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I thank Sue Webber for what is a really important question. I hope that she will take my answer in the spirit in which it is intended. I hope that, fundamentally, she will choose to believe that the decision that we have taken about self-referral for those who are 71-plus has not been taken lightly. It was a really difficult decision to take.

Just a couple of weeks ago, I spoke to those who are leading our screening programme—the breast-screening programme in particular—about this very issue. In the fundamental decision that we have to arrive at, we need to consider that, for the women at the highest risk, those in the 50-to-70 age bracket, the period when they are waiting between screens is currently too long. There is no doubt that the pandemic has had an impact—I am thinking about the difficult decision at the beginning of the pandemic to pause those screening programmes and then restart them in the summer of 2020.

The gap between screening programmes is, I think, around 39 months—forgive me if that is incorrect; I will correct that when writing to the convener. If we were to introduce the self-referral route at the moment for those who are aged 71-plus, the estimate is that that would add a further four months to the gap between screening cycles. The question, which I have asked officials to explore with pace, is whether the benefit of the over-70 referral route outweighs the additional few months that might be added on to the gap between screening cycles, which we must accept will happen if we take that decision.

That work is under way, because I am very aware that the self-referral route is open to older women in other parts of the UK. There is a difference between the UK nations in that regard, but the matter is being explored and I hope to have an update in the relatively near future. I am not a clinician, and I need a clinical view on whether, if we were to increase the gap in screening, that would have a significant impact or whether any impact would be outweighed by the benefit.

I will try to be brief. That issue has definitely gathered a fair bit of attention. Again, it will not be a surprise to anybody—I will not be articulating a state secret—when I say that, in our conversations, the RCGPS and the BMA have voiced concerns about some of the consultation proposals to move GPs from their current employment model into being employed as part of the national care service. We are yet to come to a determination on that but, at this stage, I think that they make quite persuasive and strong arguments for retention of the current employment model.

However, let us see how we are truly integrating primary care as part of the national care service. We have to do that, because integration has to be key. I will be careful what I say, because we are still going through the consultation responses, but with regard to the reformed integration joint boards proposal, again, we hope that there will, from the inception and creation of the national care service, be real integration with, for example, health boards. That will be vital. We are considering the consultation responses.

I have to be careful, because we are hurtling into the pre-election period, but my desire is to pick up the conversations—in particular with the Convention of Scottish Local Authorities—in earnest after the elections. I want to do so very quickly; I hope that the legislation on the national care service will be introduced to Parliament before we go into the summer recess. I look forward to being able to articulate our vision for the national care service in that period.

That is a really important question. First and foremost, where we can incentivise recruitment and retention in rural areas, we will certainly do that. Emma Harper spoke about the ScotGEM programme, which is an excellent example of that. There are also golden hellos, bursaries and the rediscover the joy programme. There are a number of programmes that I could point to in which the focus is on rural recruitment and retention.

Our ambition is to have 1,000 community link workers and mental health workers recruited by 2026, so that they are available in every GP practice in the country. I assure Sandesh Gulhane that that element of rural provision and island provision is central to our thoughts in that respect.

I will say a couple of things on that front. During the pandemic, there has been an explosion of interest in digital health and the accessing of health information digitally—out of necessity, no doubt. NHS Inform is a good example of a service that has been well used throughout the pandemic. I can perhaps share in my written response to the convener some of the data on how well NHS Inform has been used. That is also true for other digital platforms, with Near Me being the obvious example—its use has exploded.

Sue Webber’s point about a digital app is really important. One of the SNP’s manifesto commitments is to develop an NHS app, which will be a digital front door. We are working on that. Where it is sensible to have that discussion with other parts of the UK, we are doing—and will do—that. There is no point in reinventing the wheel if something already works particularly well. I know that you are not suggesting this, but we might not just be able to pluck an app from one part of the UK and transplant it here.

We have a really good relationship with the other health secretaries and ministers throughout the UK, so we can share that information and knowledge, and I would be keen to do that. There is a lot of progress to be made in that area. We are very focused on a potential digital front door app that can do a host of things from picking appointments to receiving results.

The agenda is important to all of us, and I recognise that you have raised it regularly in this committee and in the chamber.

We recognise the importance of screening, which has the ability to save lives, across a variety of cancers. I recognise your point: we know that there are disparities in screening uptake between people in the least deprived areas and people in the most deprived areas, which is why there is a lot of focus on how we increase uptake.

