Shake-up call as GP service makes many rural patients 'feel at risk'

The Scottish Parliament's health and sport committee found serious shortcomings in the way smaller communities were provided for.

The report was sparked by a campaign in the village of Kinloch Rannoch, which has been without an out-of-hours GP service for four years.

Christine Grahame, MSP, convener of the health and sport committee, said: "Out-of-hours services must be fully joined-up – and they are not.

"NHS boards should be given the responsibility for devising and delivering new and tailored arrangements for services which are sustainable and meet the needs of individual communities. Confidence also has to be re-built in NHS 24 to ensure it operates as a fully effective element of the out-of-hours range of services.

"Cost pressures must not be allowed to further damage out-of-hours services."

The committee heard that 95 per cent of GP practices had opted out of providing out-of-hours care since new contracts were introduced in 2004, which meant it was worth only 6 per cent of their salary.

NHS 24 was established in 2001 to complement out-of-hours GPs, community nurses and the emergency services. But the report found this had left patients confused about who to contact, while the services were criticised for failing to communicate and provide a simpler "joined-up" system.

It also said that, while NHS 24 had addressed initial teething problems, "a substantial amount of work has to be done to re-build confidence and trust in the service".

John Turner, chief executive of NHS 24, said: "We look forward to working closely with our colleagues from partner health boards and the Scottish Government to fully consider the recommendations in the report."

Theresa Fyffe, director of the Royal College of Nursing, Scotland, added:

"In some rural areas, as part of a mix of services, highly qualified and skilled nurse practitioners provide expert care and treatment to patients alongside other healthcare professionals, supported by GPs and also by telemedicine.

"RCN Scotland urges health boards to promote this type of service to the rural communities they serve more effectively.

"People living in rural communities are not necessarily being short-changed, but if health boards fail to let them know what services are available, people in these areas will continue to feel at risk."

The committee called on the Scottish Government to look at the differences in annual costs of providing out-of-hours services in cities compared with rural communities – such as less than 8 per patient in Glasgow, compared with 43 in Argyll.

Heath secretary Nicola Sturgeon said: "We're committed to ensuring all patients get the best possible healthcare at all times – regardless of where in Scotland they live.

"An Audit Scotland survey in 2007 showed that 80 per cent of patients were satisfied with the out-of-hours service they received and understood the role of NHS 24 in supporting access to these services.

"To ensure continuous improvement, I have asked NHS boards to develop national quality indicators for out-of-hours care, which will ensure services are consistent throughout the country.

"We will now study this report in detail."

• Kinloch Rannoch - the village where an emergency ambulance is an hour away