RCGP Scotland Position Statement
The review of out-of-hours care (OOH), to be led by Professor Sir Lewis Ritchie and announced by the Scottish Government on Friday 30 January 2015 is a crucial opportunity through which Scotland could access a world class out-of-hours service that is fully fit for purpose.
Throughout the review, contributors must be mindful of three major contexts through which to evaluate options:
- Everything must be based on patient safety. From this, GPs must not be expected to work beyond hours which are safe.
- The impact on GP in-hours work of any OOH recommendations. The GPs clock only has so many hours each day.
- Any solution/s to current problems has to be able to incorporate the spectrum of contexts throughout Scotland, from the inner city to remote and rural life.
RCGP Scotland believe that, to achieve this vision, four priority areas must be addressed. They are:
- To clarify the scope of the service;
- To adequately invest in the service;
- To make it easier for current GPs to undertake OOH work; and
- To offer appropriate support for leadership.
- Clarify the Scope of the Service
- The scope of the OOH service for Scotland must be established with clear responsibilities and boundaries.
- Increasingly, the OOH service is asked to provide cover and extend its role, for example through attendance at sudden deaths in lieu of forensic medical services.
- The review should allow the role of general practitioners within the service to develop towards GPs as Senior Clinical Decision Makers.
- Adequately Invest in the Service
- There must be investment in Primary Care Emergency Teams. Only in this way can the service be guaranteed to be more than a lone GP as the bare bones of care. The service should emphasise a team approach, including nursing, paramedics, administrative and service support.
- The current OOH ‘Hubs’ should be dissolved. Their functions should be devolved to the Primary Care Emergency Centres (PCECs), in order to allow more localised decision making, intelligence, planning and dispatch, based on team capacity and liaison.
- IT technology, both hardware and software, must be closely, properly interfaced with both hospital and in-hours services.
- The welfare of staff employed must be ensured in terms of accommodation, security and sustenance. This requires the establishment of Green Light Centres, akin to current Fire Service Stations.
- Make It Easier for Current GPs to Undertake OOH Work
- It must be made easier for serving, in-hours GPs to interleave OOH work with their present commitments. The current, market driven system has proven inadequate due to the falling availability of doctors.
- Better contractual security should be offered through terms and conditions and opportunities for training and CPD. The review must take a realistic view of the effect of OOH on current GP tax structures and pension development.
- Their must, similarly, be a recognition of the understanding that in-hours practices must make adaptations to allow the release of GPs for OOH work. This must be valued by the system.
- GP trainees must have sufficient and well supported training opportunities.
- Offer Appropriate Support for Leadership
- Support for leadership at a Locality level should be offered towards Quality Improvement and Interface Working.
- We propose mirroring the suggested direction of travel for Locality Clusters and peer-based, values driven Quality Improvement and Governance.
Each of these four areas must be satisfied in order to successfully establish an OOH service fit for purpose both in our current context and in light of our changing demographic needs.