Scotland

Hospital outpatient shake-up promises local care

outpatients sign

More patients will be seen by community health workers instead of hospital doctors under a planned shake-up of the outpatient system.

The Scottish government claimed the new system would lead to faster, more locally-available care.

Greater use would also be made of "e-consultations" to avoid unnecessary referrals to hospital consultants.

GPs have given a cautious welcome to the proposals but said more staff would be required to make them work.

Health Secretary Shona Robison said she would consult staff and healthcare bodies about the planned changes.

There are currently about 4.5 million outpatient appointments delivered by the NHS in Scotland each year.

Self monitoring

The new strategy, The Modern Outpatient: A Collaborative Approach 2017-2020, aims to free up 400,000 hospital outpatient appointments by 2020.

It proposes that some patients, particularly those who are waiting for a routine check-up or test results, would be seen closer to home by a team of community healthcare professionals with close links to hospital departments.

Examples of such changes already being introduced include:

  • Follow-up appointments after cataract surgery being conducted by a local optometrist rather than at a hospital
  • A scheme introduced by NHS Lanarkshire in which GPs can ask hospital consultants for advice about patients rather than the patient being referred to hospital for an appointment
  • Patients diagnosed with coeliac disease having their annual blood and bone health checks carried out by pharmacists

The plan also includes greater use of remote self-monitoring equipment and video consultations, allowing care to take place at, or near, a patient's home.

Ms Robison said the changes would help the NHS meet rising demands by avoiding unnecessary trips to hospital without increasing the workloads of GPs or community nurses.

Image caption Health Secretary Shona Robison promised to consult with healthcare professionals over the changes

She said: "This plan contributes to our strategy of shifting the balance from acute to community and primary care, something that everyone agrees is vital to the future of our NHS.

"This will work in tandem with our commitment to increase the share of the NHS budget available for primary care to 11% - an extra £500m over the next five years.

"However, I am clear that this is not about giving more work to GPs or community nurses. Underpinning this plan is an aim for our community and hospital professionals to work more closely together, reducing unnecessary waste in the system and getting people seen by the right professional first time around."

She added: "We recognise, though, that this plan represents a change to the way that things have been done traditionally, and that is why we will consult with staff and professional bodies to seek their views on this document and the future of outpatient care."

'Safety and quality'

Dr Alan McDevitt, chairman of the Scottish GP committee of the British Medical Association, said that the strategy was good news for people who wanted to work in health care in Scotland.

He added: "There are things in here which will help to make the NHS more affordable and also more effective and also easier for patients to use.

"But it's also vital, and I'm very glad that in the paper it expressly states that this isn't work that's going to move on to hard-pressed GPs and community staff who are there now, it has to be new staff in the community able to do, that but also new technology available for people.

"I think patients will want to know that consultants and specialists are being consulted and how this will work to make sure that both safety and quality are being maintained."

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