Policy responses and statements

Name of organisation:

NHS 24

Name of policy document:

Working for a Healthier Scotland - Consultation Document

Deadline for response:

31 July 2006

Background: NHS 24 is currently developing its strategic plan for the three year period from 2006 to 2009. The aim of the strategy is to continue to improve its core out-of-hours service and explore ways in which NHS 24, as an integral part of the health service in Scotland, can work with other NHS Boards to develop a service that meets the objectives set out in 'Delivering for Health'.

In developing the consultation document, Working for a Healthier Scotland, NHS 24 has had contributions from a range of individuals from partner NHS boards, voluntary organisations, employees and members of the public at a series of events held over recent weeks. The service now wishes to provide a formal opportunity for consultation, and invites the College to comment on the strategy document. This will enable NHS 24 to develop a final version of a three year strategy which it will provide to the Minister for Health and Community Care in August.

COMMENTS ON
NHS 24
WORKING FOR A HEALTHIER SCOTLAND:
CONSULTATION DOCUMENT

The Royal College of Physicians of Edinburgh is pleased to offer NHS 24 views on its consultation on Working for a Healthier Scotland.  The College has invited views from a number of Fellows working in both hospital medicine and general practice.

There was general comment that NHS 24 has to some extent been left to define its own role, firstly by responding to the vacuum in-out-of-hours service precipitated by the change in the GMS contract, and now in seeking to redefine its role in the provision of general health information, and to broaden its role into other areas of healthcare management and provision (aims 2 and3).  The document is thus pervaded with a sense of seeking a role, whereas surely it is for others to define the role, and to assess whether NHS 24 is delivering value for money.

A further general comment was that the document contains a profusion of management speak, eg “assessing existing and new operational functions and policies to identify and remove potential adverse impacts on particular communities of people” (page 15).  It must be possible to rewrite such sections in plain English.

In response to the consultation questions:

1. The main contribution of NHS 24 has become and should continue to be in the provision of a national point of telephone contact for out-of-hours services.

2. The service is improving but could be better still in its response time.  Clearer links to local NHS OOH services would help, particularly in remote and rural areas, where initial set-up and consultation was poor.  Staffing should be adequate for times of peak demand, but care should be taken not to “cream off” experienced staff from other NHS services. The re-involvement of doctors in the telephone process might be considered, as this is often sought by patients, and could be either by recruiting “NHS24” doctors, or closer linkage and more rapid transfer of calls to local NHS centres.  Modern technology should make this feasible, and a more radical solution is suggested below.

3. The strategy is clearly stated but possibly over ambitious.  Issues of cost and cost-benefit are unclear, and there seems to be potential for overlap with other health improvement and health information systems that perhaps needs a wider strategic focus.  NHS 24 should concentrate on improving its core OOH service, whilst entering into discussion with other interested parties on future roles.

4. The fragmentation of OOH services between NHS 24 and local NHS services is not well understood by the public, and still causes barriers and access delays.  A radical approach would be for NHS 24 to assume responsibility for the complete primary care OOH service.  This would open up exciting opportunities for service development, strategic change and improved local access.

5. Health improvement is certainly a laudable aim (Aim 2) but requires effective access and delivery to the population in general and those most in need in particular.  Close collaboration with HES and new mechanisms of information delivery require development, but not at the loss of more conventional means of access.

6. The proposal for NHS 24 to act as a central point for long-term managed care in co-ordinating multi-service teams requires wider discussion and illustrative examples of what would be proposed.  There will be a significant danger in undermining the central medical role in the community of the general practitioner, with potential to have conflicting advice to patients on who is responsible for what.  Supporting the planned care agenda and reducing defaulted appointments may cause further confusion with an intermediary between an out-patient administrator and a central telephone helpline.  The pros and cons of this approach need to be carefully thought through with administrators and managers before assuming that this may be the best solution.

7. The RCPE sets standards in medical education and is closely involved in promoting best practice in acute and internal medicine.  The College is happy to be consulted on future plans to develop scheduled and unscheduled care in the NHS in Scotland.

8. Engagement with the College regarding evidence based decision making and standards of health advice will benefit both organisations.

9. Measurements of performance and quality indicators cannot be easy.  Speed of response to requests for assistance, the range of options offered, uptake of such options and subsequent patient or carer satisfaction could be considered.

Lesley Lockhart,
Royal College of Physicians of Edinburgh,
9 Queen Street,
Edinburgh,
EH2 1JQ.

Tel: 0131 225 7324    ext 608
Fax: 0131 220 3939

[1 August 2006]