A NEW initiative aiming to spark a national debate surrounding the future of Scotland’s NHS was born out of the massive public engagement seen in the independence referendum.
Health Secretary Shona Robison said it was “in the spirit of the referendum” that she has decided to launch her “National Conversation” to develop a 15-year blueprint to change the health service, and vowed to reach out to the public – even going into people’s living rooms if need be.
Health boards and the Scottish Government have come under pressure in recent months, with A&E and treatment targets missed and the flagship £842 million South Glasgow University Hospital running into difficulties.
One of the first issues up for discussion will be a redesign of GP services.
“I felt that the time was right for us to have a wide conversation in some ways in the spirit of the referendum,” she said. “I feel people are up for wanting to talk and have their input into what Scotland should look like.
Insisting that patients must be at the heart of the debate, she added: “I think public engagement now is so much more than it was a few years ago. I attended an Alliance event, an organisation which does a lot of consultation, and there were 250 folk in the room. They were asked the question: ‘Had the referendum made them more likely to want change and engage in how services are delivered?’ Nearly everyone put their hand up, so there is definitely something in that.
“The conversation has already kicked off. It’s not going to be one type or a one-way conversation. We are looking at events that are high-profile and some low-key, involving all the professional bodies but also patients and the public, who are the most important people and have got to be at the heart of this.
“We have meetings all the time with the British Medical Association, Royal College of Nursing and other colleges and health representatives, but this is really about taking a 15-year look at where we want to be by 2030 and what are the new models of care that we want to see.
“Some of the conversations will be one-to-ones in someone’s living room, so we really want to get to where people are and not just folk who attend meetings.
“We are looking at trying to get out to as many people as possible through any means we can.”
Robison said she hoped that by the autumn there would be “core principles” for the blueprint to move on to its second stage.
A shake-up of GP services looks set to be the first area for change as trials for a new model are being run in Clackmannanshire, with plans for a new contract to be introduced by 2017.
She said: “There will be a sharp focus on primary care, not least that we have a new GP contract that will take place from 2017, and negotiations around that are already under way.
“What we want is to really completely modernise and transform primary care. If you look at primary care at the moment, it is based around a GP contract that is very bureaucratic. It is designed around the GP being more of gatekeeper to services.
“So the model that is emerging and the consensus which we want to speak to a wider range of people about, would be a model that is multi-disciplinary with a wide team of health and care professionals working across the locality, with the GP as the clinical expert behind them.
“At the moment about 25 per cent of the GP workload is about medicine reconciliation – the pharmacists are well placed to do that.
“We have just put in £60m and some of that is to put in some early wins of helping to shift some of the workload off GPs so they can spend more time with more complex cases.
“Similarly, about 25 per cent of their workload is around mental health issues so we are looking at how we can support, maybe through mental health counsellors.
“I am quite excited about it and think it could really transform and revolutionise primary care.”
A specialist team is already targeting problem areas in Clackmannashire in a bid to ease the burden on beds.
Robison said: “They set up a team that explicitly focuses on the five per cent of the population within their area that uses over half of the unscheduled beds in the hospital.
“The five per cent have a phone number direct to that team, in hours or out of hours, and the appropriate health professional attends and they have managed to dramatically reduce the unscheduled admissions of that five per cent. That has been one of our test sites, particularly on out of hours it has worked really well.”
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