Deep Dive Report - Primary Care
Argyll and Bute Council · 13 August 2026
Back to Argyll and Bute HSCP Clinical and Care Governance Committee — 13 August 2026 and its agenda
Text extracted from the council's PDF. Layout and reading order may differ from the original.
Page 1
1 Clinical and Care Governance Committee Date of Meeting: 13 August 2026 Title of Report: Primary Care Governance Deep Dive Report Presented by: Eilidh Gallagher, Head of Primary Care The Clinical and Care Governance Committee is asked to: • Note the Primary Care deep dive and the baseline assurance position against the Healthcare Improvement Scotland Clinical Governance Standards. • Note the proposed improvement approach, framed around what good looks like, current strengths, areas for growth and clear escalation triggers. • Note the limitations of assurance data across mixed delivery models, particularly where services are delivered through independent contractor arrangements. • Note the remedial work underway to implement the Health and Care (Staffing)(Scotland) Act 2019 across in-scope Primary Care services. • Agree a twelve-month review to monitor progress against the improvement plan and the maturation of the governance assurance framework. 1. EXECUTIVE SUMMARY This report presents a structured deep dive into Primary Care governance across Argyll and Bute, aligned to the Healthcare Improvement Scotland Clinical Governance Standards. Overall, the assessment finds that governance arrangements are established and active across the Primary Care portfolio, with clear evidence of improvement activity, professional oversight and responsive management of risk. The overall assurance position is positive but qualified: no standards are rated red, three standards show green assurance with amber direction of travel, and four standards remain amber due to areas requiring further development. Primary Care operates across a complex mixed-delivery environment, including independent contractor services, Board-managed practices, directly employed multidisciplinary teams, Public Dental Services, CTAC, Vaccinations, Forensic Medicine, Sexual Health and Community Optometry. This complexity means assurance must be drawn from multiple sources, including contract monitoring, clinical governance, risk registers, complaints, audit, programme boards, workforce data and service-specific reporting. The strongest areas of assurance are quality improvement activity, clinical review, vaccination governance, information governance controls,
Page 2
2 professional oversight and examples of responsive service redesign. Standards 2, 3 and 7 are broadly positive, although each has an amber direction of travel because data maturity, outcome measurement, access reporting, equity analysis and integrated assurance reporting are not yet fully developed. The main areas requiring improvement are leadership resilience, staffing assurance, escalation clarity, systematic learning, education and training compliance, patient involvement and evidence visibility. Standards 1, 4, 5 and 6 are rated amber. Key issues include completion of Health and Care Staffing Act baseline assessments, clearer organisational mapping, stronger risk review discipline, improved statutory mandatory and PDP compliance, earlier community engagement in service change, and better tracking of learning from complaints, incidents, audits and engagement. Several service-specific risks require continued oversight. These include dental workforce fragility and access pressures, LARC access and sustainability, forensic medicine documentation and Police Adastra implementation, CTAC access and waiting-time reporting, vaccination uptake variation, GP appraisal capacity, and the need to strengthen governance routes for developing Sexual Health provision. These risks are recognised and are being actively managed, but require clearer metrics, owners, timescales and escalation triggers. The report concludes that the next twelve months should focus on consolidating improvement activity into a single monitored Primary Care governance improvement plan. This should include named owners, timescales, RAG status, evidence requirements, reporting routes and escalation triggers. Priority actions should focus on developing a more integrated quality management system, improving data and dashboard reporting, strengthening workforce and competence assurance, embedding learning trackers, standardising engagement arrangements and ensuring clearer accountability across the portfolio. In summary, Primary Care has a functioning and increasingly structured governance framework, with many examples of good practice and active improvement. The key requirement now is to move from multiple established but fragmented assurance processes to a more integrated, evidence-led governance system that provides clearer visibility of quality, safety, access, outcomes, workforce resilience, patient experience and improvement impact. 2. RECOMMENDATIONS • Note the Primary Care deep dive and the baseline assurance position against the Healthcare Improvement Scotland Clinical Governance Standards. • Note the proposed improvement approach, framed around what good looks like, current strengths, areas for growth and clear escalation triggers.
