Chamber and committees

It is sometimes difficult to see whether there is going to be light at the end of the tunnel. Should we just accept that the levels of attendance are high right now and that that situation will continue all through winter? Part of getting people out of hospital involves working with our social care teams, and that will include falls assessments and prevention and the other things that we can do to support people to get back to their own homes. What about the pressure on demand and the resulting impact on everyone across the service? Are there any other mitigating measures that you think could be implemented in that respect?

I have a quick question. We are planning for winter. How do we avoid admissions for people with asthma, chronic obstructive pulmonary disease or diabetes, for instance? Telemedicine is working, as is telemonitoring for folk who have COPD so that they have a plan. What work is being done to prevent folk who have asthma or COPD from coming into hospitals during winter?

I asked the previous witnesses about the challenges that we are experiencing in accident and emergency. Knowing how to move people through the system—whether you bring them into A and E and discharge them if possible or move them into acute beds—is a complicated matter, and given what the previous panel said, I am interested in hearing what this panel thinks is driving the increased delays in A and E services.

Good morning, everybody. A and E discharges and the four-hour waiting time target are all over the news all the time. I know that looking at what causes those breaches in the four-hour target, and the on-going issue about delayed discharges or the whole throughput, is complicated.

John Burns just described what actions are being taken. I am interested to hear about what specifically causes the delays in A and E treatment—what causes that four-hour target to be breached? It is not the case that people are just sitting on a trolley waiting for somebody to see them; they are still getting some care at that time, whether it is blood pressure assessment, vital signs or waiting for an X-ray or whatever. It is not that people are just sitting there doing nothing. I am interested in what causes the delays and what further specific action we can take to reduce them.

Last week, we had a chamber debate about out-of-hours GP services and I quoted some percentages in relation to out-of-hours care reducing the number of hospital admissions, so that approach has been quite successful. I know that there are challenges around staffing out-of-hours services in some places in Scotland, but those have been a good way of reducing hospital admissions. Is that correct?

Does Tess White agree that the ScotGEM—Scottish graduate entry medicine—programme, which is focusing on rural recruitment for GPs and is unique to Scotland, is helping us to get rural GPs?

I welcome the opportunity to speak in the debate and thank my colleague Alexander Stewart for securing it. I supported the motion as it was quite positive, which is different from what we have just heard in the contribution. I want to start by paying tribute to all of Scotland’s GPs as well as their staff, the advanced nurse practitioners, NHS 24 call handlers and drivers. As Mr Stewart’s motion mentions, their work is crucial.

The primary care out-of-hours services are a fundamental part of our healthcare in Scotland and the service provides support to those who require medical assistance outwith normal GP surgery hours. Out-of-hours involves a number of agencies and healthcare professionals working together to provide an integrated service for patients. The quality and safety of out-of-hours care is extremely important and I agree that patients should have access to consistent, high-quality standards of care across the country.

The picture with out-of-hours care in Scotland is a comparatively good one compared to other United Kingdom nations. Each year across Scotland, about 870,000 patients use out-of-hours primary care services, resulting in just under a million consultations. Home visits account for one in five, which is about 187,000 contacts with out-of-hours primary care services, with over half of the contacts—57 per cent—taking place in a primary care emergency centre. Children under five, women in their 20s and people aged 75 and over are the most common age groups of patients contacting out-of-hours primary care services. Treatment was completed by out-of-hours primary care services for just over half the patients who were in contact with them Only 3 per cent of contacts with the services resulted in a referral to accident and emergency or a minor injury unit, showing how out-of-hours services are helping to reduce acute hospital admissions.

Those statistics are welcome and they show the importance of out-of-hours services as a way to reduce hospital admissions. They are also an important way of providing reassurance to the public that care will be provided outwith GP hours.

Andrew Buist, the chair of the British Medical Association’s Scottish general practitioners committee, recently wrote a blog reflecting on NHS out-of-hours care in Scotland now compared with the model in 2004. In the blog, Dr Buist remarked how out-of-hours services, which previously were solely doctor based and involved doctors in long on-call hours, often driving themselves, have now been transformed into a more slick operation in which the primary care sector works together. Dr Buist said in his blog:

“When I think back to what out-of-hours was like before 2004 then what a luxury it feels like now to have a driver.”

He just sits back, having read the patient’s notes. He lets someone else worry about finding the right house, safe in the knowledge that, when he is on the call, there is someone outside waiting on him. Dr Buist continued:

“You work at your own pace alongside other GPs and nurse practitioners all picking from a pool of patients who have been triaged by NHS 24 and given an appointment time slot. The cases were all appropriate, a mixture of children, coughs, urinary symptoms, with the occasional rash, chest pain or alcohol withdrawal. Compared to daytime general practice, it was so much more straightforward. There was no shopping lists ... no paperwork.”

Dr Buist said also:

“Out of hours is part of general practice. We as GPs need to support it and not give it over to hospital care.”

Those words speak for themselves and, although there is, of course, room for improvement in the out-of-hours service, as there is in other parts of our healthcare system, I want to recognise the hard work of all the staff involved to make it what it is today.

That is in contrast to the latest ask of the new UK Government health secretary, Thérèse Coffey, by the Doctors Association UK. DAUK is asking for urgent action to address GP retention, as it is predicting that 16 million people in the UK could lose access to a GP within a decade.

In closing, again I welcome the debate and the opportunity to speak highly about Scotland’s out-of-hours sector.

Since we got our papers last week, I have been doing a bit of reading about the NHS estate and sustainability, and how the NHS can achieve net zero by 2040.

I am interested in what the panel thinks about 20 million miles per annum being saved during the pandemic through the implementation of NHS Near Me. That shows that mileage reduction can be achieved—it is a hefty figure. When calculated as CO₂ emissions saved, it is in the billions of milligrams.

Another issue relates to remote virtual clinics and using telemedicine so that, for example, blood pressure readings can be obtained remotely and then analysed by a GP, who can see the results without seeing the patient.

How do we marry up the technologies? How do we get the biggest bang for our buck in saving emissions in our NHS estate? I will go to Professor Bell first, as he is in front of me.

Yes. Thank you, convener. I am sorry to keep coming in.

Leigh Johnston mentioned that data or other information was missing from general practices. Why is that? Is there a plan to get that data? Is that in process, as Audit Scotland has highlighted that that data is missing?

Journeys will still need to be made in relation to NHS travel. The Scottish Government has a switched-on fleets fund of £20 million. NHS Lothian is using it and Aberdeenshire Council has added 20 new zero-emission vehicles using that funding. We can measure those journeys and we know the mileage for NHS employees’ travel.

However, I am thinking also about dialysis patients. They have very predictable journeys if they use taxis, which many of them do. We know the start point of the journey and the end point. We know that those journeys happen on Monday, Wednesday and Friday or Tuesday, Thursday and Saturday. The same patients have the same appointments every week. If Audit Scotland is looking for data to measure emissions reduction by replacing diesel-driven vehicles with electric vehicles, those journeys would be very measurable.

Should we consider doing that? Would we be able to get a big win if we rapidly adopt electric vehicles for patient journeys that we can measure and for which we can demonstrate emissions reduction?