MSPs quiz the chief medical officer and the chief executive of NHS Scotland over NHS workforce planning
Scottish government ministers are quizzed during general questions
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Image source, bbcScotland's chief medical officer Dr Catherine Calderwood
Scotland's chief medical officer Dr Catherine Calderwood says there will be a difference seen in GPs over the next few years in terms of realistic medicine.
In February the chief medical officer said doctors should spend more time listening to patients in order to avoid unnecessary treatments - so called 'realistic medicine".
SNP MSP Willie Coffey says that in his local constituency there is a GP with 13,000 patients, where 2,000 are coming every week.
"So they're coming back every six or seven weeks" he says.
Paul Gray says: "One thing I want to say. We talk about inappropriate attendance, it's not a phrase I like, I don't want people to think it's inappropriate to come to the NHS.
"I would like to place on record the importance I attach to not doing anything to discourage people from seeking care or advice when they need it."
Dr Catherine Calderwood takes up the answer, explaining a solution that was put to her by one local service.
Dr Calderwood says: "They've put in a dedicated healthcare assistant who goes to visit these people once a week.
"They did a whole series of interventions, and have cut down on people coming to attend.
"And, they has spoken about how well the assistant has got to know these people.
"And it is less costly than using up GP resources. That's the sort of thing we need to consider."
Scotland's health "is not improving" as the NHS faces "significant challenges", Audit Scotland has warned.
The watchdog's annual report lists concerns over missed targets, longer waiting times, "stalled" improvements and growing pressure on budgets.
Scottish Labour has renewed its calls for Health Secretary Shona Robison to quit in light of the report.
Image source, ThinkstockMs Robison insisted that "significant" improvements have been made, while stressing that there is "no quick fix".
The report was the focus of much of Thursday's weekly session of questions to the first minister at Holyrood, with Nicola Sturgeon acknowledging "big challenges" for the health service.
But she insisted that "against many measures" the Scottish NHS was performing better than elsewhere in the UK.
The Scottish government published its "blueprint" for the future of the NHS in December 2016, aiming to treat people closer to home rather than in hospital.
Image source, bbcShirley Rogers from the Scottish government
Shirley Rogers from the Scottish government says bank and agency spend is high and it exists because the primary objective of the NHS is patient safety.
Ms Rogers: "None of that means we are content with the money being spent on bank and agency.
The director of health workforce says the position has improved in the first six months of this year
"We would all acknowledge that it is to high."
She says there are 35,000 nurses on the staff bank and 2,800 doctors on the staff bank which is too high.
Scotland's chief medical officer Dr Catherine Calderwood explains the changes in working practices and how they have evolved.
Dr Calderwood says: "What we did was we added a four-hour waiting time target which led to the consultants saying there aren't enough of us, and now that workforce has almost doubled in eight or nine years.
"That is a system that has responded to pressure on it.
"People are starting to realise they don't always have to see a doctor, there are alternatives.
"To our GP workforce pressures, I agree they are there and recruitment is critical, but we are responding to changing needs and that traditional knowledge of the doctor doing something is no longer the right thing to do."
Image source, Science Photo LibrarySNP MSP Willie Coffey points to the rise in staffing levels in the NHS and he also points to the public satisfaction levels being high.
Mr Coffey asks about service redesign, staffing pressures and locum costs.
NHS Scotland chief executive Paul Gray says: "We are already implementing the legislation that paved the way for the integration of health and social care."
Mr Gray says there are some successes to draw on.
He says: "Our service redesign has to be coherent around that."
Conservative MSP Liam Kerr says: "There has been a 6.3% increase in NHS staff level since 2012, but a 11% increase in staff costs.
He says: "There is not always a link between staff shortages and service delivery. Has there been an assessment on this?"
Shirley Rogers replies "The short answer is a I don't have it yet, the longer answer is we're on it and will have it."
Image source, bbcNHS Scotland chief executive Paul Gray
Tory MSP Liam Kerr asks: "Who owns this process and who will be sitting here in three years, who's got the ball?"
NHS Scotland chief executive Paul Gray: "I am the accountable officer, I've got the ball and I'm happy to be sitting here and I hope I will be sitting here in three years.
Mr Gray says: "Ultimately I've got the ball."
NHS Scotland chief executive Paul Gray acknowledges there is a difficulty in recruiting in certain parts of Scotland.
Mr Gray says: "In some areas of general practice it's close to impossible to recruit.
"I know in the Highlands they are struggling to recruit into radiology.
"But if we describe that as a failure to plan then the whole world is a failure to plan - there are places that have no supply at all.
"There is no state of perfection in Scotland but that is why we're doing what we're doing."
Image source, Science photo libraryBackground: 'Hidden shortage' of radiologists across Scotland
A national shortage of radiologists is partly to blame for recruitment difficulties at a Highland hospital, a health board claimed in September.
Medics have written a letter to NHS Highland raising concerns about vacancies at Raigmore Hospital in Inverness.
The health board said there were too few radiologists both in Scotland and UK-wide.
