Scotland politics

New blueprint needed for out-of-hours care, review concludes

Paramedics with OAP Image copyright NHS Scotland

A new blueprint is needed for out-of-hours medical services in Scotland, an independent review has concluded.

It highlights the need for multi-disciplinary teams working together at urgent care resource hubs across Scotland.

The teams would include GPs, nurses, physiotherapists, community pharmacists, social care workers and other specialists.

The review was commissioned by the Scottish government.

It forms part of the government's plans to transform primary care services in light of the demands of Scotland's ageing population, and as health and social care services are integrated.

The 28 recommendations, made by Professor Sir Lewis Ritchie in the Primary Care Out-of-Hours Review, have been welcomed by Health Secretary Shona Robison.

The other recommendations include:

  • Developing a set of national standards for urgent out-of-hours care
  • Improving patient record systems and technology
  • Further developing support for self-care
  • Enhancing joint working between health boards including the Scottish Ambulance Service and NHS 24
  • Offering newly-qualified GPs a one-year post to include out-of-hours work with extra support and continuing professional development in out-of-hours medical care.

The review found that the current arrangement for out-of hours services was "fragile, not sustainable and will worsen unless immediate and robust measures are taken to promote the recruitment and retention of sufficient numbers of GPs working in both daytime and out-of-hours services".

The Scottish government said it had made £1m of initial funding immediately available to fast-track the testing of the new urgent care model.

Image copyright NHS Scotland

A detailed government response to the recommendations and a national implementation plan, including an outline of investment to support delivery, will follow next spring.

Sir Lewis said: "The people of Scotland deserve a high-quality out-of-hours service which fully meets their needs and does so consistently and reliably throughout Scotland.

"The Scottish government commissioned this review to ensure that person-centred, sustainable, high quality and safe primary care is delivered when GP practices are closed.

"I hope the recommendations from this review help achieve that, but also look forward and begin to lay the foundations for consistent urgent and emergency care on a continuous 24/7 basis."

Ms Robison said: "Our NHS is facing different demands from those of a decade ago and we need to ensure all parts of the system work as effectively as possible to support an ageing population and more people with more complex, multiple conditions.

"This is why it was vital, more than 10 years since the current system was created, that we commissioned a review into out-of-hours primary care.

Image copyright NHS Scotland
Image caption The report recommends better working between NHS 24 and the Scottish Ambulance Service

"We are already taking a comprehensive range of actions across all areas of our health service in order to meet the changing demands and the recommendations in Sir Lewis' review will build on this, helping ensure a more effective and sustainable service for the future."

She added: "There is still a lot of work to be done, but ultimately, by getting primary care right, both in and out-of-hours, we can ease the pressure in our hospitals and meet the demands of our patients, who should expect nothing less."

Theresa Fyffe, director of Royal College of Nursing Scotland, said: "Overall, Professor Sir Lewis Ritchie's recommendations are a solid foundation on which we can build the future of round-the-clock primary care services."

'Positive steps'

Dr Miles Mack, chairman of the Royal College of General Practitioners Scotland, said: "The profession will be glad of this recognition of the pressures general practice as a whole is under to meet the needs of Scotland's population.

"We hope this report can provide lasting, meaningful solutions to patients looking for urgent, out of hours medical care."

Dr Andrew Buist, deputy chairman of BMA Scotland's GP committee, said the recognition that the out-of-hours workforce needed to be multi-disciplinary was "a welcome reflection of the vision for the future of primary care that we are working towards".

"Providing greater support to GPs working and training in the out-of- hours environment, improving IT provision in primary care and creating a national performers list are also all positive steps that will help to improve the provision of out-of-hours care," he said.

"It is essential that patients who need urgent care are able to access it when it is needed."

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