7 Summary of Recommendations
A full set of Recommendations, accompanied by detailed rationale for each, with relevant references, is provided in Appendix 2.
1. Tests of change should be established to test the concept/viability of multidisciplinary locality clinic models during public holiday periods.
2. The developing role of independent non-medical prescribers should be encouraged and enhanced. How appropriate educational and training support can be delivered needs to be further explored.
3. Greater use should be made of Community Pharmacy Unscheduled Patient Group Directions ( PGDs) to enhance the urgent provision of medication. This would also be facilitated by immediate and secure electronic access to patient medication records.
4. Community pharmacy is an important first point of contact for patients seeking advice and treatment, this should be encouraged by:
- Promoting greater use of community pharmacy Minor Ailment Service ( MAS) for eligible individuals
- Encouraging people to make more use of community pharmacies for self-care, advice and access to medicines.
- Ensuring that sufficient community pharmacy services are open and accessible during public holiday periods.
5. In order to assist the public to support self-management, where appropriate and to make optimal use of available services when required, during OOH and public holiday periods:
- There should be better promotion of NHS Inform as the reliable and trusted source of health, care and wellbeing resources (including the Self Help Guide) in Scotland.
- Particular emphasis should be placed on use of the National Services Directory as an on-line resource for the public and for all health and social care professionals to find out what services are available locally.
- Each Board area will need to determine how best to engage its local population including use of the Know Who to Turn To resource.
- The national winter health campaign should be enhanced to ensure the most critical messages and up to date resources are included to support the whole health and social care system. NHS 24 and local Board should support visibility of the national winter health campaign, delivered by NHS 24 on behalf of NHS Scotland.
6. A tested handover document should be introduced to improve the care pathway of residents in care homes. This should facilitate structured communication between care homes and NHS 24 to support optimal referral of residents who need urgent care provision.
7. In the absence of direct local helpline access, the interface between NHS Board OOH services and NHS 24 should be optimised to ensure people with palliative and end of life care needs and their carers can access timely person centred-care.
8. Individuals who attend OOH/A&E services without a defined medical need should be signposted /redirected to suitable alternative community services, including third sector provision, where available.
9. Access to specialist services should be improved for Mental Health triage, assessment and consultation within NHS 24. A stepped model of care developed by NHS 24 will support appropriate service provision based on need, from self-help assistance to complex care.
10. Further development of Distress Brief Intervention ( DBI) programmes should continue to better equip people managing their own health, offering a structured approach for medium to long-term reduction in distress.
11. On the basis of local needs assessment, Board areas should consider establishing/enhancing Community Respiratory Teams over public holidays and also for other OOH periods.
12. Timely and proactive discharge planning should be in place prior to public holiday periods, following the principles of the Daily Dynamic Discharge Approach.
13. Acute hospital discharge teams should be reviewed and augmented, where necessary, to ensure optimal patient flows within hospitals and to ensure timely and appropriate discharge of patients over public holiday periods.
14. Effective discharge planning and processes over public holidays should be reviewed to ensure that staffing levels are optimal throughout.
15. Improved access to specialist advice from a senior clinician should be readily available to Primary Care OOH services over out of hours periods, including public holidays. Where not already in place, a dedicated clinical telephone referral line should be established enabling direct professional-to-professional consultation.
16. Timely use and analysis of data is required to optimise available resources, in order to meet patient needs with differing and evolving case-mix presentations. This should help to secure best care outcomes and is in keeping with the guiding principle of an intelligence-led service.
17. Options should be pursued to streamline public protection services that are resilient at all times and are fit for the future. These should be explored with Police Scotland and other relevant partners, taking into account the Child Protection Register and the Appropriate Adult Scheme.
18. Future out-of-hours social care services must be aligned with existing primary care OOH services and directly interface with acute hospitals, in order to provide integrated health and social care on a continuous basis, including public holiday periods.
19. The identification and development of good practice approaches and shared learning opportunities across all sectors in the OOH period, should be developed for:
- Prevention of unnecessary admissions to hospitals
- Appropriate and timely discharge practice from hospitals
- The timely availability of community based social care and other services to underpin hospital discharges during OOH and public holiday periods.
20. Future information developments in social care, including the emerging single national source of social care data, should aim to provide timely and actionable intelligence to those responsible for delivering care and support, especially to people with multiple and complex needs.
21. Effective planning and resource allocation to secure delivery of these recommendations will require a whole system approach and leadership of a high order.
22. Developing national, social and primary care workforce plans should take account of the findings from this Review including sustainable resourcing for all professional groups.
23. Partnership and professional organisations should be fully engaged in the design and delivery of all planned changes to the workforce.