Out-of-hours unscheduled care hasn't suffered, in spite of what a vocal minority might think

Published on Monday 7 July 2008 21:35

RECENT correspondence in this newspaper and elsewhere has highlighted some of the significant challenges that delivering healthcare in remote and rural communities present to health service providers.

One of the greatest of these challenges is the delivery of out-of-hours unscheduled care.

Before looking at how we address these challenges, it is important to look back at the reasons why GPs opted to transfer responsibility for out-of-hours care to the NHS Boards.

Firstly, during negotiations about this particular element of the GP contract, government officials believed that the NHS-managed service could deliver a better and more efficient service for patients.

Secondly, the morale of GPs was at an all-time low. Doctors were working excessively long hours and in rural communities in particular, the onerous demands of the on-call service meant that there was a growing recruitment and retention problem.

Rural communities were at risk of losing their daytime GP service at the expense of out-of-hours availability and I would contest that the changes made to out-of-hours care since 2004 have helped secure high-quality daytime services.

The claim that doctors in general practice have deserted out-of-hours services is incorrect, because a significant number of GPs continue to work for health board out-of-hours services, providing the medical backbone that ensures the quality and standards for out-of-hours care in this country.

A recent audit of out-of-hours services conducted by NHS Quality Improvement Scotland reported that all NHS boards in Scotland have achieved their targets of quality performance.

And yet we continue to read reports from rural areas such as Kinloch Rannoch, where some residents are unhappy with their level of out-of-hours provision.

But what evidence is there that rural communities have suffered from the decision that the GP practice will no longer be responsible for the provision of these services?

There are many health advantages and disadvantages of living in a rural as opposed to an urban area, but the cost of healthcare provision per patient is an area where there are significant differences.

For example, while Dundee and Kinloch Rannoch are both served by NHS Tayside out-of-hours service, the primary care spend for daytime services per patient in Kinloch Rannoch is currently 239 per annum compared with the Dundee average of just 72.

This reflects the cost of providing care to a small, remote practice – however, because Dundee has far higher levels of deprivation and much poorer health outcomes than Kinloch Rannoch, it is difficult to support the argument that the expenditure gap should further increase, given that our government has a stated agenda to reduce health inequalities.

The solution to the provision of rural out-of-hours care is not to take the retrograde step of forcing GPs into returning to 24/7 responsibility for patient care, because this would be to the detriment of the high quality care delivered to patients during the day. Instead we need to continue to improve the integration between the services provided by the local health boards, NHS24 and the ambulance emergency service.

In particular, the ambulance service needs to be funded adequately to ensure that acceptable response times are achieved for those parts of the country that are remote and isolated.

&#149 Dr Andrew Buist is a GP and deputy chairman of the BMA's Scottish General Practitioners Committee.