Fife Out-of-hours General Practitioner Services (Closure)

– in the Scottish Parliament on 23rd October 2018.

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Photo of Christine Grahame Christine Grahame Scottish National Party

The final item of business is a members’ business debate on motion S5M-11786, in the name of Jenny Gilruth, on Fife out-of-hours closures. The debate will be concluded without any question being put.

Motion debated,

That the Parliament notes the decision of the Fife Health and Social Care Partnership to close out-of-hours GP services in Glenrothes, St Andrews and Dunfermline; understands that this was taken without public consultation; believes that it will increase health inequalities in Glenrothes and the surrounding area and see people having to pay for transport to Victoria Hospital in Kirkcaldy; further believes that it will create an additional resource burden on staff at the Victoria; considers that any public consultation that retrospectively takes place during the three-month contingency closure will be compromised, and notes the calls for the Director of the Fife Health and Social Care Partnership to reverse this decision with immediate effect.

Photo of Jenny Gilruth Jenny Gilruth Scottish National Party

This year—2018—is a very important year for Glenrothes, marking the town’s official 70th birthday. We share that special birthday with our health service, a national institution, so I want to begin tonight by thanking all the staff who make NHS Fife work. To the nurses, to the ambulance men and women, to the cleaners, to the administrative staff and to the doctors, I say, “Thank you. We value you.”

I am grateful to members from across the chamber for supporting tonight’s motion. Changes to Fife’s general practitioner out-of-hours services are not happening as a result of a Scottish Government decision, however. That responsibility rests with Fife health and social care partnership. Tonight’s debate is therefore an opportunity to share in Parliament what has been happening locally, but I would nonetheless welcome the minister’s views on how we can now move forward.

Every year, more than 850,000 people will use GP out-of-hours services in Scotland. Over half of those people will be seen in some sort of primary care facility, with just one in five being visited in their own home. The people who are most likely to use GP out-of-hours services are those over 75 or under five—perhaps the most vulnerable in any society.

On 4 April this year, elected members across Fife were contacted by the director of Fife’s health and social care partnership, to inform us that services had “fallen over”. Essentially, there were no longer enough GPs to staff out-of-hours services. That led to the start of contingency measures. In my constituency, Glenrothes hospital’s GP out-of-hours services closed from 12 midnight until 8 am, and GP out-of-hours services also closed in Dunfermline and St Andrews. Patients were told to travel to the Victoria hospital in Kirkcaldy. What was meant to be a temporary closure has now been on-going for 197 days. Given that Fife’s health and social care partnership took the decision to extend the contingency period, it will be a new year before the service is fully operational—if indeed that ever happens, because, despite a backdrop of closure, the partnership then took the decision to engage in a retrospective public consultation on transformative change.

The public consultation document, which was produced in July, some three months after the closures began, included GP out-of-hours redesign, but also community health and wellbeing hubs and community hospital and intermediate care bed redesign. That has understandably caused confusion, given that the focus is now not simply on GP out-of-hours services, and the clunky nature of analysing the provision of three separate services has meant that the partnership’s vision remains unclear. Although the consultation has—belatedly—given Fifers an opportunity to voice their concerns, it is retrospective public engagement that is taking place during a closure period. In my view, that has compromised the consultation from the outset.

I am not against the transformative change agenda. I know through my work—I am a former member of the Parliament’s Health and Sport Committee—that we need to work smarter. However, I continue to have concerns that Fife’s health and social care partnership is using the closure of GP out-of-hours services as a Trojan horse for something quite different, particularly as, in April 2018, Fife actually had one more GP than at the equivalent time last year, so this is not simply about numbers.

In 2015, the Scottish Government commissioned the Ritchie review of primary care out-of-hours services, two of the guiding principles of which are that out-of-hours services are person centred and intelligence led. Furthermore, the review made a specific recommendation regarding health inequalities, stating that

“The design and implementation of all”

GP out-of-hours services

“should demonstrate how they are ensuring equity of access and outcome”

and that

“Quality and safety implementation and monitoring of” out-of-hours services

“should be assessed for their impact on health inequalities.”

