Main Report of the National Review of Primary Care Out of Hours Services

17 Conclusions

The onset or worsening of illness can occur at any time of the day, any day of the week. Irrespective of the time and place, the people of Scotland deserve a high quality service which fully meets their needs and does so reliably and at all times.

The commission of the Cabinet Secretary for Health, Sport and Wellbeing was to secure person-centred, sustainable, high quality and safe primary care during the out of hours (OOH) period - when general practices are closed. Present OOH services are under considerable pressure, remain fragile and are not sustainable.

From the outset, it was recognised that the Review would be challenging as it is set at a pivotal moment in our health and social care integration journey - early days and many miles to travel. Equally, looming large are unprecedented demographic challenges, increasing multi-morbidity, complexity, workforce and financial constraints.

In order to navigate our way, we chose deliberately to define a set of guiding principles, a compass for the road ahead. These principles were that future primary care OOH services should be:

• Person-centred - for those who receive and those who deliver services
• Intelligence-led - making the most of what we know about our people and their needs
• Asset-optimised - making the most of all available assets and resources
• Outcomes-focused - making the best decisions for safe and high quality patient care and wellbeing

In addition to these guiding principles, such services should be:

• Desirable - high quality, safe and effective
• Sustainable - resilient on a continuous basis
• Equitable - fair and accessible to all
• Affordable - making best use of public funds

We took the view that an inclusive and transparent approach along the way would be the right thing to do. This started with the definition for primary care which should rightfully include social services, the third and independent sectors, other agencies and voluntary carers. We also took the view that we should not go alone and so our Review process was inclusive - many professional colleagues and the public have travelled with us, as part of our engagement process. Our direction of travel had to be clear at the outset, in order to fulfil our remit and therefore incremental change was not sufficient and transformational change was required and that while addressing our remit in relation to OOH services we need to think anew about 24/7 urgent care services.

28 Recommendations and a number of sub-recommendations are presented for consideration and reflection at national and local levels. They embrace new models of care, the needs of specific groups, enablement and empowerment, accessibility, health literacy, inequalities and the promotion of person-centred care. Workforce issues occupy a number of our recommendations - capability, capacity, challenges and the need for unprecedented primary care workforce planning at national and local levels with a key focus on valuing and supporting staff throughout their careers. Better quality and safety are essential for optimising patient care and this will be underpinned by better use of and access to electronic records, telehealth, telecare and mobile applications caring for our patients and the people of Scotland, supporting self-care where appropriate and ensuring best access to services when needed. A number of recommendations are made about the future roles of the third and independent sectors and other agencies, the leadership roles of Health and Social Care Partnerships and Integrated Joint Board, and the support roles of Special Health Board and Territorial Boards. Recommendations for research and evaluation are mooted and there is a strong emphasis on shared inter-sectoral planning at both national and local levels with the key imperative of ownership. The final recommendation addresses finance and best use of resources.

These recommendations have been set out as foundational. They will certainly need to be scrutinised, reviewed, challenged and updated in the light of evaluation and new intelligence - but hopefully they will reap some rewards ahead for the people of Scotland, for patients in need, for carers and for their loved ones.