Primary Care Out-of-hours Services

– in the Scottish Parliament on 1st December 2015.

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Photo of Jenny Marra Jenny Marra Labour

1. To ask the Scottish Government what its response is to the report by the independent review of primary care out-of-hours services, “Pulling together: transforming urgent care for the people of Scotland”. (S4T-01197)

Photo of Shona Robison Shona Robison Scottish National Party

The Scottish Government welcomes the report of the national review of out-of-hours services, which was published on 30 November. I thank Professor Ritchie for all his hard work in preparing such a wide-ranging and comprehensive report. Given the complex issues that are involved, we have asked all key delivery partners, including health and social care partnerships, to set out how they propose to deliver the recommendations locally. We will then use those local plans to inform a detailed national implementation plan, which we will publish in the spring of 2016. To ensure that we see action immediately, I have announced £1 million to begin testing the new urgent care hub model that is recommended in the report.

Photo of Jenny Marra Jenny Marra Labour

One of the recommendations involves effective workforce planning and calls for a national primary care workforce plan—something that I and many of my colleagues on the Labour benches have suggested before. Does the cabinet secretary now agree with Sir Lewis Ritchie that workforce planning should be taken forward urgently? What is her timescale for that?

Photo of Shona Robison Shona Robison Scottish National Party

Workforce planning is and always has been fundamental, and of course we accept all the recommendations in the report. I set out in my initial answer that the detailed national implementation plan will bring together all the elements of the report and how they will be implemented by the Scottish Government, boards and partners, and I said that I would bring that forward in the spring of next year.

In the meantime, though, it is important that we get on with elements of the report. For example, the testing of the new urgent care hub model is important. We want to get on with identifying test sites for that, and we are going to do that immediately.

Photo of Jenny Marra Jenny Marra Labour

We very much welcome the £1 million of funding that has been put in place for the testing of the pilot hub model, but the cabinet secretary will know that the out-of-hours service across the country is struggling, with reports of as few as two general practitioners covering whole regions, and real problems in Lanarkshire. The cabinet secretary says that in the spring she will bring forward information on how her Government will implement the recommendations, but what will she do now about the pressure on our out-of-hours service in Scotland?

Photo of Shona Robison Shona Robison Scottish National Party

I would not have commissioned the out-of-hours report from Sir Lewis Ritchie had I thought that there were no challenges in the out-of-hours services. That is why I commissioned him to do the report. It is excellent and it sets us on the right path to transforming our out-of-hours services. There are short, medium and longer-term aspects to the report, as Sir Lewis lays out, but we will get on with the job of transforming the out-of-hours services.

In the meantime, of course, out-of-hours services form an integral part of the winter plans, and there is £10.7 million for those plans to ensure that there is resilience in all our services. That includes making sure that the out-of-hours services are robust over the winter. Then the transformation will begin, and the report that sets out how that will happen will be published in the spring, as I said.

Photo of John Scott John Scott Conservative

The cabinet secretary will be aware of the different terms and conditions that different health boards are offering to general practitioners who provide out-of-hours services. She will know that, while some areas are able to provide GPs for their doctors-on-call services, other health boards, such as NHS Ayrshire and Arran, are moving towards providing them through the welcome services of advanced nurse practitioners. How does the cabinet secretary view that change in provision? What, if anything, is she doing about it?

Photo of Shona Robison Shona Robison Scottish National Party

One of the proposals in the report is for a national GP performance list for Scotland. However, the member has highlighted an important issue, because boards often compete with each other for the same GPs. That is why the recommendation that there be a GP performance list, along with many others, will be so important in bringing together the out-of-hours services in a more coherent way that avoids having boards competing with one another. As we work through the recommendations, we will expect boards to look at their own local plans to ensure that they reflect the recommendations about those plans in the short term and then to get on with the job of implementing the recommendations. That will make a big difference to out-of-hours services across Scotland, including in the member’s locality.

Photo of Jim Hume Jim Hume Liberal Democrat

The review points out that people in remote and rural locations are more likely to report negatively about out-of-hours care and that there is concern among people living in those areas about the distance from access to out-of-hours care. With more than 100,000 patients being treated outwith their health board area in 2014, what assurances can the cabinet secretary give to people living in remote and rural areas that they will have the care that they need when and where they need it?

Photo of Shona Robison Shona Robison Scottish National Party

Jim Hume talks about people being treated outwith their board area, but what he is referring to is the fact that many people are treated at centres such as the Golden Jubilee centre, which is a national resource. I am sure that he would not think that it was a bad thing for patients from across Scotland to go to that centre for excellent treatment.

Sir Lewis Ritchie spends a good deal of the report looking at the remote and rural challenges. As we move forward with the recommendations, I am keen to test how the new urgent care hub model will work both in urban and in remote and rural contexts. Without a doubt, there is a reliance in remote and rural areas on the local assets of the community, such as first responders, who have a very important role, as do the ambulance service and the primary care out-of-hours services. I am very keen that we test the new model in a remote and rural context for its application more widely.

Photo of Duncan McNeil Duncan McNeil Labour

I agree with the cabinet secretary that the report is worthy and that we need to make progress on it. The cabinet secretary has mentioned the GP contract for 2017 and the implementation plan for 2016. The report highlights that deprived communities are losing out now and could benefit now, so can beneficial elements of the report be rolled out and implemented prior to those dates in deprived neighbourhoods and communities, such as those in Inverclyde?

Photo of Shona Robison Shona Robison Scottish National Party

Duncan McNeil will be aware that the publication of the report coincided with the publication of research commissioned by the Scottish Government that highlighted some of the issues that Duncan McNeil has referred to. He will also be aware that, within the existing GP contract, there is an element of funding for deprivation: the 100 deep-end practices receive a total of around £5.4 million. However, as he will know—and as I have said before in the chamber—we need to go further than that, and the new contract offers the opportunity to do so.

We will have a transition year for the new contract in 2016, with large elements of the quality and outcomes framework being dismantled to remove bureaucracy. If there is anything that we can move on earlier with regard to that or, indeed, aspects of Sir Lewis Ritchie’s recommendations, I will certainly look at it. Perhaps for some of the modelling and testing, we can have a focus on testing in some of the more deprived communities to see how the model can work to best effect.

Photo of Elaine Smith Elaine Smith Labour

Given the report and the research, does the cabinet secretary think that it would be appropriate for NHS Lanarkshire to go ahead with a plan to provide a centre just in South Lanarkshire and not to have a centre at all in the North Lanarkshire area?

Photo of Shona Robison Shona Robison Scottish National Party

As I have said before—there is no change on this—we would expect NHS Lanarkshire to look at the report and apply what it says to its services. If the board moves to any permanent change in its out-of-hours provision—it is an interim service that it has at the moment—that issue would, of course, come to the Scottish Government, but I would expect NHS Lanarkshire and all the other boards to make sure that their services are in line with the report’s recommendations, as I have said previously in this place.