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Blueprint for out-of-hours care

Published: 30 Nov 2015 10:00

Independent Review publishes.

A framework for the long term future of primary care out-of-hours services, which run when GP surgeries are closed, has been welcomed by Health Secretary Shona Robison.

The independent Primary Care Out-of-Hours Review, chaired by Professor Sir Lewis Ritchie publishes today.

Its main recommendations focus on the need for multi-disciplinary teams – including GPs, nurses, physiotherapists, community pharmacists, social care and other specialists – working together at urgent care resource hubs across Scotland.

The Review, which the Scottish Government commissioned earlier this year, forms part of the government's plans to transform primary care services in light of the demands of Scotland's ageing population, and as health and social care services are integrated.

The Government has made £1 million of initial funding available immediately to fast-track the testing of the new urgent care model. A detailed Government response to the recommendations and a national implementation plan, including an outline of investment to support delivery, will follow in spring 2016.

The Review also recommends developing a set of national standards for urgent out-of-hours care, improving patient record systems and technology, further developing support for self-care and enhancing joint working between health boards including the Scottish Ambulance Service and NHS 24.

In addition, the Review recommends that newly qualified GPs should be offered a one year post to include out-of-hours work with enhanced support and continuing professional development in out-of-hours medical care.

Ms Robison joined Sir Lewis at NHS Lothian's out-of-hours centre at the Royal Victoria Hospital, Edinburgh, to launch the Review.

Sir Lewis said:

"The people of Scotland deserve a high-quality out-of-hours service which fully meets their needs and does so consistently and reliably throughout Scotland.

"The Scottish Government commissioned this Review to ensure that person-centred, sustainable, high quality and safe primary care is delivered when GP practices are closed. I hope the recommendations from this review help achieve that, but also look forward and begin to lay the foundations for consistent urgent and emergency care on a continuous 24/7 basis.

"We must think anew about what is best for both urgent and emergency care for the people of Scotland. We should now move towards a seamless service, which not only meets the needs of patients, but also offers a valued working and learning environment for all those delivering health and social care services, whether that be the NHS, local authority social services or the third sector.

"The approach to this Review has been inclusive and I am indebted to the people of Scotland who have participated through individual contributions to the review. I have also been heartened by the commitment and dedication of my colleagues who work for the NHS, local authorities and the third sector."

Ms Robison said:

"I welcome Sir Lewis' Primary Care Out-of-Hours Review which will service as a framework for the long-term future of out-of-hours services in Scotland.

"Our NHS is facing different demands from those of 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.

"This is why it was vital, more than 10 years since the current system was created, that we commissioned a review into out-of-hours primary care.

"Over the course of the Review, Sir Lewis has consulted widely with professionals and patients in every single health board area across Scotland. This reflects our open approach, and willingness to listen.

"We are already taking a comprehensive range of actions across all areas of our health service in order to meet the changing demands and the recommendations in Sir Lewis' Review will build on this, helping ensure a more effective and sustainable service for the future.

"Through our £60 million primary care fund we are making long term changes to support the development of the whole primary care team. This will allow us to recruit and retain more GPs, as well as employ more professionals like pharmacists, to work alongside GPs and allow patients to be always be seen by the person best able to address their needs.

"This whole-team, community-based care approach is the foundation on which we will transform our health system. This of course also relates to out-of-hours care, and as Sir Lewis outlines in his Review, the future model includes multidisciplinary teams working from urgent care centres across Scotland to meet the needs of their patients.

"Our recent investment of £10.7 million to NHS boards to meet winter demands means that health boards have robust systems in place, including in out-of-hours, for this winter. However, Sir Lewis' Review provides the basis to move forward and embed changes that will improve services and ensure they are sustainable well into the future.

"There is still a lot of work to be done, but ultimately, by getting primary care right, both in and out of hours, we can ease the pressure in our hospitals and meet the demands of our patients, who should expect nothing less."

Theresa Fyffe, Director of Royal College of Nursing Scotland said:

"Professor Sir Lewis Ritchie is to be congratulated on this independent review on out-of-hours care, which focuses on the need for all health and social care professionals – including doctors, nurses, physiotherapists, community pharmacists and other specialists – to work together to ensure that primary care out of hours services will meet the needs of patients into the future. We contributed significantly to this Review and the crucial role of advanced nurse practitioners and district nurses in delivering out-of-hours-services, working as part of a multi-disciplinary team, is highlighted throughout. It's also good to see our work on developing a new multi-disciplinary model of care reflected so clearly in the Review.

"Overall, Professor Sir Lewis Ritchie's recommendations are a solid foundation on which we can build the future of round-the-clock primary care services. We look forward to working with Government and all the health and social care professionals who will be part of the future of primary care out-of-hours services to implement the new ways of working proposed in this Review."

Dr Miles Mack, Chair of Council, Royal College of General Practitioners (RCGP) Scotland, said:

"RCGP Scotland warmly welcomes the inclusive approach and support shown by Professor Sir Lewis Ritchie and his Review. The profession will be glad of his recognition of the pressures general practice as a whole is under to meet the needs of Scotland's population. We hope this report can provide lasting, meaningful solutions to patients looking for urgent, out of hours medical care."

The Scottish Government will publish a full response in early 2016 which will outline the implementation of these recommendations.

Notes to editors

The full Out-of-Hours Primary Care Review is available here:

Urgent care – is care in the community which requires a response before the next routine care service is available. This differs from emergency care, delivered in A&E departments which requires an immediate response to a time-critical health care need.

Additional comments:

Sian Tucker, clinical director of unscheduled care at NHS Lothian, and co-chair of the Out-of-Hours Review National Operations Group, said on behalf of the group:

"The national operations group welcomes the national Out-of-Hours Primary Care Review which highlights the demands and workforce pressures faced by out-of-hours care.

"The Group thanks Sir Lewis who has worked tirelessly to ensure when conducting this review and compiling his report that all parties were fully included.

"We are delighted with his emphasis on valuing the workforce, multidisciplinary team working and the continued provision of excellent urgent care for patients in the out-of-hours period. The Review also recognises the vital contribution of out-of-hours services on patient care across Scotland with nearly a million consultations last year."

"This Review is only the start of improving out-of-hours urgent care and we look forward now to the on-going work with the all stakeholders to implement the Review recommendations and ensure that patients have access to the urgent care they require now and in the future.

"This will require additional resource and full commitment from all to enable the Review recommendations implementation and a new robust sustainable out-of-hours service to be successfully developed."

Professor Harry McQuillan, speaking on behalf of the pharmacy urgent care group, said:

"All three pharmacy bodies in Scotland that worked together on our submission are delighted that the profession has been recognised for its current role within urgent care and with the recommendation, along with others, of a greater profile and role for community pharmacy going forward.

"We will play our full part in making all our associated recommendations a reality."

Biography - Professor Sir Lewis Ritchie, OBE, Mackenzie Professor of General Practice, University of Aberdeen.

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 between 2012 and 2014. 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 formerly chaired the Scottish Medical and Scientific Advisory Committee to the Scottish Government (SMASAC) and the Biomedical and Therapeutic Research Committee of the Chief Scientist Office.