care. With an overarching ambition to accelerate the recovery and improvement of population health in Scotland with a focus on a whole system approach to preventative action.

The NRAC formula is an objective measure of the need for health care services across Scotland.

Under the existing formula the additional cost of providing health services in remote and rural areas is factored within one of the key components in determining funding allocations, with the formula giving greater weights to areas where there is evidence of unavoidable excess costs of supplying healthcare services.

The Scottish Government have committed to continually review the funding formula. This process is managed by the Technical Advisory Group for Resource Allocation (TAGRA) and supports vital work to reduce health inequalities; ensuring that we continue to allocate funding according to the relative need for healthcare in each Board area. Work is underway to review this, however, funding formulas are inherently complex and the review will take time.

The Scottish Government does not hold this information.

NHS Boards are responsible for managing their contracts with GP practices, whether General Medical Services contracts (referred to in the question as “17J contracts”) or Primary Medical Services agreements.

Such data as exists on practice closures, mergers or other changes of contractual status does not record whether or not practices “chose” to change.

The Scottish Government is working closely with NHS Education for Scotland (NES), to identify and deliver training opportunities for health and social care workers in rural and island areas. Through the National Centre for Remote and Rural Health and Care, housed within NES, 30 practitioners have undertaken the MSc in Rural Advanced Practice in 2023 and 2024, supporting career development, increasing equity in education and supporting the sustainability of primary healthcare services. The Centre will continue to develop new rural specific recognised qualifications to address skills gaps and drive innovation.

We are currently funding a dedicated resource in NES to scope the current skills landscape and identify where earn as you learn programmes could be expanded and where further development work is required with the aim of widening the pathways into health and care careers.

The Open University already provides distance learning Nursing degree education, which is accessed by Healthcare Support Workers already employed by NHS Boards, enabling them to train in their local area and continue to work.

Further, work is being explored via the Allied Health Professional and Healthcare Science education reviews’ recommendations and the Nursing and Midwifery Taskforce on how best to diversify the delivery and flexibility of education programmes.

In November 2021, the former Minister for Drugs Policy announced a commitment to increase the number of people publicly funded to go through residential rehab per year by 300% to 1,000 by 2026.

Whilst the Scottish Government sets the strategic policy direction for the NHS in Scotland, operational matters including staffing requirements are in the first instance the responsibility of the relevant Health Board. As such, recruitment is a matter for Health Boards. The National Health Service Reform (Scotland) Act 2004 has created a duty on Health Boards to co-operate with each other to secure and advance the health of the people of Scotland, enabling the arrangement of travelling consultants

The Scottish Government is working closely with key stakeholders, including NHS Scotland and third sector to ensure that health professionals embed conversations about alcohol consumption and the risk it carries in developing a range of cancers, for example through Alcohol Brief Interventions, into their daily practices. The Scottish Government also worked closely with Scottish Health Action on Alcohol Problems (SHAAP) to disseminate SHAAP’s guidance, highlighting the link between alcohol and cancer, to health professionals across Scotland.

Cancer remains a national priority, within the Scottish Government and across NHS Scotland. That is why we published our Cancer Strategy for Scotland 2023-2033 along with an initial three year Cancer Action Plan for Scotland 2023 – 2026 in June 2023.

The Scottish Government conducted an initial survey of residential rehabilitation providers in Scotland and published the results in November 2021. This showed that, at that time, there were 12 reported beds in Highland and 6 in the Western Isles. None were reported in Orkney, Shetland or Grampian.

Through promoting healthy living by reducing alcohol misuse we can reduce the risk of developing some cancers. The Scottish Government published our Cancer Strategy for Scotland 2023-2033 and initial Cancer Action Plan for Scotland 2023-2026 in June 2023. There are specific actions in the action plan aimed at reducing the consumption of alcohol.

A Public Health Scotland evaluation estimated that our world-leading Minimum Unit Pricing (MUP) policy has saved hundreds of lives, likely averted hundreds of alcohol-attributable hospital admissions and contributed to tackling health inequalities. We introduced an increase to MUP in September 2024.

We have commissioned Public Health Scotland to carry out a review of the evidence on restricting alcohol marketing and advertising. We will progress work in areas where evidence supports further action to address alcohol misuse and improve population health.

The following table provides the number of practices which have held General Medical Services contracts (sometimes called 17J practices due to the relevant clause in the National Health Service (Scotland) Act 1978) in NHS Highland, NHS Western Isles, NHS Orkney, NHS Shetland, and NHS Grampian for each year since 2018.

Table 1 - Practices with General Medical Services contracts