Campaigners warn that the St Andrews Out Of Hours service may still face closure as managers seek to impose reduced hours and an unsustainable staffing structure which risks patient safety
The Fife Health & Social Care Partnership is developing a model for the Out Of Hours service at St. Andrews Community Hospital which “dangerously” waters down what was promised, says the Out of Hours Group, a working group of St Andrews Community Council which represents community councils across North East Fife.
The Out Of Hours Group says managers are planning – to close the Out Of Hours unit two hours earlier than agreed on Saturday nights (10 pm instead of midnight, with the last patient seen at 9.40pm) – to open the Out Of Hours unit only between 7 and 10pm on weekday evenings – to relocate the mobile car to Kirkcaldy after an initial placement at St. Andrews – initially to have full GP cover in the unit except between 6-7pm, but this is to reduce in the future with GPs only available for 6 hours on Saturdays (when the unit is open for 14 hours) and Sundays (when the unit is open for 12 hours).
These new hours have necessitated the Fife Health and Social Care Partnership advertising for staff to cover 3-hour shifts. The Out Of Hours Group says their research with Out Of Hours service medical staff shows many will not work such short shifts, and they will be hard to fill. Moreover, both GPs and nurses are very nervous about nurses being left on their own in the Out Of Hours service for extended periods without a GP on site. The worry is that nurses lack the experience and training of GPs to deal safely with unscheduled care emergencies.
According to the Out Of Hours Group, while the time when GPs were present at the Out Of Hours service in St Andrews was 100% before the current contingency measures, current proposals reduce it to 24%.
The Out Of Hours Group has written to NHS Fife to complain in particular about the introduction of the 3-hour shifts which curtail the Saturday evening opening. It argues that this is a particularly busy period because of the 9000+ student residents and 600,000 annual tourists, and the Partnership has not counted the high number of walk-ins in its figures.
Dr Angela Andrews, chair of the OOH Group said: “The permanent OOH service the Partnership is planning to reinstate at St Andrews in December will cover fewer hours, with less GP presence and less car availability locally than we and the IJB were led to believe in June. The only reason for this reduced service can be cost as St Andrews had enough GPs willing to work in the Out Of Hours service”.
“The introduction of three-hour shifts despite warnings from Out Of Hours service GPs that they are unworkable will make staffing so difficult that the service may well be unviable. We are afraid the Partnership is setting up the new service to fail”.
” We are also extremely disappointed by the assurances we were given by NHS Fife about the Partnership’s “ongoing commitment to continue discussions with us to help develop, refine and implement the revised model for the Out Of Hours service”. In practice, the Partnership has progressed plans without consulting with us in any meaningful way, and has continued to ignore the voices of those working in the Out Of Hours service at St Andrews”.
“The depleted Out of Hours service brought in last year under contingency measures has left many patients toughing it out at home rather than trying to get to Kirkcaldy in the early hours. It has also left First Responders, the ambulance service and A&E departments struggling with significantly increased demand.” When the A&E becomes overwhelmed, they struggle to meet their 4-hour target for treating patients”.
“A&E at Kirkcaldy is neither a cost-effective nor safe alternative to a proper Out Of Hours service at St Andrews, but this is what we fear awaits all of NE Fife residents, University students and the many visitors to the area”.
Health minister Jeane Freeman has pledged to investigate the claims that the GP out-of-hours service is St Andrews is being set up to fail. The minister said: “I would be very disappointed indeed if what seemed to me a genuine community-devised and community-led solution in terms of out-of-hours services in St Andrews was in any sense in jeopardy because relationships had broken down or for any other reason.
“I will certainly look at this with some urgency and ensure that members are informed of what I uncover and what steps I might take to resolve any difficulties that might exist.”