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.’