Minister to probe GPs’ out of hours service

Shona Robison has announced a national review of GPs' out-of-hours medical cover. Picture: Jayne Emsley

Sir Lewis Ritchie, the director of public health NHS Grampian, will head the inquiry to examine the wider impact of GPs in Scotland no longer having to provide care for patients at evenings, weekends and holidays.

Ms Robison said the review would look at the availability of GPs at peak holiday times, such as Christmas, and gauge “public expectations” of the service.

It comes ten years after the current system, which shifted responsibility for out-of-hours service from GPs to health boards, was introduced.

There have been reports of patients facing longer waits at hard-pressed hospital A&E departments over the festive period, with some not being treated for up to 20 hours. Some of the blame has been directed at GPs for not offering more flexible working hours.

Ms Robison said: “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 ten 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.”

But GPs’ leaders said they saw thousands of patients daily and were already effectively acting as “emergency doctors” despite cuts to funding and a decline in the number of GPs working across Scotland.

Both the British Medical Association and Royal College of General Practitioners (RCGP) recently urged the Scottish Government to take immediate action to tackle the crisis in general practice, claiming that funding shortfalls put patients at risk.

Dr Martin McKechnie, chair of the College of Emergency Medicine Scotland, has voiced concerns about the “lack of alternative healthcare” to A&E during peak winter periods, which results in people turning up at hospitals because they do not have anywhere else to go.

Miles Mack, chair of the RCGP, said GPs were “the hub of the NHS”.

He went on: “In Lothian over the festive period, for example, the out-of-hours service dealt with over 8,000 patient contacts, a staggering 1,000 per day. They recorded their busiest day ever for home visits on 2 January. GPs are crucial.”

He said the review must examine how the “funding, capacity and workforce of GPs [can] be increased to allow proper care” for patients and improve information sharing.

“There is, inevitably, an overlap between the ‘normal hours’ care that GPs offer and the extraordinary work they carry out at all times of the day and night.

“They act as emergency doctors and, at the same time, as senior clinical decision-makers when the NHS is presented with a complex case entailing more than one illness. That’s the great, individual specialism of general practice – the ability to deal with the increasingly complex nature of the health of our changing population,” he said.

The review will also cover recruitment and retention of GPs, and staff availability, Ms Robison said on a visit to Ninewells Hospital in Dundee.

She also announced an overhaul of the way accident and emergency (A&E) services are managed, with a new “collaborative” approach to unscheduled care. Each hospital 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.

The review, which is expected to come up with recommendations by late summer, is likely to present pilot schemes to test new models.

Theresa Fyfe, director of the Royal College of Nursing Scotland, said the new collaborative approach was an “important first step” to tackling the problems in A&E.

She added: “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.”

Labour health spokeswoman Jenny Marra stepped up calls for the SNP to support a £100 million “Frontline Fund”.

She said: “Our hospitals are under severe pressure and need extra capacity now. Shona Robison should be pulling together an emergency task force for this and using the Barnett money that she has not yet spent to free up capacity in our hospitals today. If ever there was evidence needed that the SNP have been complacent, this is it.”

Liberal Democrat health spokesman Jim Hume described the review as “better late than never”. He added: “The SNP has taken its eye off the ball and as a result people are waiting longer to be treated at A&E units whilst the proportion of NHS spend on GPs has dwindled to 7.5 per cent.

“I will be seeking assurances that these warm words will be matched with swift action.”

COMMENT

Jenny Bennison: ‘My days extend to 12 hours without a break’

AT MY practice in Leith, the demand has increased dramatically since I started as a partner, and days usually extend to 12 hours without a break. Very few of our patients come in with sore throats or coughs and colds. For instance, last Friday I visited at home two palliative care patients near the end of life and had two extended appointments with people who required urgent referral to psychiatric services.

This was on top of dealing with more than 30 telephone calls from patients, reading about 50 letters and results, and signing and checking about the same number of prescriptions.

Towards the end of the day, I realised that seeing my patients had meant I had missed the chance to speak to anyone in the psychiatry team about my urgent referrals (their office closes at 4pm) and so I would have to action those the following Monday, my precious day off.

I would also have to try again to speak to a social worker about another patient about to be discharged home from temporary respite care (their office closes before 5pm on a Friday too).

How can I be expected to do all this, day after day, and tick all the boxes that the government wants me to do? Have I asked my patients if they smoke? Did I suggest, of course, that they should stop? Did I ask if they have a family history of heart disease or diabetes? Have I measured their cholesterol? Their weight? Their height? Their blood pressure?

The day job is a very tall order. I think I generally do OK by my patients. But, if the review concludes that we should all do out-of-hours as well as in-hours work, I would have no choice but to cut my hours in the practice by day, and become even less available to the patients who want to see me.

• Jenny Bennison is a GP in Edinburgh with more than 21 years experience

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