Page 3
3 • Note the limitations of assurance data across mixed delivery models, particularly where services are delivered through independent contractor arrangements. • Note the remedial work underway to implement the Health and Care (Staffing)(Scotland) Act 2019 across in-scope Primary Care services. • Agree a twelve-month review to monitor progress against the improvement plan and the maturation of the governance assurance framework. 3. DETAIL OF REPORT The Primary Care portfolio covers a broad range of services, including General Practice (GMS), Board-managed General Practice (2C), Public Dental Services, Community Treatment and Care (CTAC), Vaccinations, Forensic Medicine, Sexual Health and Community Optometry. The developing GP walk-in service in Dunoon also forms part of this wider Primary Care portfolio and should be understood as a targeted service innovation rather than a standalone access model. It aligns with the strategic direction of travel set out in the Joint Strategic Plan by seeking to improve timely access, support care closer to home, reduce avoidable pressure on urgent and unscheduled care pathways, and test more responsive models of multidisciplinary primary care delivery. As the model develops, it will require proportionate governance through the Primary Care Clinical and Care Governance and Unscheduled Care governance routes, operational performance reporting, risk management, patient feedback and post- implementation review. This will ensure that the service is evaluated not only on activity and access, but also on safety, equity, patient experience, workforce impact, sustainability and contribution to the wider transformation of Primary Care services across Argyll and Bute. The service areas operate across a mixed governance environment, and this should be recognised when interpreting assurance, performance and escalation arrangements. General Medical Services (GMS) practices are independent contractors delivering services under the national GMS contract, with NHS Boards and Integration Authorities retaining responsibilities for contract oversight, service planning, assurance and delivery of transferred services under the 2018 GMS contract reform and associated Memorandum of Understanding. Vaccination and Community Treatment and Care services sit within the wider primary care reform programme and are predominantly NHS Board/HSCP responsibilities. Governance is focused on safe delivery models, workforce competence, clinical standards, access, audit and escalation. Some practices continue to provide remote, rural and island services directly, with HSCP funding; in these circumstances, governance is shared and assurance must be interpreted in the context of the local delivery model. Public Dental Services are directly managed NHS services providing safety- net and specialist community dental provision, with HSCP accountability for quality, access, workforce, risk and clinical governance. Forensic medical services have a specific statutory and standards-based framework, requiring NHS Boards to provide trauma-informed, person- centred and legally robust healthcare and forensic medical examination
Page 4
4 services. This includes clear governance, training, documentation, evidence handling and quality assurance requirements. Historically, services in Argyll and Bute were delivered through contracted models, with governance devolved through those arrangements. Following service review, some services have transitioned to managed provision under HSCP responsibility over the past six months. The current landscape remains mixed, with work underway to standardise provision in line with national standards over the next twelve months. Community ophthalmology and optometry are delivered through a combination of national General Ophthalmic Services arrangements, community optometry contractors, Health Board ophthalmic lists and increasingly enhanced community eye care pathways; governance therefore combines national contractual and clinical requirements with Board-level oversight of local schemes, referral pathways, quality, data and patient safety. These differences mean that assurance must be drawn from different sources across the portfolio, including contract monitoring, national returns, professional standards, statutory duties, locally managed service metrics, clinical governance reporting and exception-based escalation. The report included in appendix 1 provides a Primary Care deep dive and reports the framework of assurance and direction of travel to the Committee. Committee members are asked to consider the position and the framework for improvement aligned to the Healthcare Improvement Scotland Clinical Governance Standards and agree a point of review. 4. RELEVANT DATA AND INDICATORS Relevant data and indicators are summarised throughout the report and include IPMF measures, workforce compliance, iMatter, absence, complaints, adverse events, risk registers, audit activity, vaccination uptake, annual GMS assurance returns and programme-specific reporting. 5. CONTRIBUTION TO STRATEGIC PRIORITIES The report supports the Service Renewal Framework and the Argyll and Bute Joint Strategic Plan priority to provide safe, effective and person-centred care closer to home. It also supports the development of a more consistent clinical governance assurance framework across Primary Care. 6. GOVERNANCE IMPLICATIONS 6.1 Financial Impact No direct financial decision is requested within this report. Financial implications may arise from specific service developments, including workforce contingency arrangements, dental access solutions and managed service changes, and will be considered through the appropriate governance routes. 6.2 Staff Governance Staff governance implications are described throughout the report, including staffing resilience, absence, Health and Care Staffing Act implementation, statutory mandatory training, PDP compliance, professional governance and organisational design.
