Rural Scotland needs innovative solutions to deliver out of hours careBMJ 2010; 340 doi: https://doi.org/10.1136/bmj.c2291 (Published 27 April 2010) Cite this as: BMJ 2010;340:c2291
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Your correspondent Bryan Christie cites the out-of-hours situation in
the Highlands Perthshire village of Kinloch Rannoch in his article Rural
Scotland needs innovative solutions for out of hours care (BMJ
2010:340:c2291). The subject of the article was the report on rural out-of-hours provision that was published by the Scottish Parliament's Health
and Sport Committee on 23 April.
As one of the local residents who testified to the Committee when it
came to the village to hear oral evidence, I would like to correct a
misapprehension in the article and then go on to a wider point.
Bryan Christie writes that "it has been calculated that it would
cost a minimum of £150 000... a year to provide round the clock medical
cover for Kinloch Rannoch."
In fact, senior officials at NHS Tayside informed their Board on 13
November 2008 that it would cost an annual £556,876 to provide this
service. We local residents have challenged this figure, believing it
to be wildly exaggerated. We have done what we can to find out what
kind of costs are actually incurred when a local GP (or GPs) provides 24/7
cover, as happens in a number of medical practices in the Highlands and
Islands (there were 51 of these as of the summer of 2008). The reality
seems to be that there is a wide variation and that GPs may be paid by
their Health Boards at anything between £2 and £18 an hour, in addition
both to their "normal" contracts and the retained 6% of the Global
So even the £150,000 annual sum cited by your correspondent would
appear to be at the higher end of the scale, with a number of these remote
places having the advantage of 24/7 local medical cover for much more
modest sums. This is not to speak of the savings that follow from having
24/7 cover in terms of expensive and to the patient distressing unplanned
The attempts that have been made to discredit the campaign by local
residents to restore the lost 24/7 local GP service on cost grounds
(whether the figure cited is £556,876 or £150,000) are suspect since the
true state of affairs in the remote areas is so variable and nowhere (so
far as we have been able to establish) does any medical practice use 3.8
GPs and 4 drivers for the out-of-hours period - which is the assumption
made by the Tayside officials.
The wider point raised by this focus upon costs rather than
entitlements is that it has been seriously argued by the Tayside Area GPs
sub-committee in their evidence to the Parliamentray inquiry (ROH19 on the
Health and Sport Committee's website) that the money that would be spent
on a local GP out-of-hours service would be better spent on deprived
people in Dundee and this because of the longevity of the folk in Rannoch.
As a lay person who is neither doctor nor health economist, and who
happens to be 73, I find this an extraordinary argument. The NHS
Resource Allocation Formula, as it applies to Scotland's 14 territorial
Health Boards, weights the basic per capita allowance not only for
deprivation (using a proxy measure) but also for age/sex composition.
This is done by accumulating the relevant statistics from the data zones
that make up the larger area of any particular Health Board.
So, unless I am mistaken, NHS funding arrangements take account of
both these sets of circumstances: concentrations of poverty and the
presence of relatively large numbers of old people. Both sets of
circumstances will tend to produce proportionately greater calls upon
health services, which will need to be funded accordingly. This is what
the Resource Allocation Formula seesk to address. So there is no need
to rob Peter to pay Paul.
Competing interests: No competing interests