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GPs will no longer be 'default' person for out-of-hours care in one region

An NHS board has approved plans to overhaul the out-of-hours service to remove the current ‘over-reliance’ on GPs, with GPs no longer being the ‘default’ person to see patients for urgent care.

The plans approved by NHS Highland also involve teams comprising nurses, paramedics and pharmacists delivering care across wider geographical areas.

A report to the board said the current system is unsustainable and GPs will still make an important contribution to the service.

But it added that staffing shortages have led to contingency plans being activated on a number of occasions in recent months, with locum cover costs spiraling to £12.5million a year – a significant overspend. 

The report said: ‘The service is overly reliant on doctors at present with 25% of all out-of-hours doctor hours in Scotland currently being delivered in Highland.'

A national shortage of GPs has prompted a rethink about how out-of-hoursH care is provided but those problems are felt ‘most acutely and most urgently’ in the region because of its remote and rural areas, board members heard.

The report proposed: ‘Future urgent care will be delivered by well-led and trained multidisciplinary and multi- sectoral teams’ with GPs providing clinical leadership and expertise, particularly for complex cases. '

The changes include moving the boundaries of the area to be covered by each ‘team’ as previously a number of small, more remote, bases had received very few calls.

Concerns were raised at the meeting that some areas, such as Glenelg, would see a reduction in medical cover.

NHS Highland’s clinical lead and GP Dr Antonia Reed said there was a clear acceptance that the current situation is ‘simply not sustainable’ and change is required.  

She said: ‘Quite what these changes will be in practice will require some further work and engagement with different communities such as Glenelg.

‘There won’t be one size fits all.’

She said the extensive use of locums needed to be addressed as a priority.

Dr Miles Mack, chair of RCGP Scotland, said they had consistently supported a healthy skill mix in primary care but stressed that patients should always have access to a GP when necessary.

He said: ‘Advanced nurse practitioners and paramedics, while hugely valuable members of any team, are not doctors. There have been challenges to recruitment in remote and rural access for many years which has been exacerbated by the underfunding of general practice.

Dr Alan McDevitt, chair of the Scottish GPC, said significant problems in recruiting and retaining GPs was having an impact on the level of GP services that practices and health boards were able to provide.

‘While Sir Lewis Ritchie’s review into out-of-hours care in Scotland last year rightly concluded that an increasingly multidisciplinary approach... was required, it is important to also recognise the real pressures that are leading to proposed changes such as this.

‘It is essential that more is done to once again make general practice an attractive career option, so that we can ensure we have enough GPs working both in hours and out of hours to meet the rapidly increasing health needs of people in Scotland.’

Readers' comments (10)

  • There's a "no" missing from the headline, Mr Editor.

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  • The clear message here is cost. Doctors are too expensive is the sub text. How can this be run more cheaply think NHS Highland?

    Short answer is that if you skimp on this people will die.

    As Red Adair is reported to have said "If you think it's expensive to hire a professional to do the job, wait until you hire an amateur."

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  • "Pay them and they will come" with apologies to "Field of Dreams" with Kevin Costner

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  • Not sure I want to be held responsible for the decisions of others who are not 'my ' team

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  • Interesting and a good template for the future - in terms of assessing increase in AE admissions and attendance.

    I'm fairly sure these will go up as numerous studies have shown that GPs are the best at managing risk.

    As a user said above - the pay for OOH is so dismal that is not worth the risk you are taking

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  • Like many older GPs I did out of hours for more than 25 years. It was by far the most difficult and pitfall strewn work that I have tackled.

    The first problem with delegating OOH is that it is never really possible to know how 'complex' a problem is until you go and see.

    The second problem is that 'whoops - I did my best' just doesn't cut it with the coroner anymore.

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  • The NHS unfolds further and further in small steps so the general public do not notice.
    Actually why have doctors at all???
    AsJezza once said that the boys in Silicon valley explained that in the future, doctors will be an optional extra-effectively...

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  • Mr Mephisto

    The bottom line on all of the Out Of Hours Algorithms are "See GP" or "Attend A&E". This would prove difficult if there are no GP's in the system and a trip to A&E in the Highlands is a bit of a Bear Grylls type expedition - "Hitch the RIB to the Land Rover love we are off to A&E - I know you think you have a cold but the computer thinks you might have myastyhenia gravis".

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  • Not sure this is new news. Mostly ANPs locally anyway. Gp doesn't do the first or last 30 mins of the shift due to provider cost cutting.

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  • This philosophy is frightening - and the MDU need to be involved - To ask GP's to provide "clinical leadership " is fraught with a multitude of interpretations -as is the comment "complex cases "-and is a complex case decided before the pt is seen or retrospectively ,or retrospectively when something goes wrong ?When I see a patient I may not be taking a history or examining them all the time ,but I am aware of how they are behaving/how children are relating to their parents etc -all the time. You lose that if you "cover other people "and just write a script that someone else isn't qualified to write .The only safe cover is where you see that patient as though they were a new consultation for you .Are all the various professionals going to have the same indemnity cover ?The time that it could get really nasty is in a court of law if these points aren't addressed now.

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