Fife’s health and social care partnership did not complete any equality impact assessment before deciding to close GP out-of-hours services. It should have assessed how closing local services would impact on the poorest communities. Despite numerous requests from my office for that information, it was only after I raised concerns with Healthcare Improvement Scotland in July that an equality impact assessment was very quietly uploaded online and backdated.

Reducing health inequalities is, however, a key deliverable in the Scottish Government’s 2020 vision for health and social care, which states:

“We will refocus our efforts on health inequalities particularly in the context of benefits cuts which will impact those most at risk of ill-health.”

Perhaps Fife’s health and social care partnership should have looked at the impact of benefits cuts on my constituency. Had it bothered to do so, it would have found that welfare cuts have hit Glenrothes harder than any other area in Fife. Over £1 million has been lost in benefits payments to the vulnerable people whom I represent. My constituency is already being disadvantaged by the political priorities of Westminster. Removing healthcare access for the poorest will only make that worse.

However, it is not just about benefit cuts. It is about hard, real poverty. In 2013, the Mid Fife and Glenrothes constituency had the worst child poverty figures in Scotland outside Glasgow. Five years on, it is the year of young people and our town is 70. What value is Fife’s health and social care partnership placing on the next generation and its access to healthcare?

NHS Health Scotland says that there are fundamental causes that drive health inequalities, including

“Societal values to equity and fairness”

and

“Political priorities and decisions”.

Although the closure of Fife’s GP out-of-hours service was not a decision taken by the Scottish Government or indeed this Parliament, it is reflective of a decision that was taken by health and care officials locally. Fife’s health and social care partnership did not complete and has not completed any transport appraisal. My constituents fear that they will be unable to afford the taxi fare to Kirkcaldy in the early hours if they need to go there. Even worse, the transport system that exists requires patients to ask for financial help if they cannot afford a taxi. That is completely undignified.

The rationale for GP out-of-hours closures back in April was predicated on clinical advice. Politicians cannot argue with clinical advice, nor do I believe that we should. The clinical advice was for a temporary closure. It said that patient safety would be compromised due to staff shortages. However, it did not assess patient safety the other way around. What about the mum who cannot afford a taxi to Kirkcaldy, the elderly man who has no car and the chronic asthmatic who cannot travel? The decision will widen health inequalities because it will be the poorest who suffer.

From elderly residents to the parents of children with serious medical needs, worries were raised at the various public meetings that I spoke at that residents in Glenrothes and the surrounding villages would become isolated from round-the-clock healthcare. Our national healthcare service was founded in 1948, which was the same year that the first turf was cut to build Glenrothes. From the cradle to the grave, it would be free at the point of need. For Glenrothes to lose out-of-hours GP services in our 70th year would be a travesty for the people whom I represent.

I look forward to the outcome of this public consultation, with the wellbeing of the kingdom’s most vulnerable in mind. I am confident that Fife’s health and social care partnership will come to the correct decision.

Photo of Murdo Fraser Murdo Fraser Conservative

I congratulate Jenny Gilruth on securing the debate and on raising an important issue for her constituents in Glenrothes and all those across Fife who are similarly affected. Although Jenny Gilruth understandably concentrated on the issue in her Glenrothes constituency, the issue affects people in the whole of Fife.

Public meetings have been held in Glenrothes, Dunfermline and St Andrews, and they were attended by large numbers of local people. My Conservative colleagues have attended them all, and Liz Smith and I attended a public meeting that was hosted by Willie Rennie in St Andrews earlier in the summer. We could tell from the attendance at that meeting how important the issue is to the local community. I understand that Mr Rennie has hosted another meeting more recently and it was even better attended than the one earlier in the summer. I could not be there that evening, but press reports indicated how much public concern there is about the issue.

