Fears over future of out of hours GP care in Highlands
Fears have been raised that people risk being frozen out of the NHS under plans to replace out of hours GPs with First Responders and video conferencing facilities.
The Highland Health Board has made the startling admission that the service is on its knees and a search is underway to find a solution to scale back the use of locum GPs who are on up to £180-an-hour.
Senior health boss Gill McVicar described the Highland service as "a patchwork of piecemeal local arrangements which are increasingly difficult to sustain due to staffing models, lack of GPs, high use of locums and unaffordable costs".
The Scottish Government has funded several million pounds towards exploring some other measures and board members are expected to approve - in principle - installing kiosks called a telebooths in communities.
This would mean patients struck down ill on the evenings or weekends would have to explain their symptoms via a computer screen to a doctor sitting at a hospital miles away.
And the health service is also negotiating with the Scottish Ambulance Service, the Red Cross and First Responders, who include nurses, firefighters and other volunteers with a defibrillator to stabilise the patient until more help comes.
The hope is that they will be able to step in far more that before to treat patients in the community.
A spokesman insisted no changes would be made that would endanger patients - and said the controversial move was being forced upon the board which was struggling to recruit GPs and persuade salaried GPs to work out of hours.
But the move has prompted concerns from Highland Conservative MSP Mary Scanlon. She said people expect more from the NHS than First Reponders and speaking to their doctor via a computer screen.
She said: "There is a place for First Responders but they should compliment rather than replace NHS doctors. They shouldn’t be a substitute. I would want to know what kind of consultation is being done with patients and patient groups and GPs - patients are still entitled to an NHS service at all times, regardless of their rurality."
The Highland out of hours service has been in place since 2004. The local centre is based at Aviemore medical practice.
In her report to members of the health board which meets next Tuesday, Ms McVicar, director of operations, north and west operational unit, says the system was "put in place very quickly" to allow the opt-out of GPs, as agreed through the General Medical Services contract that year.
She was unavailable for comment yesterday, but in an earlier interview about the out of hours service she explained that the changes in 2004 lifted the obligation on doctors to work out of hours but placed more emphasis on quality and improvement, dramatically increasing recording procedures - and paperwork.
Those extra workload pressures have resulted in fewer opting to see patients after 6pm or at weekends.
Waiting times at accident and emergency departments are also rising as more people bypass NHS24 and head straight to hospital.
This is also taking its toll on health care budgets, with locum doctors costing up to £8,000 a weekend in some places, such as Wester Ross. Agency costs are £126.89 per-hour but a wide variation of pay rates exist across Highland.
Ms McVicar reports that a GP may work in Wick for £60 per hour but if this shift is not filled it may be offered at £120 per hour and occasionally a GP has been able to negotiate this up to £180 per hour. A GP doing a weekend overnight shift in Inverness on double time may receive £156 per hour. A salaried GP only gets £5 per extra for doing an out of hours shift.
And the £10.5million out-of-hours budget is predicted by next month to be more than £1 million in the red.
A health board spokesman said it was not yet known where the video-conferencing booths, known as telebooths, would be situated in communities.
He said: "We have to ensure that we produce a service which is sustainable and safe and we are not going to do anything which would endanger any patient. We are going to deliver a service which is fit for the 21st Century."
