Doctors: 24/7 care will push NHS to the limit

Published on Sunday 7 February 2010 21:55

THE NHS in Scotland will soon be unable to cope with the growing number of patients trying to access care outside normal hours, doctors will warn this week.

The ambulance service, hospital A&E departments and telephone service NHS24 have seen demand soar in recent years.

And now in a report seen by The Scotsman, the British Medical Association Scotland has concluded that future increases in demand will not be sustainable, and services will be placed under unbearable pressure.

If demand continues to rise, tens of millions will be added to the cost of NHS services.

The BMA – which represents medical staff – is calling for better education for patients so they can access the appropriate care at the right time. Figures show huge increases in demand for A&E and ambulances in recent years.

The Scottish Ambulance Service says 999 call-outs went up 35 per cent between 2003-4 and 2008-9, with a 41 per cent rise in calls out of hours.

Tomorrow's report from the BMA is also expected to call for an urgent investigation into why more patients are choosing to access NHS services outside normal working hours.

It comes as the BMA and the Royal College of General Practitioners mark the first ever National General Practice Week in Scotland.

The BMA report will look at the future of general practice in Scotland, addressing issues such as access to care and out-of-hours demand.

It follows a lengthy consultation involving doctors, charities, patient groups and the public. There has been controversy in recent years after the new GP contract in 2004 allowed GPs to pass responsibility for out-of-hours care to health boards.

The change led to the creation of NHS24 to direct out-of-hours calls to the appropriate services, with many doctors stopping work at evenings and weekends.

Last week, Scottish Tory leader Annabel Goldie said patients were getting a "raw deal" on out-of-hours medical care, and urged the Scottish Government to back their plans to renegotiate the GP contract.

But doctors have challenged the assumption that the contract has been behind rising levels of demand. Dr Dean Marshall, chair of the BMA's Scottish GPs committee, said: "What has been happening is this has been put at the door of GPs when our contract changed. It's another example of where people don't consider all the reasons and facts.

"This has been going on for the past decade, if not longer. There has been a real rise. That was why the previous system with the GPs doing their own out-of-hours was unacceptable."

Dr Marshall said one possible reason was changes to the way people work. "People's lives are very different. A lot are working shifts and it suits them to access their care at different times. I am not aware of an actual change in the conditions that people are getting, so it is when they are trying access healthcare that has changed."

Dr Marshall said if people wanted care outside normal hours, they needed to decide what level of service was appropriate.

He said: "The idea you can get the same level of service 24 hours a day isn't likely to be deliverable. Financially, even if you could deliver it, the consequences would be massive."

Their report is expected to call for research into why people contact out-of-hours services and why demand is rising so much Dr Marshall said there could be consequences for patients if the service was not being used appropriately.

"The risk is that you can't get to the people that really, really do need to be seen immediately. They are hidden in a list of increasing calls.There are a variety of services available now if you need to contact the NHS out of hours. What we need is a clear message so people know what they need to do.

"The public need to take responsibility as well. The vast majority of the public use the service appropriately. Unfortunately, a small minority don't and we need to help them make better decisions about how to access the NHS."

Dr Marshall said this was not necessarily the fault of patients, who needed better guidance on when they should access services, but he said without action, the NHS could be overwhelmed.

"If the rise we have seen over the last couple of decades continues, then I think it is unlikely the NHS will be able to cope.

"Unless people are getting iller, which is unlikely, what it will be is about demand. If there is that demand there, we need to manage it better than we have been doing."

One suggestion is that advice on accessing health services and the consequences of inappropriate demand be included in the school curriculum.

Dr Marshall said: "If you look at public health messages given to children they are very effective."

Margaret Watt, chair of the Scotland Patients Association, said she believed GPs opting out of out-of-hours had helped increase demand for ambulance and A&E services.

"Patients know now if they call for a doctor out of hours it might take a while for them to be seen," she said. "People sometimes have no option. They either have to phone NHS 24 or find a hospital that can deal with them.

"There are areas with one GP for thousands of people which is not enough for out-of-hours. Patients have got to find someone who can help them and tell them what's wrong."

A Scottish Ambulance Service (SAS) spokesman said: "Across Scotland we have seen a year-on-year increase in demand, in line with the rest of the UK.

"We continue to manage that demand and ensure that everyone gets an appropriate response."

NHS 24 medical director Dr George Crooks said: "NHS 24 works closely with the SAS and the GP out-of-hours services provided by local health boards across Scotland to ensure that patients can access the appropriate level of care when their GP surgery is closed."

A Scottish Government spokesman said they had been trialling a public information campaign in Grampian so people know what services to access.

He said: "In spite of increased demand, our A&E departments continue to show sustained improvements in performance with 98 per cent of patients seen within the four-hour A&E target time at the latest count."

Ms Goldie said: "The taxpayer is currently paying far more for out of hours cover but getting a poorer service in return."

Scottish Labour health spokesman Dr Richard Simpson said: "The health secretary Nicola Sturgeon needs to take these warnings from the BMA very seriously. It is vital that we have an out-of-hours service which is capable of providing for those patients who need to be seen immediately.

"We all have a responsibility to use the service properly, but the real problem is that the SNP have given the NHS its worst spending settlement since devolution and lack of funding is putting pressure on services across Scotland."