19
Nov
2018
0

Out of hours and the IJB

To blame forces beyond one’s control is the reflex action of politicians and management when unpopular decisions they have made come under pressure. When this explanation is challenged, the temptation to scapegoat others can be overwhelming.

Thus we have seen GPs blamed for the emergency closure of some GP out of hours services (OOH) at St Andrews Hospital in April, and the allegedly unavoidable proposal to close all of them permanently since then.

The underlying implications have been that GPs are lazy (they won’t commit to shifts at unsocial hours) and/or greedy (“financial inducements” by NHS Fife, ie increased pay to get them to sign up, aren’t working because they are too well-paid already).

This handily obscures two glaring areas of management responsibility which underlie the OOH crisis in Fife. The first is that there are just not enough GPs. The responsibility for that lies with the SNP government. For over a decade it has failed to deal with the crisis in GP training, recruitment and retention, which has been looming for at least as long as the SNP has been in charge of the NHS and education in Scotland. Of course, no government can remedy such a situation overnight, or even in a year or two, but that does not absolve it of the responsibility or power to do so in the medium and long term. Treating the lack of GPs as a fact of nature is politically expedient for both the Scottish Governemnt and NHS Fife.

The second area of reponsibility for the collapse of OOH services in St Andrews lies with the Integrated Joint Board for Health and Social Care (IJB) which comprises equal numbers of representatives from Fife Council and NHS Fife. The Board is responsible for organising and overseeing the management of GP OOH services.

Other IJBs and health boards in Scotland have managed to retain their OOH services, and attract GPs. Why is that? More generally, how much communication and co-operation has there been with GPs in Fife, and particularly NE Fife – both to avert the emergency closure and to put in a longer-term OOH structure to secure a commitment from Fife GPs?

When sending out emails to ask for volunteers or upping the pay rate don’t work, surely it’s time for managers to work directly with the GPs in Fife, find out what they could offer and under what conditions, identify what works in Dundee and elsewhere and then get a bit creative?

Willie Rennie recently called for an investigation into the board at NHS Fife after a string of high-profile departures, citing a “real risk” to the delivery of healthcare. GPs in St Andrews and the East Neuk have been clear that the full closure of GP out of hours services here constitutes a real risk to their patients at home and in the community hospitals in St Andrews and Cupar. Nobody believes they are not committed to their patients and the retention of some sort of OOH service. The question is how ready and willing are the board members and senior managers at the IJB and NHS Fife to work with them and service-users to find a solution.

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