Health boards have a duty to apply the standards, imposed by NHS Quality Improvement Scot-land (NHS QIS), which performs many of the quality functions of NICE in England and Wales.
But GPs unable to opt out of out-of-hours because their health board could offer no alternative provision say the standards are not appropriate to their practices.
Fifty-three practices in Scotland have been unable to opt out of out-of-hours care.
‘The standards have been drawn up for an organisation covering hundreds of thousands or millions of people,’ said Dr Andrew Buist, a Blairgowrie GP and deputy chairman of GPC Scotland. ‘They are not written for the average GP. Some of these GPs have lists of 200 or 300 patients.’
In The Provision of Safe and Effective Primary Medical Services Out-of-Hours, NHS QIS reported its assessment of Scottish health boards’ out-of-hours performance against three statutory standards – access and availability, safe and effective care and monitoring and reporting.
It showed that all health boards were more or less delivering care that was accessible, safe and effective although boards have been told to improve clinical governance and risk management processes.
But measures that mattered to GPs were not considered, Dr Buist said. GPs are concerned about the overflow of patients who contact the out-of-hours service close to hand-over and are re-routed to their GP practice.
Since health boards took over responsibility for out-of-hours care, face-to-face consultations have been cut by 50 per cent. Telephone and triage have taken over from a home visit by the GP as the main means of providing out-of-hours care in Scotland.
Opportunities from the change in out-of-hours care had been lost, Dr Buist said.
‘The change has cost a lot of money and patients have lost face-to-face contact. In exchange it has given an opportunity for integration between GPs, social services, the ambulance service and hospitals but that is not yet happening,’ he added.
When opt outs first took effect at the start of 2005, health boards attempted to block more than the current 53 practices from ditching out-of-hours. A group of 13 Highland GPs won a reprieve after successfully arguing their Thurso practices were not remote (GP 10 December 2004).
- Inadequate handover to in-hours teams.
- Less face-to-face interaction.
- Lost opportunities for integrated services.