Main Report of the National Review of Primary Care Out of Hours Services

Chairman's Introduction

The onset or worsening of illness can occur at any time of the day, any day of the week. Irrespective of the time and place, the people of Scotland deserve a high quality service which fully meets their needs and does so reliably and at all times.

The commission of the Cabinet Secretary for Health, Sport and Wellbeing was to secure person-centred, sustainable, high quality and safe primary care during the out of hours (OOH) period - when general practices are closed. I hope that the recommendations from this Review should help to achieve that, but looking forward, also begin to lay the foundations for consistent urgent and emergency care, on a continuous basis (round the clock, 24/7), throughout Scotland. The National Conversation, instigated by the Cabinet Secretary, should help to shape and secure these aims.

OOH primary care services are under considerable pressure, as is daytime general practice. They are completely interlinked and mutually supportive. Improvements made to OOH primary care services should be applied from a person-centred, whole systems perspective, in order to avoid any adverse impact on daytime services. The converse is also true.

We must think anew about what is best for both urgent and emergency care for the people of Scotland and also be very sensitive about the imperative of narrowing health inequalities. We should now move towards a seamless service, which garners and retains the confidence of the people of Scotland and represents a valued working and learning environment for all those delivering health and care services - whether that be NHS, local authority social services, the third and independent sectors, and other agencies.

My colleagues and I have approached this Review in an inclusive way, on the premise that all those who receive and deliver health and care services are entitled to shape them. We are indebted to the public of Scotland who have participated through individual contributions in response to our Review and also during our national engagement programme. Equally, we have been gratified and humbled by the commitment and dedication of our colleagues who work for the statutory services and the third and independent sectors, throughout Scotland. We are very indebted to all those who generously supported this Review in many ways, times and places, who are too numerous to mention by individual name.

Guiding Principles in Health and Care Service Design and Delivery

We suggest that a service that is fit for the future should be underpinned by key guiding principles:

• Person-centred - for those who receive and those who deliver services
• Intelligence-led - making the most of what we know about our people and their needs
• Asset-optimised - making the most of all available assets and resources
• Outcomes-focused - making the best decisions for safe and high quality patient care and wellbeing

In addition to these guiding principles, such services should be:

• Desirable - high quality, safe and effective
• Sustainable - resilient on a continuous basis
• Equitable - fair and accessible to all
• Affordable - making best use of public funds

People seeking urgent help and advice need to be seen by the right professional, at the right time and in the right place - which might be face to face either physically or remotely, by telephone or video link. Traditionally, clinical advice and assessment has usually been delivered by general practitioners (GPs) face to face. In the future, health and care needs will be delivered by the most appropriate member of a multi-disciplinary team in person, or remotely - according to need and circumstances. The ongoing commitment and expertise of GPs to OOH services is essential and must be secured. Future urgent care provision must also include key and expanding contributions from the nursing workforce, pharmacists, paramedical practitioners, other allied health professionals, social services workers, third and independent sector personnel and support staff.

For this new approach for urgent care delivery to be successful, multidisciplinary and multi-sectoral teams should be effectively trained, work together and be well supported by a professional team of administrative and support colleagues. We also need to create the right conditions to value people, facilitate communications, learning and continuous professional development. This requires technologically enabled and innovative working environments, which are fit for purpose - for both service delivery and training. These environments must also be safe and secure for both patients and professionals alike.

Strong leadership will be crucial going forward, as will rapid and robust workforce planning at national and local levels, with the right capacity, capability and skill mix to underpin these aims.

A key recommendation in this Review is to develop a national implementation plan, supported by local implementation guidance. This recognises the importance of a holistic approach for urgent and emergency care at national and local levels.

We indicate that clarification of the roles, responsibilities and leadership of Health and Social Care Partnerships and Integrated Joint Boards will be essential to rapidly progress community based urgent care.

I am very conscious of the expectations from this Review, which concludes that we must rapidly transform our OOH urgent care provision in Scotland. We should also ensure robust and seamless pathways of community care - linking effectively with emergency departments and other acute hospital services. Some of our recommendations should have an impact in the short-term, but many will take some time to be fully implemented. The journey of effective and efficient integrated health and social care has barely begun - there are many miles to travel.

Closing on a personal note, for most of my career, I have been privileged to work in both daytime and OOH services on the front line, as a serving general practitioner. Reflecting back, I have experienced some of the most fulfilling moments in the OOH period, working closely with medical, nursing, ambulance service and support colleagues - pulling together as a team to help patients in urgent need, their carers and families.

Getting urgent and emergency care right is of paramount importance for the people of Scotland and for those who provide care for them. The case for immediate action is clear. We need to do this well and to do this with resolve.

Lewis D Ritchie

Chairman
National Review of Primary Care Out of Hours Services