Intended for healthcare professionals


Rural Scotland needs innovative solutions to deliver out of hours care

BMJ 2010; 340 doi: (Published 27 April 2010) Cite this as: BMJ 2010;340:c2291
  1. Bryan Christie
  1. 1Edinburgh

    Serious shortcomings have been identified in out of hours services to rural and remote parts of Scotland since family doctors were allowed, in 2004, to opt out of providing 24 hour care.

    A report from the Scottish parliament’s health committee says that trust and confidence in current services “has clearly been lost” and urges NHS boards to work with local communities to develop solutions.

    The report was prompted by complaints from several remote communities across Scotland that they have been left with little or no medical cover at night and at weekends. In one of these, Kinloch Rannoch in Perthshire, the nearest doctor is 30 km away along single track roads. Out of hours care is currently being provided by first responders who have been trained in first aid.

    It has been calculated that it would cost a minimum of £150 000 (€175 000; $230 000) a year to provide round the clock medical cover for Kinloch Rannoch, which works out at around £400 a patient. This compares with £8 a patient for out of hours care in Glasgow and £43 in rural Argyll.

    However, the health committee says that innovative solutions to these problems have already been found in some parts of Scotland and should be examined by other areas to see whether similar approaches can be effective. These include the use of teams of advanced nurse practitioners in Grampian and salaried GPs in the Borders who also work in hospital accident and emergency departments to make the work more varied and attractive.

    The report, the culmination of a six month inquiry, says, “NHS Boards should be given responsibility for devising—and should be enabled to deliver—specific, sustainable and often innovative arrangements to meet the needs of individual communities. This should be delivered in consultation with these communities.”

    The committee also found that rural communities had little confidence in the medical helpline NHS 24 and that patients were confused about whom they should contact for help.

    Many of the health committee’s recommendations echo those made by Scotland’s GPs in a report earlier this year on the future of general practice (BMJ 2010;340:c796, 9 Feb, doi:10.1136/bmj.c796). Andrew Buist, deputy chairman of the BMA’s Scottish GP committee and a rural GP, said, “We believe that out of hours provision should be better integrated, and we would agree that the public are confused about who to contact for out of hours services and that this should be addressed.

    “We also welcome the commitment to review the current national core standards for out of hours services, which will ensure that all patients, no matter where they live, receive consistent high quality out of hours healthcare.”


    Cite this as: BMJ 2010;340:c2291


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