Liberal Democrats believe that the provision of healthcare in our communities should be led by our health professionals. We are deeply sceptical at the way in which NHS 24 has developed and is being developed into a call centre for general medical advice.

Ross Finnie MSPThat is not to denigrate the work of those employed by NHS 24. However, we believe it is in the interest of each patient for more time and effort to be put into developing a model of 24 hour care that is driven and delivered by health professionals rather than spending more money diverting front-line staff into supporting ever bigger call centres.

Reducing the concerns of patients and the professionalism of our healthcare professionals to the lowest common denominator is not the answer to the many questions that must be answered if we are to improve healthcare in Scotland.

We need fundamental change to 24 hour health provision. We need to end our reliance on NHS 24 to plug the gaps in a system that is crying out for change. The Herald editorial (January 12 2009) concluded that because GPs opted out of out-of-hours care after the introduction of the new GP contract and, because of what The Herald pejoratively described as “the furore” over additional hours, they were not interested in developing a new model of community care.

It takes a remarkable leap of logic to arrive at that conclusion and I have to say simply does not square with anything I have gleaned from talking to GPs and the BMA about the provision of care in our communities. First, let’s look at the numbers.

NHS 24 costs the taxpayer £55 million a year. This pays for 4 call centres, over 500 call handlers, over 300 nurse advisors, 56 health advisors, 19 pharmacists and 9 dental technicians. On average, 400 calls an hour are handled by NHS 24 staff and its website is viewed by around 40,000 people each month.

In truth, the way that figures are trotted out on NHS 24 to prove it has turned the corner show up the faceless nature of the system. We are being treated as statistics and our healthcare has been reduced to a series of numbers that don’t come close to scratching the surface of the healthcare challenges we face.

Instead of focusing on healthcare based on how you reply to a few pre-ordered questions, we should be making the change to providing 24 care based on the individual and in the community. The Liberal Democrats want to challenge medical professionals to offer 24 hour care that is grounded in these principles instead of focussing on an impersonal telephone answering service.

This can be done. The same £55 million which funds NHS 24 could instead be used to employ 568 GPs or 2,183 nurses. I would prefer my taxes to be spent funding professional, medically trained doctors and nurses to help build a new 24 hour community care model.

In general terms, Liberal Democrats support the development of Community Health and Care Partnerships (CHCPs). We see great merit in taking a more holistic approach and in co-ordinating all of the elements of health care provided by the NHS and the Local Authorities. However, because we believe that GPs should be the fulcrum of any new 24 hour community care model it follows that GPs must also be at the centre of the development of CHCPs which, sadly is not the case in too many instances at present.

To that end now that the GP contracts have settled down, we think new contracts should be developed to facilitate GPs providing collaborative out-of-hour cover. Liberal Democrats are clear, there must be no going back to the situation where GPs were expected to be on-call 24 hours a day.

Whilst GPs should be the focal point, they are only one element in the jigsaw and it may be that other contractual arrangements might have to be revisited in order to provide adequate 24 hour cover. Our vision encompasses not only GPs but also care provided by Local Authorities, the critical services provided by the nursing profession, the community pharmacies, the allied health professionals and, of course, the ambulance service.

All of these elements combined would produce an excellent service. With new flexible contractual agreements and a better CHCP with GPs at the core, Scotland could and should have 24 hour care that is based on the individual and centred on communities.

Article published in The Herald - 16th January 2009