For people who live in places such as north-east Fife and west Fife, the problem of the distance to travel to Kirkcaldy are more acute than they are for Jenny Gilruth’s constituents in Glenrothes. That is where the real public concern lies. How do people access services, particularly out-of-hours services, when they are a long distance away from where they live?

A whole range of risks are thrown up by the proposals from the Fife health and social care partnership. Will there be more ambulance call-outs as a result of the fact that people will have to travel further to access out-of-hours GP cover? Will more people attend accident and emergency services as a result of the fact that they cannot access such out-of-hours services? I do not think that we have so far had adequate answers to those questions.

There are practical issues for those who do not have access to private transport. If someone is living in a rural part of west Fife or north-east Fife, how do they get to Kirkcaldy after 11 o’clock at night or before 6 or 7 in the morning, when public transport commences? Again, I do not think that we have had adequate answers to those questions from the local health and social care partnership.

There is a particular issue in north-east Fife. Many of the doctors who are operating out of hours in the community hospital at St Andrews have offered to continue to do their shifts but, thus far, the health and social care partnership has told them that, unless they are prepared to relocate to Kirkcaldy, their services will no longer be welcome. That is deeply unfortunate. When trained GPs are prepared to offer a service locally, a local bespoke solution should, at the very least, be explored by the health and social care partnership, rather than it simply saying that if a doctor is not prepared to be available to work in Kirkcaldy, it does not want to hear from them or use their services at all. It is unfortunate if we cannot find a solution at least for the GPs in St Andrews and north-east Fife because of the attitude of the health and social care partnership.

I want to touch on two broader issues. First, the problem that has been identified is not unique to Fife; it is happening elsewhere in Scotland and in the region that I represent. The minor injuries units in Crieff and Pitlochry are facing problems because their difficulties in attracting qualified staff mean that they have to restrict their opening hours. The issues that Jenny Gilruth raised are reflected elsewhere.

That goes back to the second, and fundamental, issue of workforce planning. We simply do not have enough GPs to fill existing vacancies across the country. The Scottish Government needs to address the issue of better workforce planning. In particular, should we be capping the number of university places that are available for Scottish-domiciled medical students when we have the demand for more doctors and more GPs? We know that we have not met that demand in the past, and for those we are training here in Scotland, it is time to rethink the issue.

I agree with Jenny Gilruth. The health and social care partnership in Fife needs to think again. More than 6,000 people in Fife have signed a petition calling upon the partnership to do that, and it should listen.

Photo of Claire Baker Claire Baker Labour

I thank Jenny Gilruth for securing this debate, which is on a subject that is of interest to all MSPs who represent Fife.

She has set out many of the concerns about the decision to close the overnight out-of-hours GP services in Glenrothes, Dunfermline and St Andrews, with a service between midnight and 8 am now being available only in Kirkcaldy. MSPs from various parties have shared platforms at local meetings to hear the concerns of our constituents about the decision.

To start at the beginning, I point out that MSPs were emailed on 4 April, right at the start of the Easter holidays, by the director of health and social care, to be told that, as a contingency measure in response to nursing and medical staffing difficulties, the out-of-hours services at Glenrothes hospital, Queen Margaret hospital in Dunfermline and St Andrews community hospital were being suspended. Since I was elected in 2007, NHS Fife has held regular meetings with MSPs: I may be wrong, but I cannot recall the extreme pressures on out-of-hours services being raised with us prior to the decision being made.

At subsequent meetings since the decision, we have heard how precarious the service has been in recent months, yet the possibility of contingency measures was not discussed with MSPs or the public. There was no opportunity for scrutiny.

Moreover, the decision to suspend the services is not risk free—the additional pressure at the Victoria hospital in Kirkcaldy, which is already the accident and emergency site, needs to be closely monitored.

The difficulties that health boards are facing in recruiting and retaining GP and primary care staff are well known. In Fife, a number of GP practices operate closed lists and a number have had to come under the control of NHS Fife. Too many practices are relying on locum cover and are described as being in high-risk situations. Work should have been well under way on solutions that would have seen the hospitals remaining open overnight. I have heard GPs say that they were not aware of the precariousness of the service and were not consulted, so something has gone wrong in communication.