But officials at Raigmore insisted the service was "safe and effective".
Image source, bbcNHS Scotland chief executive Paul Gray
NHS Scotland chief executive Paul Gray says: "I am perfectly clear that in all things I could do better."
Mr Gray says: "We have already published part one of a workforce plan, we are developing part two and part three of it.
He says: "That to me does not seem like failure."
To say that we have failed to produce one is not right, he says.
Mr Kerr asks: "Who has failed to plan?"
Mr Gray says: "Nobody has failed to plan."
Conservative MSP Liam Kerr is putting questions to NHS Scotland chief executive Paul Gray
Conservative MSP Liam Kerr asks NHS Scotland chief executive Paul Gray what his role is.
Mr Gray explains: "I have two roles. I generally describe it as having three.
He also explains the government's arrangements.
Mr Gray says: "At the top level I have to satisfy myself that the accountable officer for the health board has the capability and capacity to carry out these functions. I require certain assurances.
"I have powers of intervention through the ladder of intervention. There are five steps.
"The fourth step involves direct intervention from me, the fifth by the cabinet minister."
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SNP MSP Colin Beattie asks if there is a gulf between the confidence of the witnesses in what seem logicla ideas and the consideration on the ground.
Mr Beattie asks the cost of bringing forward a major IT project of creating one workforce planning.
Shirley Rogers says: "Sharing that methodology is a journey."Ms Rogers says efficiencies are expected from building one platform.
Image source, ThinkstockMr Beattie asks: "Why hasn't all this been done before?"
NHS Scotland chief executive Paul Gray: "Because we're changing the way we do workforce planning."
"We're moving from a board based approach to a national approach."
Image source, Scottish ParliamentScottish Parliament
Click here, external for the Public Audit and Post-Legislative Scrutiny Committee's page on NHS Workforce planning, which is a very extensive and useful resource.
Shirley Rogers from the Scottish government is explaining the changes they are making to training.
Ms Rogers says "We're not just looking at health but all the services that supply support.
"For the first time we're considering the workforce, not just the established workforce, but understanding them in training.
"What is it a student entering medical school is going to come out with at the end?
"The ambition is not just the supply we have now, but also those people coming through training, what their choices are - not just staying in Scotland but choosing their specialties."
Ms Gray continues: "The other thing the work force plan has allowed us to do is look at the training ratio.
"In the past if we needed a GP, we trained a GP. That's no longer good enough.
"So we're now training two for every one we need, so our ratios are not simply one for one. Sometimes it's four for one or six for one.
"It isn't finished yet, but we're a lot more mature now."
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Image source, bbcsays she joined the NHS in Scotland 23 years ago and "we've been workforce planning for as long as that".
Shirley Rogers, director of health workforce and strategic change, with the Scottish government says she joined the NHS in Scotland 23 years ago and "we've been workforce planning for as long as that".
Ms Rogers says the new workforce plan is introducing one methodology.
She says the six step methodology in place across Scotland will lead to the same approach across the country.
Ms Rogers says part one of the workforce plan involved consulting 79 different stakeholder organisations.
NHS Scotland chief executive Paul Gray is answering questions on the planning that is in place.
Mr Gray says: "If we had no plan there would be no people.
"Universities don't train people on the basis of speculation that something might happen.
"I don't accept this is all jam tomorrow. There are people working in the NHS today because of the plan we did."
Image source, ThinkstockMr Gray continues: "We have substantial amounts of data but we need to improve how we coordinate that and present it.
"Because we have made a determination to consult on the different chapters and phrases of the plan as we go along - then clearly if I was to ask any chief executive how this will work exactly, the answer would be we don't know in full as we won't know until it's here.
"We do have the necessary governments and consultation in place. If the feedback is they want more clarity we'll be happy to provide that."
Image source, bbcAuditor General Caroline Gardner said the government and health bosses "urgently" needed to improve future planning
Auditor General publication 'NHS workforce planning: The clinical workforce in secondary care', external, by Auditor General Caroline Gardner, said it was vital that the government and NHS bosses plan more effectively for the future.
It highlighted that spending on NHS staff had increased by 11% between 2011-12 and 2016-17, with the overall staff hitting a record high of 139,341 whole-time equivalent workers.
However, in reaching these staffing levels almost all NHS boards overspent against their pay budgets, and agency staffing costs have more than doubled over six years to more than £171m.
And the report warned that the government and NHS boards "have not planned their NHS workforce effectively for the long term".
It said the health service faces "urgent" staffing challenges, including:
Image source, bbcSNP MSP Colin Beattie
Ms Baillie asks why there has not been "horizon scanning" and not just thinking in five year bursts.
NHS Scotland chief executive Paul Gray says Scotland is up against the same pressures in the NHS as other countries face.
Mr Gray says the inclusion of the social workforce in this plan is new.
He says NHS Scotland have been working on a workforce plan for a year.
SNP MSP Colin Beattie says he can see nothing in the document but "jam tomorrow", adding there is nothing firm here.