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FEEDBACK
SEMINAR ON GP OUT OF HOURS SERVICES
27th
Jan 2003
This was held as a
result of initial consultation across Ashford, Bexhill
and Rother, Eastbourne Downs, Hastings and St Leonards,
Shepway and Sussex Downs and Weald PCTs. At some time in
the near future, GPs will be able to opt out of providing
24-hour care to their patients in the way they do now.
Over 360 individuals and organisations across South East
Kent and East Sussex contributed to the review (82%
Hastings and St Leonards GPs responded).
Generally it was felt
that this presented an opportunity to develop an
imaginative and groundbreaking out of hours service
model. It was also recognised that patient led services,
the need to review the skills of those working in out of
hours teams, issues about access to services, quality and
the need to work closely with all providers of health and
social care were vital to the success of any future
changes. It is proposed that work for the implementation
should be complete by April 2004.
RESULTS OF THE
CONSULTATION- GPs- The majority of GPs will opt
out of providing OOH (out-of-hours) care once appropriate
arrangements are in place. 65% GPs felt that the focus of
OOH care should be on the main hospital sites. The
remainder felt that this would present access problems
particularly for patients in rural areas. Varying skill
mix was essential with nurses, therapists, carers and
other staff especially social care services.
Other
considerations which concerned GPs included-
Patient education to
ensure that OOH services were not abused.
Funding- Future
OOH services will be very much more expensive if GPs are
to continue to deliver.
Better use of daytime facilities to avoid unnecessary
night time call outs.
Other Key Stakeholders- PCTs (Primary Care Trusts),
Private Providers, and Ambulance Trusts felt that
existing arrangements should be built upon rather than
commission a new service and that there was a need to
make the service more integrated with Social and Mental
Health Services and the Voluntary sector. The service
should be linked to the idea of providing a single point
of services and alternative arrangements for OOH. Most
respondents felt that this was an opportunity for
developing new partnerships and skill mixes. Access
should be through transport provided for patients
although what kind, when and how, were subject to much
discussion in the workshop session.
Patients- Members
of the public had been contacted across all 6 PCTs.
The main results were- An out of hours service, which
could be accessed with one phone call.
Prompt response to requests for home visits.
More co-ordinated service between health and social care.
The service should not be limited to doctors but should
include nursing and paramedic staff.
Familiarity and continuity was important to patients and
the key to this was their medical records so that whoever
cared for them out of hours would be familiar with their
history so that they would not have to keep on repeating
things over and over.
The Voluntary
Sector- Single phone call for all OOH services
for immediate access to information and advice from
trained staff.
Information should be available in a variety of formats.
Increased partnership working so that patients have
access to a professional with appropriate experience.
Staff should have access to records while preserving
confidentiality.
Community Health
Councils- The Community Health Councils voiced
the same concerns about prompt, accessible appropriate
services and in addition they asked where the extra
nursing staff would come from.
CONCLUSIONS
The service must be
patient needs led.
A single call number is essential to enable patients to
access services quickly and easily.
Existing services are operating well (Seadoc) and any
future change must be built on this success.
Better co-ordination with other service providers.
New OOH bases will need to be developed where there can
be better concentration of medical expertise and closer
working with doctors and nurses at the secondary and
emergency care centres.
This could mean having bases near Accident &
Emergency departments at acute hospitals such as the
Conquest.
New arrangements will only work if there are enough
well-staffed satellite bases and excellent transport
links.
Different skill mixes will have to be developed with a
variety of staff disciplines.
It is clear that GP involvement will be very expensive in
future.
Patient records will have to be developed to ensure
continuity of care possibly computer accessed.
Patient education will be essential to ensure that the
service is used appropriately.
Daytime access to medical services will have to be
improved to cut down the need for OOH services.
Quality standards of care will have to be explicit and
agreed at an early stage with patient input.
Care must be taken to ensure that patients do not use
Accident & Emergency care as a substitute for primary
care.
At the end of the
seminar it was very clear that there must be much more
discussion on this subject as it potentially has an
impact on every person living in the area and as such it
is important to ensure that the public voice is heard at
every step of the planning process. MELANIE RYCROFT
28.1.03
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