The immediate concerns that have been raised by constituents are about the difficulties that centralising of the service presents. Quite simply, the distances that are involved in travelling to Kirkcaldy in the middle of the night are significant for the majority of my constituents. For people who do not have a car, there is no public transport, and they will struggle to get a taxi at those times—never mind whether they have the money to pay for it. How is a single parent or someone who is elderly or vulnerable supposed to get to Kirkcaldy? We did not hear significant enough assurances from NHS Fife and the integration joint board that the issue would be dealt with, or that concerns about travel would not act as a deterrent to people who need to see a doctor. Jenny Gilruth’s points about an equality impact assessment were fairly made.

The situation was supposed to be a contingency measure for three months. However, at the end of that period, the fundamental issues of staffing had not been resolved and the contingency measure continued, which is now consumed by the joined-up care consultation that has just closed.

I want to raise three additional issues. I attended in St Andrews a public meeting that was organised by Willie Rennie. As Murdo Fraser has described, with a commitment from local GPs, St Andrews hospital is able to run an out-of-hours service, but NHS Fife argues that it needs to deliver for all of Fife and is refusing to accept a solution that would serve only St Andrews. I would like to see NHS Fife being flexible about St Andrews. A strong case has been made that the combination of the student population, many of whom are overseas students, an elderly population, and rurality justifies continuation of out-of-hours services, so a resolution that would achieve that should be worked on.

Secondly, on governance, the IJB took the decision to suspend the services based on clinical advice. I fully accept that patient safety must be paramount and that safe staffing levels must be maintained, but NHS Fife is actively avoiding taking any responsibility for the decision, although it was based on clinical advice. The IJB has delegated powers over GP provision—it does not have devolved powers.

I understand that Audit Scotland is examining the roll-out of IJBs and that governance is a key area of concern that has also been raised by the Health and Sport Committee. The decisions of the IJB are dependent on the workforce decisions that NHS Fife has made when it comes to clinical staff, and the GP situation in Fife has been approaching tipping point for the past few years. NHS Fife cannot hide from the decisions.

Finally, I acknowledge the Government’s arguments that the new GP contract will improve the situation, and I am aware of the work that is being undertaken at the University of St Andrews and the University of Dundee to increase the number of GPs through the Scottish graduate entry medicine—ScotGEM—programme. That is positive, because we need imaginative solutions to increase GP numbers, which is the issue at the heart of the situation.

However, we in Fife should never have got to a situation in which health services are being closed and we risk exacerbating health inequalities because we do not have enough GPs and primary care staff to deliver services. I have to say that all this has come about during the past 11 years of the Scottish National Party Government, which could be seen to have taken its eye off the ball while the crisis was looming.

Photo of Mr Mark Ruskell Mr Mark Ruskell Green

I thank Jenny Gilruth for lodging the motion and for reminding us that the changes in service delivery will take away the dignity of some of the most vulnerable people in our communities. It is important that we listen to their voices in considering how to deliver a fair and equitable service.

I will focus on the national context for GP out-of-hours services.

Although closure of the services in Dunfermline, Glenrothes and St Andrews is an issue of great importance and concern to our constituents, the situation is not unique to Fife. It is deeply affected by the shortage of GPs in Scotland, which was blamed for the emergency closures back in April, but it is also part of a national strategy to change how primary care emergency services are delivered.

The Ritchie review, which the Government published in 2015, warned that out-of-hours services across Scotland in their current form

“are fragile, are not sustainable, and may worsen rapidly if we do not rise to the occasion.”

The review stated that patients should no longer expect to see a GP for urgent care, which instead should be delivered by a multidisciplinary team that could include nurse practitioners, community nurses, paramedics, pharmacists and other allied health professionals, as well as GPs. The review also recommended that the multidisciplinary teams be co-ordinated through a central urgent-care resource hub.