Page 5
5 6.3 Clinical and Care Governance Clinical and care governance implications are central to the report. The proposed improvement approach will strengthen evidence visibility, escalation, learning systems, risk management and assurance reporting across the portfolio. 7. PROFESSIONAL ADVISORY Professional advice has been provided by relevant clinical, nursing, dental and operational leads. Further professional advice will be sought as improvement actions and service-specific developments progress. 8. EQUALITY & DIVERSITY IMPLICATIONS Equality and diversity considerations should be built into any decisions arising from this report, including the Rights of the Child under the UNCRC, island impacts, Fairer Scotland duties, socio-economic impacts and protected characteristics. 9. GENERAL DATA PROTECTION PRINCIPLES COMPLIANCE No new data protection decision is requested within this report. Data and information governance implications are described under Standard 7. 10. RISK ASSESSMENT Risk implications are described throughout the report and summarised through the Primary Care risk register. Particular areas for continued review include staffing resilience, dental access, LARC provision, forensic medical governance, risk register review cycles and service-change engagement. 11. PUBLIC & USER INVOLVEMENT & ENGAGEMENT Public and user involvement is reflected through complaints learning, community engagement, service-specific consultation and emerging Patient Participation Group arrangements. Further work is required to standardise proactive engagement expectations for future service-change proposals. 12. CONCLUSIONS Primary Care has established governance arrangements across a complex mixed delivery environment. The review provides assurance that risks are known and actively managed, while also identifying clear opportunities to strengthen consistency, evidence visibility, data quality, learning systems and proactive engagement. The proposed twelve-month improvement plan will support continued alignment with the Healthcare Improvement Scotland Clinical Governance Standards and provide a clearer basis for future assurance reporting. 13. DIRECTIONS Directions required to Council, NHS Board or both. Directions to: tick No Directions required x Argyll & Bute Council NHS Highland Health Board Argyll & Bute Council and NHS Highland Health Board
Page 6
6 14. PREVIOUS REVIEW OF THE REPORT Meeting Title of report Date Output (if relevant) REPORT AUTHOR AND CONTACT Author Name Eilidh Gallagher, Head of Primary Care Email Eilidh.gallagher@nhs.scot Appendix 1
Page 7
7 Appendix 1 : Visual Governance Summary
Page 8
8 Appendix 2: Clinical Governance Standards Self-Assessment Summary 1. Overview Standard Position Standard 1: Leadership and Staffing Good Standard 2: Quality Management and Continuous Improvement Good Standard 3: Clinical Effectiveness Good Standard 4: Clinical Safety and Risk Management Good Standards 5–7 In progress 2. Summary of Key Strengths Established governance and reporting arrangements across Primary Care Active management of risk, complaints, incidents and service performance Ongoing quality improvement and service redesign activity Alignment to national standards, contracts and clinical guidance Positive organisational culture and staff engagement Implementation of a structured Governance Assurance Programme 3. Key Themes Identified Consistency Variation in governance processes across services, including risk management, quality improvement and clinical documentation Visibility of Evidence Governance arrangements are in place but are not consistently documented or easily accessible Data and Monitoring Fragmented datasets and limited standardised indicators across services Learning and Feedback Learning from incidents, complaints and audits is not consistently captured, shared or tracked Escalation and Assurance Escalation routes are in place but require greater clarity and consistency across services
Page 9
9 4. Priority Areas for Improvement Development of a central governance repository Standardisation of governance documentation, risk registers and SOPs Definition of minimum datasets and core indicators Strengthening thematic learning and feedback processes Improved visibility and use of safety, quality and performance data Clear escalation triggers and early warning indicators 5. Overall Position The self-assessment indicates that governance arrangements across Primary Care are established and functioning. The Governance Assurance Programme provides a structured route to strengthen consistency, evidence visibility and sustainability of assurance. The current position should be treated as a baseline from which further improvement will be delivered as the programme progresses.
Page 10
10 Appendix 3 : Enhanced Service Provision (25/26) Area List Size Enhanced Service Minor Surgery - Injectio ns Minor Surger y - Invasi ve Minor Surger y - Varico se Veins & Piles Extend ed Hours Access Palliati ve Care Drug Misu se Anti- coagulati on Monitorin g IUCD Fittin gs IUCD Fitting s – Non Patien ts Implan ts – Non Patient s Basket of Servic es Older Patien ts in Care Home s Medicines Reconciliati on Min or Injur y Argyll and Bute 90,718.00 % Populati on with access 91% 91% 13% 31% 69% 61% 87% 100% 100% 100% 93% 82% NA 11% OLI 23,503 % Populati on with access 96% 95% 0% 36% 100% 91% 95% 100% 100% 100% 100% 91% NA 20% MAKI 21,078.00 % Populati on with access 97% 97% 6% 26% 57% 0% 99% 100% 100% 100% 92% 77% NA 26% Cowal & Bute 21,598.00 % Populati on with access 88% 88% 45% 17% 31% 69% 53% 100% 100% 100% 98% 81% NA 0% Helensburg h & Lomond 24,539.00 % Populati on with access 83% 83% 5% 43% 83% 78% 100% 100% 100% 100% 83% 78% NA 0%