The new GP contract introduces a funding formula based on the workload that the practice population is expected to generate. It is based on the best available evidence and as such it more accurately reflects the workload of GPs.

The impact of deprivation on the workload of a practice is better reflected in the new workload formula than the previous Scottish Allocation Formula. Methodological improvements mean both deprivation in urban areas and isolated pockets of rural deprivation are better addressed by the new formula.

The new formula was developed as part of a 2016 review of the Scottish Allocation Formula (ttp://www.gov.scot/Publications/2017/11/1343/downloads ), and was informed by the 2017 Review of GP Earnings and Expenses ( http://www.gov.scot/Resource/0052/00527540.pdf ). The impact of the new funding formula will be monitored during implementation.

Information is only collected centrally for colonoscopy and not for pre-colonoscopy assessment. ISD have published information on performance against the 6 week waiting time standard for colonoscopy since 30 June 2009 - this information can be obtained on the ISD website at:

http://www.isdscotland.org/Health-Topics//Waiting-Times/Publications/data-tables2017.asp?id=2107#2107

 It is primarily for NHS Boards to co-ordinate interpreting and translation services that best meet the needs of their local populations. The new contract requires GPs, who are responsible for setting appointment lengths, to engage through their clusters with Health and Social Care Partnerships in local service planning to ensure the primary care team is focused on local population needs.

We are investing £23 million to support the new Scottish Workload Formula which ensures a better match between resources and population need.

Information on patients who did not attend an outpatient appointments is collected only for a first outpatient consultation with consultant or dental led clinics. The following table provides information on the number of new appointments and the number of patients who did not attend first outpatient consultation for 2016 and 2017.

It is every patient's responsibility to keep their NHS appointment and it is important that they let the NHS know when they cannot attend. However, we also recognise that the NHS has to be flexible in helping make appointments convenient to patients. The Scottish Government is committed to supporting health boards implement policies to reduce missed appointments such as providing reminder services through text, emails and social media. This will allow reminder services to be tailored to patients who are most likely not to attend.

The West Lothian Health and Social Care Partnership (HSCP) is planning on consolidating GP services for all patients registered at Breich Valley Medical Practice to the Fauldhouse Partnership Centre site as of 1 June 2018 and to re-advertise the practice on this basis. Applicants would be offered the option of using the Stoneyburn branch for medical provision if they wished.

Additional support will continue in the form of the specially trained Paramedics to support home visits and GP Advanced Physiotherapy Practitioners. Community services will continue to be provided in Stoneyburn and housebound patients will receive exactly the same service as they do at the moment.

A letter has gone out last week to the whole practice population to advise them of the situation and the HSCP are continuing to work with the Practice to enable a smooth transition.

Our ambition is to increase the number of GPs by at least 800 over ten years to ensure a sustainable service that meets increasing demand.

The GP Practice at Whitburn Health Centre are operating fully without any restrictions. The Practice have 8 GP partners and are currently training more of their nursing staff to take on advanced clinical roles. Whilst there can be delays in getting appointments if patients will only see a specific GP there are currently both pre-bookable and on- the-day appointments available. Since the beginning of the year the Practice have registered 291 new patients, have launched a Healthy Lifestyle Clinic and are in the process of enhancing their current service provisions.

The Dispenser Payments and Prescription Cost Analysis report provides, on annual basis, information on the volume of drugs prescribed in the community, including opioid analgesics and for the treatment of opioid dependency.

The report is published on the National Services Scotland Information Services Division website:-

www.isdscotland.org/Health-Topics/Prescribing-and-Medicines/Community-Dispensing/Dispenser-Remuneration/

The information requested in part b) of the question is not available in a format which can be aggregated by substance or therapeutic group.

Apologies for the delay in my response.

The requested information is not available centrally. NHS hospital data submitted centrally does contain information on where patients are admitted to acute NHS settings from. However, it is not possible to explicitly identify all patients who are admitted from care homes. There are a number of reasons for this, including the recording of admissions from care home admissions as “admissions from private residences” or using the “no additional detail” code if the information on the admission location is not known. ISD will follow up these specific issues with NHS Boards to identify potential resolutions, although the longer term solution may be to use record linkage to link individual care home records to hospital admission data to give a more accurate picture of where patients have been admitted from.

Medicines that have been approved for use in Scotland and not England:

• Bevacizumab (Avastin)
• Fulvestrant (Faslodex)
• Regorafenib (Strivarga)
• Nusinersen (Spinraza)

The Scottish Medicines Consortium published advice on 7 th May 2018 which accepted both Regorafenib (Strivarga) and Nusinersen (Spinraza) for use by the NHS in Scotland.

The first three medicines are used to treat certain indications in ovarian, breast and liver cancer respectively. Nusinersen (Spinraza) has been accepted for restricted use in type 1 spinal muscular atrophy.

Medicines that have been approved for use in England and not Scotland:

• Cabozantinib (Cometriq)
• Pertuzumab (Perjeta)
• Atezolizumab (Tecentriq)
• Obinutuzumab (Gazyvaro)
• Eculizumab (Soliris)
• Etelcalcetide (Parsabiv)
• Elosulfase alfa (Ataluren)

The first five medicines are used to treat certain indications in thyroid, skin, breast, bladder and lymphatic cancers respectively. The remaining medicines are used in the treatment of kidney disease, a rare metabolic disorder and Duchenne muscular dystrophy respectively.

In the case of Perjeta, my officials most recently met with the manufacturer, Roche, on 4 May. Roche has also held discussions with NHS NSS National Procurement and I expect that dialogue to continue in order that Roche can bring forward a new submission to the Scottish Medicines Consortium for their consideration.

NHS Lothian have clarified in a press release that they are not predicting a £31 million shortfall in funding. As with all NHS Boards, we are continuing to work with NHS Lothian to ensure public money is being used effectively to deliver better services, better care and better value. We expect NHS Lothian to continue to reform their elective services to improve waiting times and outcomes for patients.

The National Access Collaborative is supporting NHS Boards in that respect and, in 2018-19, NHS Lothian will also receive a share of £175 million to support reform, along with a resource budget uplift of 2.1% (£28.9 million) – the highest percentage uplift of any Territorial Board. This uplift includes a £8.6 million share of additional NRAC parity funding and takes the Board’s annual resource budget to £1,384 million and within 0.8% of NRAC parity.

The NRAC formula remains the most objective way to ensure funding equity and is reviewed and updated on an annual basis.