If the recommendations in the Ritchie review were delivered in their entirety, they could significantly strengthen out-of-hours provision in Fife and improve patients’ access to and experience of care. We need to accept that the status quo might not be the best option if we are to move forward in a meaningful way.

That said, I am highly critical of the options that the Fife health and social care partnership laid out in its recent consultation, as I made clear in my submission to it earlier this month, which drew on the experiences that I have heard about in public meetings. The partnership seems to be delivering only half of the Ritchie report recommendations. It is jumping at the opportunity to centralise service delivery without putting in place a multidisciplinary team to help to deliver the services in the community.

The consultation emphasises the low number of people who use the overnight services between midnight and 8 am, but it then uses that to justify complete withdrawal of the services from Glenrothes and St Andrews, including during evenings and weekends. On average, nearly 150 people a day use the weekend service. To leave people in Glenrothes and north-east Fife without any kind of local service for a full 62 hours, from Friday night until Monday morning, is simply unacceptable.

The health and social care partnership needs to go back to the drawing board, and to consider how it can use a multidisciplinary team to retain some level of local service. That might look quite different from how it looks now, perhaps with nurse practitioners delivering care during the daytime, with remote access to GPs who are based in Kirkcaldy. It could involve using ambulances as urgent-care centres in rural areas, or referring patients to a community pharmacy for consultation and prescribing. All those options were proposed in the Government’s Ritchie review, but were not considered in the recent Fife consultation.

I urge my fellow members to engage fully with all the options and not just to cling to the status quo. We will not solve the crisis in GP recruitment any time soon, so in the meantime we need to understand what kind of care the most vulnerable people in our communities need, and how we can realistically deliver it. That requires further work on all sides, so I hope that Fife health and social care partnership will come back to the table soon with a workable solution.

Photo of Willie Rennie Willie Rennie Liberal Democrat

I, too, congratulate Jenny Gilruth on securing the debate. She set out the circumstances of the consultation very well. However, I gently disagree with her point that there has been an increase in the number of GPs in Fife. Perhaps there has been, but the whole-time-equivalent figure has certainly gone down, which has led to the problem and the circumstance that we are dealing with. It is expected that, by 2021, we will be short of 800 GPs nationwide. Otherwise, I agree with Jenny Gilruth’s analysis of the situation—we need a change of heart from the Fife health and social care partnership.

The change to GP out-of-hours services is a big issue in east Fife. About 2,300 people from the east neuk filled out postcards as part of a campaign that was led by the community council and by Daryl Wilson, who did a tremendous job. More than 6,400 people, including students and others from across the community, have signed my petition, and people from all parts of east Fife have been coming forward and offering to collect signatures for the petition. The public meetings have been packed to the gunwales; people from every part of the community have been there. There are more people at the public meetings in east Fife than there are at such meetings anywhere else in Fife. That reflects the fury and anger about the situation that exists there.

I make a special plea for east Fife. There are large numbers of students and elderly people in the area, and there are remote and rural communities. The distance to Kirkcaldy is quite a problem, and it is difficult for many people to get there. It is incredibly expensive to get a taxi to Kirkcaldy in the middle of the night. We need to consider those issues when we are considering what kind of services we should be providing in east Fife. There is, in east Fife, a strong general feeling that if a service is going to be cut, it will be cut in east Fife first. That is not acceptable, and I hope that the Fife health and social care partnership reflects on that.

We are supposed to have a back-up service from King’s Cross hospital in Dundee so that people in Newport, Tayport and the north end of east Fife can nip over the Tay to receive services there. However, there are already capacity issues on Tayside, so such access is not always guaranteed. Apparently, people from St Andrews can access King’s Cross at night time if there is capacity available, but in general there is confusion about where people are supposed to go—about whether they should go to Kirkcaldy or Dundee. We need clarity on that.