I discussed that very issue recently with officials who are involved in the national screening programme. We talked about, for example, how we use mobile screening units. From memory, I think that we have more than 20 mobile screening units—and I should say that I am referring here to breast cancer. How do we use those mobile units to get into areas of higher deprivation? That illustrates some of the work that is being undertaken as we speak.

Going back to a point that Gillian Mackay made in her first question, how do we get more targeted communications to individuals in the areas of highest deprivation?

The third point that we are thinking about is how we ensure that there are appropriate voices from those communities where uptake is lower—among ethnic minority communities, for example. I know that you have asked about that. There are often intersectionalities with deprivation. In certain screening programmes, the uptake for ethnic minority women is lower than for their white Scottish counterparts. How do we use voices from minority communities—as opposed to a middle-aged white male doctor, for example, who of course has great clinical expertise but might not be as impactful as a female doctor from an Asian background, for instance—in speaking about the importance of going to screening appointments? There is a lot of effort and work going into that, as we recognise the disparities that exist.

The programme is going well. For the sake of brevity, it would be better for me to write to the committee with more detail. We are continually looking at how we can expand the ScotGEM programme and increase its capacity because of the value that we have seen even in its early years. My written response to the convener will include a number of things that I want to come back to the committee about and I am happy to give you some more detailed data about how that programme is going. Whenever I have conversations with my primary care team about GP services, ScotGEM is always seen as a critical component of that.

Absolutely—that is the primary focus of that work. I do not need to explain to Emma Harper that there are real issues with how rurality affects GP recruitment and retention. ScotGEM is an absolutely vital part of tackling that. We are taking forward some work after the report by Professor Sir Lewis Ritchie. I spoke to him last week about that work, which will be vital for sustainability. It is absolutely key to the rural challenges that we continue to face in GP practice and in primary care more generally.

Again, you have said nothing that I disagree with. Investing in our public services locally is so important. The member referenced libraries. A library in my constituency has not only a public space, but a quieter space where people can go online should they need to look at something that is particularly sensitive, subject to all the appropriate checks and safety measures that we would expect.

The member makes a good point in relation to exploring whether we can do more in GP practices and health centres. It would probably be easier to do that in larger health centres. We would need to consider how to do it in smaller locations where space is already at a premium. I will take that point away.

In short, yes. The digital team hears from me regularly that more investment and resources will come their way. I am committed to that, because the current digital team needs to be beefed up. They are a great team—they do a heck of a lot and, blooming heck, they have worked really hard throughout the pandemic. There is value in not just upskilling but increasing the numbers in that team.

As I said to our health board chief executives and chairs yesterday, when we talk about infrastructure, we put a lot of focus on bricks and mortar. That is understandable because it is important to build health centres, hospitals and community services, but I think that we should put equal focus on investing in digital infrastructure. In the discussion yesterday, there was lots of broad agreement on that.

The short answer to your question is yes. The digital team in the Government will be appropriately resourced, and that resource will undoubtedly have to increase to meet our ambitions.

I entirely agree with your articulation of that. Telephone consultations, video consultations and face-to-face consultations are all parts of the hybrid model. Even given the current pressures, there are people who should be seen face to face, and if that is not happening, I am not happy about it. In the future, however, as we look towards that hybrid model, continuing with video or telephone consultations will be the preferred option for many people.

That is the preferred option for me. I have used it during the pandemic. Trying to show the doctor the back of my knee, where I have some eczema, was not necessarily the most comfortable experience, but we got there, and it worked well. That was in the morning, and the ointment that I needed was at the pharmacy down the road by the afternoon. It saved me from having to take time out of quite important meetings to travel to my GP, sit in the waiting room and get assessed. For me, it worked perfectly. For many people who have work pressures, family pressures and so on, it will be far more convenient to be seen by video or have a telephone consultation.

I make the point, which in some respects goes back to Paul O’Kane’s point about digital inclusion and exclusion, that we have to be really careful that people who are digitally excluded are digitally included as much as possible. However, I accept that that will not be the case for everybody, and alternative pathways have to be available. Nobody is talking about removing the need for face-to-face appointments. No GP that I have met has ever suggested that, and we want to work collaboratively with GPs on the matter.

It is probably worth stating that it has been quite upsetting to see, in some of the public discourse in the press and involving politicians, finger pointing and, almost, blame being directed towards some elements of primary care, including GPs. That undervalues the really important contribution that GPs and the entire GP staff have made. I am really thankful for their efforts.

I also understand the frustration of people who try desperately to get an appointment but are unable to get one. That is the challenge that the pandemic has caused. However, I have no doubt that, as we ease our way out of the pandemic, or into a more endemic phase, access to primary care will improve.