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OOH Arrangements:
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58 people from throughout the Upper Tay valley, as well as from Kinloch Rannoch, Pitlochry and Tummel, attended the meeting facilitated by journalist Pennie Taylor (pictured below). Besides representatives of NHS 24, NHS Tayside, the Scottish Ambulance Service and Perth & Kinross Public Partnership there were also paramedics, GPs from the Pitlochry and Aberfeldy practices, members from several community councils and MSP John Swinney. Expressions of public anxiety and dissatisfaction were made with aspects of the current and possible future levels of Out of Hours (OOH) service. These were met with frank and reasoned explanations by spokesmen of the various operations involved. The issue of the absence of a Minor Injuries & Illness Unit (MIIU) in Aberfeldy recurred throughout the two hour long gathering. Many present feared that the nearest of these (Pitlochry) was too far away. |
Professor Elizabeth Wilson, director of the Tayside Primary Care Unit, held that the statistics for the Aberfeldy locality had not, to date, justified setting up such a unit. MIIUs are staffed by nurses who receive special training in diagnostics and prescribing skills. She said that the indicators were that there is insufficient opportunity for them to practice their new skills within an Aberfeldy catchment area.
Although it was noted by a Pitlochry GP that the MIIU in that town is presently at a low level of activity, the meeting was assured that this did not pose any threat at all to its operation in future.
“When considering the level of operation that was brought into play when the GPs opted out of the former system and hastened the introduction of the new provision,” noted MSP John Swinney, “It’s a minor miracle that we have not had a calamity in Highland Perthshire.”
He spoke for many at the meeting when expressing concern that there should be no retreat from the level of service that is currently available. He also stressed that there is an urgent need to develop that level of service, and to improve upon it.
The meeting heard that one Pitlochry-based ambulance team calculated that it had a 30% increase in call-outs during the past year.
Research
A survey conducted with users of NHS24 and NHS Tayside’s arrangements during the first three months indicated a 27% dissatisfaction with the service. This drew rueful observation from the MSP in comparing it with customer ratings for a public utility like Scottish Gas.
The meeting learned that, of those currently contacting the OOH services, 10% are identified as being trivial or inappropriate calls; 40% receive advice directing them to self-care; and 50% lead to a requirement for face-to-face care.
It was explained that a decision had recently been taken to establish a new mini-call centre in Dundee to be staffed by trained nurses who will bring local knowledge as well as their medical skills to the management of OOH calls.
The first phase of this is to be achieved by this autumn and expanded, in phase 2 next year, to a target of 20 ‘seats’. These are anticipated to be filled by experienced nurses, on part time contracts, returning to the profession for the special training.
Integration
Facing criticism that the different boundaries and cultures of the component services’ are of no interest to the public users of NHS24, Professor Wilson emphasised that big strides were being made to integrate all the various professionals involved.
A confident vision statement was made that the OOH service, having acknowledged its growing pains and shortfalls, is building a new model in Tayside. The early benefits of this, it was predicted, would be experienced by the end of this year and would be fully in place by next summer.
MSP Welcomes Outcomes
Speaking afetr the meeting, John Swinney said: “I welcome the commitment from NHS Tayside that they are proposing no reductions in the present level of Out of Hours cover. I am firmly of the view that the current level of cover is the absolute minimum to support our Highland Perthshire communities and that any reductions would be indefensible.
“I believe that NHS Tayside need to further engage with the community on how it can expand Out of Hours cover in Highland Perthshire and build greater public confidence in the service.
“I also welcome the announcement that there is to be a bank of nurses introduced to Tayside to deal with NHS 24 calls. One of the areas of the NHS24 service that attracts the greatest criticism is the delay that is often experienced by patients in being able to speak to a medical professional to have their condition assessed.
“The availability of more nurses based locally should assist with this problem by tackling delays and minimising or eliminating call-back time.
“NHS Tayside stated at the meeting it has no proposals to change the situation in Kinloch Rannoch, whereby the GP service continues to be part of the Out of Hours provision. This is vital for patients in the area.
“Finally, I hope that NHS Tayside will seriously examine the call for an minor injuries and illness unit to be established in Aberfeldy. It was felt by many at the meeting last night that the unit in Pitlochry was too far away and the issue of convenience of access to these services is a critical factor.”