We are told that we can access services at King’s Cross, but the GPs on Tayside will not do home visits in east Fife. GPs on such visits will have to come from further west, so the distance issue therefore also applies in those circumstances.

As Murdo Fraser rightly mentioned, GPs are prepared to step up to provide a service for east Fife. It might be a different type of service, but they are prepared to participate, and their offer should be taken up. I know that discussions on that are under way.

Finally, the consultation process was wholly inadequate. I do not know who made the decision to wrap three consultations into one, but it was a poor decision. The document was riddled with jargon and it was difficult to find the link to complete the consultation. There are a lot of intelligent people in St Andrews, including many academics, but several of them have come to me to say that although they have two degrees—some of them even have three—they found it difficult to complete the consultation document. It is pretty clear that, despite the advice that people have received from various parts of the health service, the consultation process was inadequate.

My final plea is to the Minister for Public Health, Sport and Wellbeing. If the Fife health and social care partnership does not make the right decision on the matter and does not reflect on the huge opposition that exists in east Fife and in other parts of Fife, he should step in and ensure that it does make the right decision.

Photo of Annabelle Ewing Annabelle Ewing Scottish National Party

I, too, congratulate my Fife colleague Jenny Gilruth on bringing to the chamber this important and timely debate on the position of out-of-hours primary care in Fife. She set out clearly the background to the issue, so I will not go over the same ground. However, I will say that I, too, as MSP for Cowdenbeath, raised concerns when the initial announcement was made out of the blue, in April this year, that out-of-hours care would be offered only at one site—the Victoria hospital in Kirkcaldy—rather than over the four sites that were being used prior to the announcement.

I wrote to the director of the Fife health and social care partnership, Michael Kellet, and had several discussions with him on the matter. In those discussions, I raised a number of issues, including capacity at the Victoria and transport. I asked what arrangements were in place for those who did not have access to a car; those who are lone parents with other children at home as well as a sick child who needs medical attention; and those—to whom Jenny Gilruth referred—who have long-term conditions such as chronic asthma. The information that has been forthcoming on those points to date has not exactly been clear and, as Jenny Gilruth said, it appears that no transport appraisal has been commissioned.

The issue is all the more pressing as we look to the recent NHS Fife consultation on out-of-hours urgent care redesign in Fife, among other issues. As has been mentioned, in essence two options have been put forward, with the status quo—that is, what was in place before April and had been in place for some years, before these contingency arrangements were introduced—being ruled out, apparently by clinicians, on sustainability grounds, we are told.

Although I can well understand the frustration of people in other parts of Fife about the approach that is being taken—we have heard that frustration tonight in clear and cogent terms—I must stress, as the constituency MSP for Cowdenbeath, the importance of maintaining the footprint of the Queen Margaret hospital in Dunfermline. In recent years, there has been a considerable expansion in the number of services that are offered at the Queen Margaret hospital, to the benefit of my constituents and those of my colleague, Shirley-Anne Somerville, the MSP for Dunfermline. I feel sure that local people would not wish that trend towards expansion to be impinged on to their detriment. Hence, in the context of the options that are being proposed by NHS Fife at this time, option 2 seems preferable to option 1. Option 2 would see the Victoria and the Queen Margaret open overnight for out-of-hours urgent care, which would represent a better service for my constituents.

However, the important issue of transport still remains to be clarified. In that regard, I note that page 18 of the consultation document says that Fife health and social care partnership will, with a view to ensuring that people have equal access to urgent care,

“develop a procedure to support people who have difficulties getting to an appointment.”

I am seeking clarification about what exactly that means, and I ask the minister to confirm that he will seek appropriate assurances from Fife health and social care partnership on the important matter of transport, which has been raised by every member who has spoken today.

Particular reference is made in the consultation to the position of paediatric services, with the point being made, fairly, about the importance of immediate and direct access to specialist support if that suddenly becomes necessary, given that children can become very unwell very quickly. That support is available at the Victoria, but not at the other sites. The consultation document does not explore in detail that issue or the impact that it might have on the viability of the health and social care partnership’s position with regard to the viability of option 2. However, I would have thought that it would have been possible, if deemed appropriate, to separate paediatric out-of-hours services from services for other users, as necessary, and still allow the two sites to be used for overnight appointments in general.

