Health boards’ views vary on out-of hours care

Mark Rowley
Mark Rowley

NHS Borders and NHS Lothian are taking different views on changes that are needed to their out-of-hours services.

Nurse practitioners will head up the out-of-hours service in the Borders while NHS Lothian still plan on the service being GP led.

In their review of out-of-hours care, NHS Lothian say: “Home visits are a key and core component of patient care out-of-hours services delivered by GPs and this should continue until alternatives are demonstrated safe and effective and efficient.”

They are looking at two clinical models for across the Lothian region - GPs and nurse practitioners based out of the Western General Hospital, St John’s Hospital and Royal Infirmary Edinburgh, while East and Mid Lothian “should be a GP delivered service with reduced opening hours and one car, driver and GP covering both East and Mid Lothian in the evenings with support from the Royal Infirmary, Edinburgh (RIE) as needed”.

NHS Borders were forced into taking emergency action in autumn 2013, basing all out-of-hours GPs and nurses at the BGH due to staff shortages.

A spokesperson explained: “Over the last two years as is common with all out-of-hours services within Scotland, we have struggled to recruit enough salaried GP staff to meet the needs of the service.

“This lack of ability to recruit GPs threatened the long term viability and sustainability of the service. There were inadequate numbers of staff available to provide cover to peripheral sites in Hawick, Kelso and Duns as well as the BGH. The cover being provided peripherally was sporadic at times and there was the risk that, were patients to present there, that there may be no GP on duty or that the GP may be out for a protracted period of time on home visits.

“Due to these risks and concerns, the service required to be centralised to ensure safety and stability. This was undertaken initially in the evenings in autumn 2013 and throughout the out-of-hours period (including weekends and bank holidays) in January 2014.

NHS Borders undertook an exercise to identify how much of the work previously undertaken by GPs could be delivered by nursing staff, concluding that around 70% of the workload could be undertaken by nursing staff.

A patient satisfaction survey of people seen at BGH in June-July 2014 indicates that of those who responded 94.4% were completely satisfied with the care they received from the out-of-hours service.

“Since implementing the changes required to sustain the out of hours service, our performance has significantly improved and now both meets, and exceeds in some cases, that provided by other out-of-hours services in Scotland,” continued the NHS Borders spokesperson.

“We continue to work with the Scottish Health Council (SHC) to ensure we are maintaining our communication and engagement with the public.

“Following a meeting with representatives from SHC in November 2014 we agreed that we would ‘engage with all community councils on the changes to the out-of-hours service and provide them with an opportunity to give feedback on the changes to the service,’ in advance of a paper being submitted to the February meeting of the NHS Borders board.

“All community councils were asked to respond by January 21. This was to give community councils an opportunity to provide feedback on the changes; it is not a formal consultation as we cannot raise unrealistic expectations about options that simply do not exist when we are unable to recruit Out-of-Hours GPs.”

However, a number of community councils did not receive the letter from NHS Borders and after being told that by Lammermuir Community Council chair, Mark Rowley, who also suggested the feedback period be extended, NHS Borders has agreed to accept comments until February 13.