Primary Care National Out of Hours Oversight Group minutes: April 2019

Attendees and apologies

Attendees

• Sir Lewis Ritchie (LR), Scottish Government (SG)
• Fergus Millan (FM), Primary Care Division, SG
• Gillian Stocks (GS), Primary Care Division, SG
• Michael Vacher (MV), Primary Care Division, SG
• Anne Harkness (AH), NHS Greater Glasgow & Clyde (NHS GG&C)
• Jan Beattie (JB), Primary Care Division, SG
• Andrew Buist (AB), Scottish General Practitioner Committee (SGPC)
• Sian Tucker (ST), Chair of National OOHs Operations Group
• David Small (DSm), NHS Lothian
• Stephanie Phillips (SP), NHS 24
• Michael Kellet (MiK), Chief Officer (CO)
• Moya Kelly (MoK), NHS Education for Scotland (NES)
• Maria McIlgorm (MMc), Chief Nursing Officer Directorate, SG
• Belinda Robertson (BR), Healthcare Improvement Scotland (HIS)
• David Shackles (DSh), Royal College of General Practice (RCGP)
• Jenny Long (JL), Scottish Ambulance Service (SAS)

Apologies

• Richard Foggo (RF), Primary Care Division, SG (Chair)
• Jim Ward (JW), SAS
• Amjad Khan (AK), NES
• David Leese (DL), CO
• Laura Ryan (LR), NHS 24
• Helen Maitland (HM), Unscheduled Care, SG
• Kirsty Walker (KW), Chief Nursing Officer Directorate, SG

Items and actions

1. Welcome, introductions and apologies

LR welcomed attendees to the meeting, noting apologies and advised he was asked to chair this meeting on behalf of RF.

2. Note of last meeting

The note of the previous meeting on 22 January 2019 was agreed.

3. Role, remit and membership of the group 

LR gave a short overview of the role and remit of the group which is to provide scrutiny and drive forward changes to make the OOHs service more sustainable and resilient. 
This group has been set up following the OOHs summit meeting in August 2018 and the National OOHs event in November 2018, which set out some key actions that the group are taking forward to improve OOHs services in the short, medium and long term.

FM said that the membership of the group had been extended for this and future meetings, and if members feel that further omissions or amendments are required, then this can be reviewed ahead of the next meeting in August 2019.

LR invited comments from the group on this agenda item and, the following points were raised in discussion:

• The group discussed and agreed, that a mapping exercise should be carried out to gain a better picture of OOHs services across Scotland. This was discussed further under agenda item 4, action 011
• FM said that HIS are in the early stages of drafting a report from the National OOHs event in November 2018 to identify and share good practice models with operational colleagues. This group needs to think more strategically and have linkages with Health Boards (HBs), NES and HIS
• BR said HIS are exploring what quality improvement support they can bring to the OOHs service, following feedback from the National OOHs event in November 2018. BR noted that this work has only just begun and is in very early stages
• ST said that the National OOHs Operations Group are pleased that this group is set up and there is a need for this group to engage with CO’s
• DSm asked if this group can have more involvement (than outlined in the Terms of Reference) in the scrutiny and policy development on the developments being taken forward by Health and Social Care Partnerships
• LR said that this group could meet virtually between meetings when required and this would be an opportunity for members to update each other on progress ahead of the next meeting.
• There is a need to identify the roles of specialist paramedics both in hours and out of hours to support the Service. The group had mixed views on this point. JL and AB agreed to discuss this further out with the meeting along with the SG
• Some members are keen to see rotational roles for Advanced Nurse Practitioners (ANPs) both in hours and out of hours. The group agreed there needs to be a drive towards staff being recruited on a rotational basis, between in hours and out of hours, for improved development and retention. The group noted that social care was another omission for the group and representation should be included at the next meeting

Actions:

• FM to discuss social care representation with Iona Colvin (Chief Social Work Adviser, SG) before the next meeting in August 2019
• Meeting to be set up between BMA, SAS and SG to discuss the role of paramedics in daytime services

4.Work plan update

ST provided a brief overview of the OOHs service which included particular areas of concern:

• NHS Borders and NHS Dumfries & Galloway are having challenges recruiting GPs
• NHS Lothian and NHS Grampian are having challenges retaining nurses
• NHS Glasgow are having challenges recruiting GPs and are currently advertising for salaried GPs but have not been successful in recruiting yet
• LR said that he has been asked to carry out an independent review of NHS Glasgow’s OOHs service

FM then went through the latest version of the work plan and provided an update on the following points:

• 003 GP Training Practices – a letter of interest was circulated by NES (on behalf of SG) on 10 April 2019 to all GP Training Practices. DSh advised that there are mixed views across practices and said that the practices interested may already be providing this training. DSh is keen to see a frequently asked question document produced to share with practices.
• 004 GP OOHs Development Fellowships – eight HBs registered interest in recruiting a development fellow. The advert went live on the GP jobs website on 17 April 2019
• 007 Enhance the recruitment and retention of OOHs working – SG colleagues are in the early stages of a business case for the Scottish Terms and Conditions (STAC) committee meeting in June 2019 to support enhanced rates for nurses working in OOHs. This was prompted by the loss of ANPs to in hours GP services. The group agreed that this proposal would need to be supported by  HBs and HSCPs. DSm agreed to share NHS Lothian’s recruitment and retention model with the group. MMc expressed some concern about this approach and implications. 
• 009 Resolve superannuation Issue – latest position is we will require amendments to the 2004 Regulations to allow GPs to opt in or out of the pension scheme. SG colleagues are looking into what amendments are required. The group noted their concerns of the lack of progress made to date on this issue.
• 011 Update on Progress of Pulling Together. 3 elements – update of Special health Boards activity, SG Policy  and an Integrated Joint Board (IJB) survey – this is a new action on the work plan following a request from LR to carry out a survey of IJBs, seeking an update on their progress against the recommendations of ‘Pulling Together: Transforming Urgent Care for the People of Scotland’. The plan is to issue the survey to IJBs by end of May with responses returned to SG by end of June. The aim of this survey is to gain a full picture of progress to date across Scotland, and present an update at the National OOHs Event in 2019 (which is currently being planned for November). The draft survey will be shared with Chief Officers as it develops. The group were in support of this survey. It is likely that the follow up with the special health boards and SG policy teams will proceed over a similar timescale. The plan is to pull this together for the next planned national OOH event in November.  

Action:

• DSm to share NHS Lothian’s recruitment and retention model with the group.

Any other business

There being no other business the meeting concluded.

Next meeting: 29 August 2019, 14:00 – 16:00, Apex Hotel, Waterloo Place, Edinburgh.