I agree that the way in which the matter has been dealt with so far by Fife health and social care partnership has not been optimal, to say the least. However, we need to see longer-term out-of-hours arrangements in place, and, as far as my constituents are concerned, it is vital that the excellent role that the Queen Margaret hospital plays in the community is not diminished in any way.

Photo of Alexander Stewart Alexander Stewart Conservative

I, too, congratulate Jenny Gilruth on securing the debate on this vital issue. We have heard many members speak passionately about the process, which is important.

We have already heard that the primary care emergency services in Glenrothes, Dunfermline and St Andrews were suspended due to the lack of GPs and other staff, and we have heard about where we are with regard to the process of ensuring that we have enough cover for the growing communities across the Mid Scotland and Fife area. At the meeting that I attended in Dunfermline, there were some passionate individuals who articulately expressed their opinions about the health and social care partnership, and the representatives of the partnership gave what I can only call lip service to those views and opinions, which did not go down very well. The people did not feel that the views that they were expressing in the consultation were being listened to. I found that very disappointing.

I have heard that similar views were expressed at the other meetings that took place across the region. People felt that the situation was more of a fait accompli than a process that was being looked at and challenged. Those meetings were and continue to be very important, because they are the only opportunity for some individuals to engage with the process. It is vital that we are confident that we can engage.

Every member who has spoken this evening has talked about the partnership’s inability to manage the situation on behalf of our constituents. That must be taken into account. The partnership has said that this is happening because it could not ensure patient safety, but patient safety will be compromised all over the region if patients are unable to access out-of-hours GP services.

We have heard tonight about transport issues. I hope that the minister can tell us exactly what is happening in that respect, because it is totally unacceptable to ask people to travel long distances to Kirkcaldy or Dundee. We are just about to get into winter, when our climate can be very volatile, especially in the evenings. We would be asking individuals to make journeys that could be quite treacherous—the anxiety that some would experience is also a big problem.

The consultation has been very much mismanaged by the health partnership and that has resulted in huge difficulties in the region. As I said, decisions seem already to have been taken, and people believe that real consultation is not taking place. The possible consequences could be detrimental to the communities that we represent.

The Government has acknowledged that it faces recruitment and retention issues, but it needs to come up with solutions to ensure that those issues are dealt with. In Glenrothes, Dunfermline and St Andrews, we have an opportunity to ensure that individuals feel that their priorities are being taken into account. The status quo is totally unacceptable—these facilities cannot continue to close, and individuals with health conditions cannot be asked to travel long distances.

The partnership must sit up and listen, which it is not doing at the moment. In discussions that I have had with some clinicians, it is as if they know best in this situation. We expect the health service to ensure that people are given the treatment that they require. The partnership must acknowledge that this situation will not be resolved without it making big changes for the communities that we represent.

Photo of Joe FitzPatrick Joe FitzPatrick Scottish National Party

I, too, congratulate Jenny Gilruth on securing the debate and echo her thanks to the staff in our NHS for everything that they do for us in Fife and throughout Scotland.

Access to urgent primary medical services outwith normal GP surgery opening hours is a fundamental part of unscheduled care in Scotland. The service is there for people who become unwell when their GP surgery is closed and the illness cannot wait until the surgery reopens. Every year, around 870,000 patients across Scotland use the out-of-hours service. In Fife, around 4,470 patients are seen every month by the out-of-hours service, with an average of 20 a week seen between midnight and 8 am.

I acknowledge that there have been difficulties across Scotland in sustaining the out-of-hours service. It is also important to acknowledge that general practice is not a 9-to-5 business.

