Out-of-hours needs better links to GPs

The call came as the Scottish parliament debated out-of-hours services last week in the wake of a report by MPs on its health and sport committee.

Dr Buist: patients need educating on who to contact out-of-hours (Photograph: MC Green)

The report found public confidence in rural out-of-hours services had been lost.

Nanette Milne MSP (Conservative, North East Scotland) said that the early failures of NHS 24 - the Scottish equivalent of NHS Direct - had undermined public confidence in the service, particularly in rural areas.

Dr Richard Simpson MSP (Labour, Mid Scotland and Fife), a former GP, said there was also public confusion about who to contact out-of-hours.

'The first thing that a patient must do is decide what their condition is and which of the raft of possible opportunities - contacting 999, contacting NHS 24, going directly to accident and emergency or, in rural areas, calling their GP - is appropriate,' said Dr Simpson.

Dr Andrew Buist, deputy chairman of the Scottish GPC, agreed. 'More needs to be done to educate patients as to who to contact out-of-hours,' he said.

Work also needed to be done to ensure a more integrated out-of-hours service, he said.

Tayside GP Dr Buist said NHS boards should involve all stakeholders to ensure a seamless service.

'A&E, GP services - both in-hours and out-of-hours, NHS 24 and the ambulance service should be getting together regularly to look at pathways.

At present, this is not always happening,' he said.

BMA Scotland has also called on the Scottish government to commission research on the beliefs that underpin decisions to contact out-of-hours services, to identify why demand is rising.

'It would be interesting to see where the calls come from - are they from younger or older people and what are the problems? Are calls from urban or rural areas or across the whole country,' said Dr Buist.

He suggested one theory for the increased demand was the rise of a 24-hour culture.

'There's an increasing group of patients who seem to use a variety of health services as 24/7 Tesco-style service. But our services are not designed for that,' said Dr Buist.

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