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Review of out-of-hours primary care

And new approach to unscheduled care.

A review of out-of-hours primary care services and a new approach to unscheduled care have been launched by Health Secretary Shona Robison.

Review of out-of-hours primary care:

Access to urgent primary medical services outwith normal GP surgery hours is a fundamental part of unscheduled care in Scotland.

The review will consider how best to deliver these services in light of the challenges of Scotland’s ageing population, and as health and social care services are integrated.

It also builds on the Scottish Government’s 2020 Vision for the NHS, and the work underway with stakeholders to determine the short and long plans for Scotland’s NHS.

The review comes more than a decade after the 2004 UK GP contract, which transferred responsibility for delivery of out-of-hours primary care services to the management of health boards.

It will address issues such as recruitment and retention of GPs, staff availability, especially during peak holiday times, consistency of service and the public’s expectations of the service.

Health Secretary Shona Robison announced the review, which will be led by Sir Lewis Ritchie, during a visit to Ninewells Hospital’s A&E department.

Ms Robison said recently:

“Primary care is the cornerstone of the NHS with more than 90 per cent of patient visits starting and finishing in primary care.

“Out-of-hours services are a crucial component of this and it is now more than 10 years since the current system was created.

“Our NHS is facing different challenges from 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.

“That is why the time is right to review these services to ensure they continue to deliver sustainable, high quality, safe and effective care.

“The review will look at core requirements for services at night and the weekends as well as what roles and skills are needed, and where. This review will be complemented by the new collaborative approach to unscheduled care the Government is adopting, in partnership with the Academy of Royal Colleges, the Royal College of Nursing and other key partners, which I am also announcing today.”

Commenting specifically on the review of out-of-hours primary care, Miles Mack, Chair of the Royal College of General Practitioners, said:

"I welcome this out-of-hours primary care review. This will be an important opportunity to see the work GPs do in out-of-hours recognised and allowed to develop in a sustainable way."

The out-of-hours review will consider:

  • Care expected at night and at the weekend
  • Current best practice
  • Ensuring a high quality and safe experience for patients and health professionals
  • Core requirements for service at night and at the weekend, including roles and skills needed
  • Where service delivery of out-of-hours makes sense on a ‘Once for Scotland’ basis, and where local variation is needed
  • Pilots to test new models

The review is expected to provide recommendations by late summer 2015.

New approach to unscheduled care:

The Scottish Government plans to roll-out and embed a new collaborative approach to unscheduled care across Scotland.

Developed in partnership with the Academy of Royal Colleges, the Royal College of Nursing and other key partners, the new essential action points for unscheduled care aims to ensure the whole NHS system works together effectively from a patient’s first contact with the NHS to, if they require admission, their discharge from hospital back into the community.

Announcing the new approach, Ms Robison said:

"Our new collaborative approach for unscheduled care is currently being developed in partnership with the service and key professional bodies.

“It aims to ensure the whole NHS system works together effectively to support people in their own home. Where they require urgent or emergency primary or secondary care, this will be joined up from a patient’s first contact with the NHS to their discharge from hospital, if they require admission.

“Both the collaborative approach to A&E and the review of out-of-hours care complements the Government’s overarching commitment to tackling delayed discharge and will involve a shared commitment to deliver on key issues, such as discharging patients within 72 hours of clinical readiness, and reducing the number of hospital admissions that are avoidable.”

Commenting specifically on the new collaborative approach on unscheduled care, Professor Derek Bell, President of the Royal College of Physicians of Edinburgh, said:

“I welcome the announcement of this collaborative programme of work, which will re-energise our approach to the pressures in unscheduled care and importantly improve care for the acutely unwell patient. It is important that this programme is supported and driven by all professions associated with health and social care, and that a whole system approach is planned and adopted”

Again, referring specifically on the new collaborative approach on unscheduled care, Martin McKechnie, Scottish Vice-President of the College of Emergency Medicine, said:

“The College of Emergency Medicine Scotland support the Scottish Government’s unscheduled care essential actions, having been at the heart of their development and refinement, these actions include several of the pillars of the CEMs STEP campaign. The CEM Scotland looks forward to continued collaboration with its partners in all arenas of emergency, primary and social care to help improve standards for our patients and staff”

Also referring specifically on the new collaborative approach on unscheduled care, Theresa Fyffe, Director of the Royal College of Nursing Scotland, said:

“If we are to come up with sustainable solutions to the pressures currently facing our health service, we need all clinicians to work together to deliver high quality care right across the NHS. People need to know they are accessing the right care in the right place whenever they need it, whether that’s in hospital, at home or in their community.

“This needs a well-oiled, joined-up system, with teams of highly-skilled professionals including doctors, nurses, pharmacists and other health professionals such as physiotherapists, who can take appropriate and timely decisions with the patient. Supporting a collaborative approach which focuses on all settings where people need care, not just hospitals, is therefore an important first step from the Scottish Government. “

The new collaborative approach for unscheduled care includes six essential action points:

  • Each major site will have a management team made up of a hospital manager and a senior doctor and senior nurse with the autonomy to manage all patient workload – elective and emergency. This is to ensure that each patient is seen by the right person at the right time in the right environment. This team will be expected to manage the internal and external clinical relationships and work with the new Integrated Joint Boards to improve patient care links.
  • Each hospital will develop a balanced elective and emergency patient capacity management plan. That will be used to manage patient flow 365 days of the year.
  • Patient rather than bed management – empowering and enabling specialty teams to get the right balance between patients arriving and being discharged each day, including weekends.
  • Improving patient flow between emergency departments and acute medical and surgical units and downstream specialty wards.
  • Focus on primary and secondary care seven day services that maintain people in their own home and promote early appropriate discharge.
  • Realign existing services to safely maintain patients in their own home.

Dedicated support teams will help embed this best practice and will be in place by spring 2015. This will include four national improvement managers who will be supported at board level by clinical leads, programme managers, improvement managers and analysts.

Notes To Editors

Biography - Professor Sir Lewis Ritchie, former Director of Public Health, NHS Grampian:

Lewis Ritchie is a graduate of Medicine and Chemistry of the University of Aberdeen and in Community Medicine of the University of Aberdeen. He has undertaken specialty training in both general practice and public health medicine. Since 1984 he has served as a general practitioner at Peterhead Health Centre and Community Hospital. In 1992 he was appointed to the Mackenzie Chair of General Practice, University of Aberdeen. He was appointed Director of Public Health NHS Grampian in 2012. He has chaired a number of national committees on research, eHealth, cardiovascular prevention, immunisation, community hospitals, quality, professionalism and excellence in medicine, community pharmacy, ME-CFS, telecare (NHS 24), quality, and academic general practice career development. He presently chairs the Scottish Medical and Scientific Advisory Committee to the Scottish Government (SMASAC) and formerly chaired the Biomedical and Therapeutic Research Committee of the Chief Scientist Office.


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