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

Attendees and apologies

Attendees

• Richard Foggo (RF)Scottish Government (SG), (Chair) 
• Sir Lewis Ritchie (LRi), Primary Care Division (PCD), SG
• Fergus Millan (FM), PCD, SG
• Gillian Stocks (GS), PCD, SG
• Michael Vacher (MV), PCD, SG
• Jan Beattie (JB), PCD, SG
• Kirsty Walker (KW), Chief Nursing Officer Directorate, SG
• Fiona MacDonald (FMac), Analytical Services Division (ASD), SG
• Iain MacAllister (IMac), ASD, SG
• Julie Main (JM), Unscheduled Care, SG
• Amjad Khan (AK), NHS Education for Scotland (NES)
• Belinda Robertson (BR), Healthcare Improvement Scotland (HIS)
• David Leese (DL), Chief Officer
• David Shackles (DSh), Royal College of General Practice (RCGP)
• Jenny Long (JL), Scottish Ambulance Service (SAS)
• Jim Ward (JW), SAS
• Laura Ryan (LRy), NHS 24
• Stephanie Phillips (SP), NHS 24
• Sian Tucker (ST), Chair of National OOHs Operations Group

Apologies

• Andrew Buist (AB), SGPC
• Anne Harkness (AH), NHS Greater Glasgow & Clyde (GG&C)
• David Small (DSm), NHS Lothian
• Helen Maitland (HM), Unscheduled Care, SG
• Maria McIlgorm (MMc), Chief Nursing Officer Directorate, SG
• Moya Kelly (MoK), NES

Items and actions

1. Welcome, introductions and apologies

LRi welcomed attendees to the meeting, noting apologies and advised RF would be joining the meeting at a later point. LRi also noted that this would be RF last meeting thanking him for his support and wished him all the best in his new role.

2. Horizon scanning session – are we on the right track?

LRi reflected that it is just over a year that some of the members in the group met to discuss the resilience of OOH. A number of actions were agreed that would bolster OOHs in the short to medium term. Progress has been made, but the aim of the session is to think about what the future of OOHs could look like.

There then followed a round table discussion – details of this discussion can be found in Annex A to this note. 

The following key themes were identified by the group:

• The importance of public awareness, education and messaging
• limitations of the available skilled workforce remains a significant risk
• capacity and capability of the system to enable change remains limited
• IT data related issues

As part of this session the group carried out a system-mapping exercise. The thoughts from this exercise have been captured and will be circulated in due course.

Actions:

• FMac/GS to share themes from the system-mapping exercise with the group
• BR agreed to scope out previous public engagement work that’s been carried out and produce a summary report for the group
• NHS 24 and SAS to present on how they work together to deliver emergency and urgent care at the next meeting
• LRi/FM to re-visit principles with the BMA which were agreed in support of OOHs

3. Note of last meeting and matters arising

The group then moved onto the business as usual part of the meeting.

The note of the previous meeting on 24 April 2019 was agreed. Matters arising where covered under the following agenda item.

4. Work plan update

LRi invited GS to provide an update on the latest version of the work plan. GS provided an update on the following points:

• GP OOHs development fellowship scheme: 8 fellows, working a mixture of part time and full time, have successfully been recruited across four NHS Boards (Fife, Lanarkshire, Lothian and Tayside) and commence in post between August and December of this year. We are in the process of organising a networking opportunity at the national event in November 2019, as a chance for fellows to meet and share their experiences to date. As this is the first year the scheme was established we will be carrying out an evaluation and a lessons learned exercise. Going forward, we are looking to grow this scheme and repeat it again in the future.
• AK advised NES have been legally advised that fellows on a fix term contract, for example 12 months, are required to complete the fixed term if they have to take time off (i.e. for maternity or long-term sick leave)
• GP training practices: We are still working on final numbers. Currently we have 35 practices involved in the scheme and awaiting confirmation from a further 4 practices – this has reduced from 46 practices who registered interested to be involved in the scheme. Again, as this is the first year the scheme was established SG colleagues will be working with NES to carry out an evaluation of this scheme. We will also be contacting those practices that withdrew to establish whether we need to do things differently next year. Similar to the fellowship scheme, we are looking to grow this scheme and repeat it again in the future.
• AK said that early concerns from practices and trainers was around payment for completing OOHs shifts, and directed practices to discuss concerns with SG colleagues
• ST noted this proposal had come from an ask at an RCGP training conference
• Recruitment and Retention of Nurses: Initial discussions have taken place, between Primary Care Division colleagues and the Chief Nursing Officer Directorate, about the possibility of applying a premium payment in order to retain nurses in OOHs. Further discussions need to take place as well as exploring other options through educational training or rotational models.
• KW advised that education provision (pre-registration, advanced practice, transforming roles and district nursing) for nurses needs to be considered in the round, and suggested this group should have representation from Scottish Executive Nurse Directors (SEND)
• ST raised two points around palliative care: 1) there’s a need to increase the number of community nurse prescribers, helping to reduce the pressure on GPs in OOHs; and 2) amend the confirmation of death policy to allow district nurses to confirm death of patient
• LRi suggested that a short note is required on the current position of where we are with the recruitment and retention issue and what the possible options are to saturate the market with nurses
• Health and Social Care Partnership (HSCP) survey: work is still ongoing regarding the survey. A draft version has been shared with a Chief Officer and Clinical Lead to get initial feedback. The feedback was generally positive. SG colleagues are considering the possibility of carrying out a suite of visits to OOHs services once the survey has been shared.

LRi then invited GS to provide a brief update on the planning that’s underway for the National OOHs event.

GS said that following the success and positive feedback from last year’s event the second national event will held on 13 November 2019 at the Stirling Court Hotel. SG colleagues are in the process of finalising the agenda and confirming leads for each individual workshop – this will replace the world café style session from last year’s event. The theme of this year’s event is experiences, success and challenges. GS advised that a link to registration for the event will be issued in the next couple of weeks.

Actions:

Invite representation from SEND to attend future meetings
KW/GS to produce a paper on the current position and possible issues around the recruitment and retention of nurses

5. Any other business

LRi then invited the group to raise any other business. The following points were raised:

• ST noted SG colleagues have changed the OOHs question in the Health and Care Experience survey, which should provide more useful data going forward. Additionally SG have commissioned ISD to carry out a GP OOHs workforce survey in the Autumn of 2019
• FM advised that the SG had seconded Charlene MacLaughlin from NHS Ayrshire & Arran to support Boards with use of Adastra. FM said the majority of Boards do not get support from their eHealth leads and struggle to manipulate Adastra to get helpful data out of it (i.e. automated reports on Monday morning of the weekend’s activity) Charlene will be supporting Boards in standardising the use of Adastra across Scotland.
• DSh said the next focus for the group should be on OOHs clusters and cluster development

There being no other business the meeting concluded.

Next meeting: 14 January 2020, 14:00 – 16:00, St Andrews House, Edinburgh