How did we get to where we are? It is not just about GP numbers. Claire Baker mentioned action that the Government is taking to tackle that issue. The root of the problem is a consequence of a change to GP contracts that was negotiated way back in 2004, which made working in the out-of-hours setting non-mandatory. As a result, over time, some GPs coming into the service have decided that they do not wish to work in the out-of-hours service, and time has crept up on those GPs who have continued to work in the out-of-hours service, with a significant number having now retired from general practice. I am extremely grateful to those GPs and other clinicians who do work in the out-of-hours service.

As a number of members have noted, in 2015, the Scottish Government commissioned Sir Lewis Ritchie to carry out a national review of our out-of-hours service. The report that he published was “Pulling together: transforming urgent care for the people of Scotland”. The review considered how best to deliver out-of-hours primary care services in the light of challenges posed by Scotland’s ageing population and the integration of health and social care services. The review highlighted that a multidisciplinary model should be adopted in the service design and delivery of urgent care in the community, and it provided a foretaste of the direction of travel for the delivery of primary care in-hours.

The report outlined the expectation that GPs will no longer be the default healthcare professional whom patients see for urgent care. However, they will continue to play a key and essential part of urgent care teams, providing clinical leadership. As Mark Ruskell said, the proposed model of care is clinician led and supported by a multidisciplinary team that includes GPs, nurses, community pharmacists, paramedics and other specialists. It recognises that patients will be seen by the most appropriate professional to meet their urgent care needs.

I turn to the out-of-hours service in Fife. In April this year, Fife’s health and social care partnership took the difficult decision to reduce its overnight service provision from the three centres in Dunfermline, Glenrothes and St Andrews to one centre for the overnight period, which operates from the Victoria hospital in Kirkcaldy. That was not a decision for this Government or this Parliament. The partnership set out that it believed that the decision had to be taken quickly, and I understand that it has conceded that the implementation of contingency measures for the provision of the overnight element of the out-of-hours GP service felt sudden. That has been echoed by members from around the chamber, who feel that there was a lack of consultation. Perhaps that is a lesson that the partnership will take from today’s debate.

As members will be aware, the partnership subsequently extended the contingency arrangements to the end of January next year.

I appreciate that there have been many local concerns about the contingency measures and the consultation exercise on the future of the service. In response, the partnership has said that it has considered the consultation since 2016-17, when it completed an options appraisal exercise. It told me that that included workshops with members of the public in Fife, and that the intention was to look at the future of the service using the latest data and evidence.

The next phase of planning by Fife health and social care partnership was a consultation exercise to share the decisions about the options appraisal exercise. At best, it was unfortunate timing that the decision to implement contingency measures happened just as the consultation was announced. The partnership has repeatedly sought to provide assurances to the Scottish Government that, at that stage, no decision had been made about the outcome of the public consultation.

I understand that the consultation period ended on 8 October and that the responses are currently being analysed. It is important to enable the local consultation process to run, and I am not in a position to comment on any likely outcome at this time. However, I understand that draft proposals will be taken through the partnership’s governance committees during November. The report and final proposals will be considered by the Fife integration joint board at its meeting on 20 December.

The Scottish Government has been very clear that NHS boards and health and social care partnerships are expected to ensure the delivery of safe and sustainable services across the locality that they serve and in the round.

The points that were raised by Willie Rennie and Murdo Fraser are important. If there are options, they should be fully explored. I understand that the option that Willie Rennie mentioned is still under discussion, as he said, and I hope that it is being seriously considered as part of the solution.

Jenny Gilruth, Claire Baker, Mark Ruskell, Annabelle Ewing and Alexander Stewart all raised important issues, such as the impact of contingency measures on people’s ability to access services, which particularly applies to those who have limited or no access to travel options—I apologise to any other members who also mentioned that issue. I am clear that the partnership should carefully consider such issues as it plans for the future.

I again thank Jenny Gilruth for bringing this issue to the attention of the chamber. I hope that I have provided reassurance that the Scottish Government takes these matters seriously and that we expect decisions by partnerships to follow meaningful community engagement.

Meeting closed at 17:45.