For most people contact with NHSScotland begins and ends outwith a hospital environment. Community based healthcare services, which encompass a wide range of professional roles are a key part of the unscheduled care landscape and a sustainable seven day service cannot be delivered without them. As well as the direct treatment and care such services provide, these services play a crucial role in avoiding unnecessary admissions to hospital and supporting appropriate discharge arrangements and moving forward we will consider what further contribution community based nurses and AHPs can make to the development of sustainable services.
In out of hours periods NHS 24 is the first point of contact for most people requiring care. They receive around 1.5 million calls from patients across Scotland every year. NHS 24 receive advice over the telephone or are redirected to another service, including the Scottish Ambulance Service, the local General Practice Out of Hours service or the nearest Accident and Emergency Department. Responsibility for the provision of GP out-of-hours services rest with the 14 territorial NHS Boards.
Another option for referral or access to care is through community pharmacies. There are some 1,240 community pharmacies located in our towns and communities across Scotland. Most are open 6 days a week, and NHS Boards operate a rota for out of hours which includes evenings, Sundays and public holidays. As part of the community pharmacy based NHS Minor Ailment Service (MAS), pharmacist in the community can also treat eligible patients for common and minor self-limiting conditions without the need to see a doctor. There are currently over 890,000 patients registered for MAS. In addition, under Patient Group Directions, pharmacists in the community may dispense a drug, before receiving a prescription form, where the conditions for urgent supply are met and if the pharmacist is satisfied that it is appropriate to do so.
The recently announced Primary Care Out-of-Hours Services Review will review the current delivery landscape and recommend action to ensure primary care out-of-hours services:
- Are sustainable, high quality, safe and effective
- Provide access to relevant urgent care where needed
- Deliver the right skill mix of professional support for patients during the out-of-hours period.
The review will look at all territorial NHS Boards' out-of-hours service models and profiles of access, demand and delivery. The range of primary care services are diverse and whilst the Review does not strictly exclude any specific service, its initial focus will be on how primary care services are provided to patients when their GP surgeries are closed. It is expected to provide recommendations by late summer 2015 and its outcome will inform the steps that are necessary to support sustainable seven day services.