Out-of-hours General Practitioner Services

– in the Scottish Parliament on 4th June 2019.

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Photo of Jamie Greene Jamie Greene Conservative

1. To ask the Scottish Government what action it is taking to improve out-of-hours GP services in the NHS Greater Glasgow and Clyde area, in light of reports that only one in five centres was open on Sunday. (S5T-01686)

Photo of Clare Haughey Clare Haughey Scottish National Party

I expect all integration authorities to take every measure possible to ensure that safe and sustainable out-of-hours services are provided. However, arrangements are in place for Sir Lewis Ritchie and senior Scottish Government officials to meet the management team in Glasgow regarding their review of out-of-hours care and the difficulties that are being experienced by the service.

Since 2016-17, the Government has provided an additional £6.6 million to the Glasgow integration authorities to support implementation of Sir Lewis Ritchie’s review of out-of-hours services.

Photo of Jamie Greene Jamie Greene Conservative

The reality is that, this weekend, only one centre was open across the whole of the city of Glasgow. I pay tribute to the staff at Vale of Leven hospital, who had to deal with the huge amount of people coming in to see them.

When people in the south side or east end of Glasgow phone NHS 24 and are directed to an out-of-hours service, it is virtually impossible out of hours to get to that location because it requires a taxi or a lengthy car journey. Most people will turn up at an accident and emergency unit, which puts more pressure on our emergency centres on busy Saturday nights.

What I did not hear in the first answer is what action the minister—or, indeed, the Scottish Government—is taking to address the issue of GPs who are not contracted to do out-of-hours shifts choosing not to do them. What are the reasons behind GPs choosing not to do those shifts? Why is it becoming a systemic problem in Glasgow?

Last year, more than 211 shifts in the NHS Greater Glasgow and Clyde area were not filled because of staff shortages. In her second answer, perhaps the minister can go into more detail about what action she is taking to address the problem.

Photo of Clare Haughey Clare Haughey Scottish National Party

My understanding is that arrangements were put in place between NHS Greater Glasgow and Clyde and NHS 24 over the weekend to deal with the closures. Home visits by GPs were available to people who had clinical need for that.

I am not happy with the level of service, and I expect NHS Greater Glasgow and Clyde and the health and social care partnerships to take every possible step to stop that happening again.

As I said in my first answer, Sir Lewis Ritchie and the out-of-hours policy team have a planned meeting with NHS Greater Glasgow and Clyde to discuss progress on the review of its out-of-hours services. That meeting will be on Monday 10 June; this weekend’s issues will form part of the discussion. We expect to receive an update in due course following that meeting.

I also pay tribute to the staff at the Vale of Leven centre, who were under pressure at the weekend because their centre was open.

Photo of Jamie Greene Jamie Greene Conservative

I thank the minister for that further update.

However, the reality is, as we learned last week, that across Scotland, more than 100,000 patients have had to find new GP services because their local practice has closed due to excessive shortages of GPs. Every member will have constituents who are struggling to get an appointment—who are queuing on a Monday morning or who cannot get through on the telephone to get an appointment. This is not just an out-of-hours problem; it is an in-hours problem.

I would like to hear what action the Government is taking to address the systemic problem of GP shortages right across Scotland. Can the minister assure us and the wider public that what happened at the weekend in Glasgow was just a blip—that it was just a one-off—and that there is not a systemic problem that is facing us right across the country on a continuous basis, because that would simply not be good enough?

Photo of Clare Haughey Clare Haughey Scottish National Party

I assure Jamie Greene that I share his concerns. I want to ensure that the people of Glasgow—and, indeed, the people of Scotland—get the NHS that they need. Jamie Greene will be aware that we have recently rolled out the new GP contract, which helps to reduce GPs’ workloads so that they can spend more time dealing with the more complex cases and patients in their case load. We are considering expansion of the primary care team, which encompasses advanced nurse practitioners and other allied health professionals, in order to free up GP time so that they have smaller workloads and can use their skills more effectively.

We have also been investing in primary care pharmacy and the minor ailments service. I assure the member that we are looking at GPs’ workload.

We are also looking to expand the number of GPs. We have increased the number of medicine places in Scottish universities, which will increase by 22 per cent—an extra 190 places—between 2015 and 2021.

Photo of Jackie Baillie Jackie Baillie Labour

I am delighted that the Vale of Leven hospital’s out-of-hours service was open, and join other members in praising the staff. Of course, the irony is that it is normally the Vale’s out-of-hours service that is closed. Last year alone, there were more than 80 shutdowns of the out-of-hours service, and there have been more than 40 so far this year. Will the minister consider use of salaried GPs, or even allowing local GPs who cover the Vale of Leven catchment area to arrange out-of-hours care at the hospital?

Photo of Clare Haughey Clare Haughey Scottish National Party

I expect that that will be discussed in Lewis Ritchie’s review, in looking at what NHS Greater Glasgow and Clyde is doing to ensure that it has GPs to cover out-of-hours services. My understanding is that there are some salaried GPs in the out-of-hours GP service as a whole, but most of the GPs who work in the service are not salaried.

Photo of Stuart McMillan Stuart McMillan Scottish National Party

As the minister will be aware, staff can be deployed throughout the system to ensure that adequate cover is maintained across the health board area. Given that, is the minister aware of whether there is a preference as to which out-of-hours centres will be open on any given weekend?

Photo of Clare Haughey Clare Haughey Scottish National Party

I do not have that information to hand for Stuart McMillan, but I make a commitment to request that he gets it as soon as I have it.

Photo of Anas Sarwar Anas Sarwar Labour

Obviously, Saturday night is a peak time for accident and emergency services across the west of Scotland and the whole of Scotland. There are two impacts. One is on patients who perhaps have to wait longer to access NHS 24, or who show up in A and E departments when they would not normally do so, which increases their waiting time.

There is also an impact on the NHS staff, who are already overworked and who face more pressures because there are fewer staff and more requirements on them. I understand the point about the review, but if the minister recognises those two pressures, what urgent steps will she take to reassure patients across Glasgow and the west of Scotland that they can have a wraparound out-of-hours service?

Photo of Clare Haughey Clare Haughey Scottish National Party

As I said in answer to Jamie Greene, I am not happy with the level of out-of-hours service that was provided at the weekend. We expect NHS Greater Glasgow and Clyde and the health and social care partnership to look at the service to ensure that we do not end up in the same situation again. Mr Sarwar has raised valid points. I again pay tribute to the staff who were on duty on Saturday night and Sunday night and who provided a service to the people of Glasgow.