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Independents' Day

GP out-of-hours services to include more prominent role for nurses

The Scottish Government is trialling giving advanced nurse practitioners a significantly more prominent role in providing out-of-hours care as part of £10m worth of investment going into urgent GP care. 

It will use the experiences of eight primary care pilot sites next year to determine how to allocate £10 million specifically for out of hours care.

The sites will trial different ways of working, including:

  •  An ‘urgent care resource hub model’ in Crosshouse Hospital in Kilmarnock, which will see multi-disciplinary teams including GPs, nurses, pharmacists, third sector workers and other professionals.
  • NHS Lothian basing a GP in the emergency department at the Royal Hospital for Sick Children at weekends. Its pilot will develop the clinical paediatric skills for out of hours GPs.
  • A GP will provide clinical leadership for a multi-disciplinary team delivering community out of hours care in Tayside.

A number of sites will focus on making more use of advanced nurse practitioners.

NHS Greater Glasgow and Clyde will train nurse practitioners for home visits in Glasgow, testing the required levels of clinical support from GPs and monitoring the appropriateness of hospital referrals.

Highland, Fife, Lanarkshire and Grampian are all training or recruiting advanced level nurses for out of hours services to ease the workload of GPs. The nurses will be involved in prescribing and high level assessing and consulting.

The moves are in response to recommendations in the National Review of Primary Care Out of Hours Services by Professor Sir Lewis Ritchie, published in November. 

He said services were stretched because of doctor shortages and increased patient demand, and called for a ‘multi-disciplinary and multi-sectorial’ approach to out-of-hours care. Advanced nurse practitioners should make a ‘significant contribution’, said Professor Richie.

Health secretary Shona Robison said: ‘This multi-disciplinary team approach, which moves away from the traditional model of the doctor as 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.’

Readers' comments (11)


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  • GPs in East Anglia man phones to support paramedics with managing patients at home instead of taking to hospital. 80% of ambulances are stood down. Managing unreasonable demand is the name of the game these days.

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  • "GPs in East Anglia man phones to support paramedics with managing patients at home"

    Sounds good, but rolling out such a scheme would require more GP man-hours. Which are not in plentiful supply.

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  • Demand will continue to grow until patients are phoning for daily consultations regarding their self limiting back pain, URTI...

    Ultimately some form of direct payment is the only answer.

    If we could all have free cars paid for out of our taxes increasingly we would all go for new Audis, BMWs etc when a three year old Ford Fiesta / Focus would bee more than sufficient.

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  • Doctor informed.

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  • Cheap in the face of it, much more expensive in the long run

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  • 7.31 - I agree - nurses are cheaper per hour but take longer to see and treat, and refer more - the experience of Walk in centres seems to support this. Nurses rarely have a 2nd gear to see more to clear a backlog or increased demand when there is a local or national panic (flu, meningitis, septicaemia, Zika, ebola etc etc)

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  • We all knew that out of hours would become a nurse run service did'nt we ?
    Why not give patients the choice
    Pay their own GP to see them out of hours or see a nurse for free
    Oh no politically unacceptable

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  • Obviously juxtaposes with an increasing difficulty in attracting "time served" GPs to do these sessions which are during "unsocial hours" at the "greedy fat cat rates" much discussed in various highly authoritative(politically partisan ergo anti-doctor) newspapers.I don't have any objection to advanced nurse practitioners trying to do this work although it would help if I knew what training in examination/diagnosis and management they have had,what scrutiny this has been subjected to and what ongoing appraisal ensures their standards.I personally would not be happy to supervise someone in this situation.I know a lot of nurses who feel very confident about doing this but confidence does not equate to competence.Are these nurses going to be given medical training and who is going to provide this.Handing them stacks of protocols and algorithms and throwing in some Crown Immunity may prove very costly to the British tax payers in the short,medium and long term.

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  • I know GP's are protective of their role but there is a shortage at present especially in OOH.
    GP's wish to come in at the last minute to get higher pay rates which puts an already underfunded service under pressure
    Advanced Nurse Practitioners have worked in general practice for years
    We trained to take histories, assess,examine,diagnose ,refer for tests /X-rays or to hospital.
    We can do 80% of GP work and no we aren't slower. I work in OOH in England and NI at same pace as the GP I work with next door.
    We can complement your service we aren't looking to take over the role as scaremongers like to advise. We want recognition and to be valued for the job we do

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