£10 million to support national roll-out
A total of £10 million will be available next year to fund a National Delivery Plan to transform urgent care – in the next step to take forward the recommendations of Sir Lewis Ritchie's Review of out-of-hours services.
The Delivery Plan, which will be published in the autumn, will build on the initial testing programme which is funding eight pilot sites across Scotland to test new ways of delivering out-of-hours health services.
These test sites, based in Highland, Grampian, Glasgow, Lanarkshire, Tayside, Lothian, Fife and Ayrshire & Arran, will be used to inform the development of a wider national strategy for urgent care out-of hours.
Crosshouse Hospital in Kilmarnock will be the national flagship test site for the recommended Urgent Care Resource Hub model, seeing multi-disciplinary teams working in a hub to support primary care patients out of hours.
Other models being tested include a GP-led out-of-hours team in Grampian, nurse led home visits in Glasgow and new pathways of care for paediatric and mental health services outside of normal working hours.
It also includes a £400,000 investment in the out-of-hours technology system, Adastra, to establish a standard system across Scotland.
Health Secretary Shona Robison said: "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, with more complex, multiple conditions.
"We want a high-quality out-of-hours service which fully meets their needs and does so consistently and reliably throughout Scotland.
"Sir Lewis Ritchie's Review into out-of-hours care in our NHS has provided a blueprint to take forward this work, and today's announcement of eight test sites across Scotland is the first step towards delivering on the excellent recommendations made.
"This will be followed by a £10 million National Delivery Plan later this year which will look at what we have learnt from these pilot sites and how this could feasibly be rolled out across Scotland.
"This multi-disciplinary team approach, which moves away from the traditional model of the doctor being the first point of contact for all patient care, will utilise the skills of other highly trained professionals in the NHS and ensure patients are seen by the person best able to address their needs.
"We are supporting this with £85 million of funding specifically for transforming primary care – both in and out-of-hours. Change on this scale does not happen overnight, and the next two to three years will be critical in transitioning towards these new models of care.
"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."
Sir Lewis Ritchie said: "I very much welcome this funding commitment by the Cabinet Secretary, which recognises the importance of the recommendations made in the Primary Care Out of Hours Review Report, many of which are pressing.
"Getting urgent and emergency care right is of paramount importance for the people of Scotland. We need to do this well, to do this with resolve and to do this together."
The pilot projects are:
Ayrshire & Arran - £195,000
National Test Site for Urgent Care Resource Hub – funding to support the development of Crosshouse Hospital at the national flagship test site for the recommended Urgent Care Resource Hub. Testing the multi-disciplinary team approach to delivering out-of-hours services with pharmacists, nurses, allied health professionals, optometrists, paramedics and the third sector all involved in seeing and supporting a range of patients with urgent problems.
Grampian - £195,000
Developing urgent care workforce – Creating the new role of a 24/7 GP Lead who will be responsible for allocating clinical resource across the out-of-hours service. Training Advanced Nurse Practitioners to manage more patients presenting with minor illness in the out-of-hours services at the busier community hospitals.
Glasgow - £80,000
Nurse led home visits – training nurse practitioners to carry out certain home visits within Glasgow City, testing the required levels of clinical support from GPs and monitoring the appropriateness of hospital referrals.
Lanarkshire - £150,000
Paediatrics and mental health services – testing new referral pathways out-of-hours. Funding will be used to recruit new Advanced Nurse Practitioners and develop the technology to link the urgent care centre with the clinicians in hospital.
Tayside - £70,000
Developing the GP led community urgent care team in Perthshire. With this model, a GP will provide the clinical leadership for a multi-disciplinary team working to deliver out-of-hours care in the community.
Lothian - £195,000
Basing a GP in the Emergency Department at the Royal Hospital for Sick Children at weekends. Clinical experience suggests that children under five are more difficult to assess by telephone triage and are more likely to referred by out-of-hours GPs for a second opinion. The pilot will develop the clinical paediatric skills of out-of-hours GPs, to improve the service they offer, and ensure that children are able to see the right clinician, first time, no matter where they attend. In addition to telephone advice, parents will be offered a face-to-face appointment with a triage nurse to assess who would be the most appropriate clinician to see their child at this attendance.
Fife - £70,000
Advanced Nurse Practitioner development – funding to develop one or two nurses to Advance Nurse Practitioner level. These specially trained nurses would work as a senior member of the Primary Care Emergency Service Team and compliment the GP, by being able to carry out consultations at a higher level.
Highland – £195,000
Strengthening the existing out-of-hours primary care hub that coordinates urgent care across the majority of Highland with NHS 24 staff and Scottish Ambulance Service Emergency Dispatch teams. The funding would employ a doctor to work in this hub to provide senior clinical support across the three services; funding to train up three staff to Advance Nurse Practitioner level to work with GP practices in Thurso; trial of equipment to give out-of-hours teams mobile reception in communications 'dark spots'; employing an additional call handler in the hub to deal specifically with palliative care patients; and providing CPR training and defibrillators to community responders and fire crews to support a faster response to cardiac arrest patients in rural communities.
Technology investment - £400,000
The initial testing programme includes investment in phase one of improvements to the out-of-hours technology system, Adastra, used by NHS staff to record clinical assessments. The funding will result in a standardised system across health boards, enabling multi-disciplinary team working. This funding will also enable healthcare practitioners in prison settings gain access to healthcare requirements of people who have been in police custody.
The £10 million to fund the National Delivery Plan in 2016/17 is part of the £85 million, three-year, Primary Care Fund.