Temporary closure of out-of-hours GP cover in Fife as a result of staff shortages has concerned local residents. As of last Monday, primary care emergency services (PECS) at St Andrews, Queen Margaret and Glenrothes hospitals will be closed for three months.
This means that patients put in place by Fife Health and Social Care Partnership (FHSCP) will be referred to the Victoria Hospital in Kirkcaldy.
An NHS Fife spokesperson has assured the community that “NHS Fife has made clear that this contingency should be temporary and that the FHSCP makes all efforts to both recruit and reinstate the service as quickly as possible.” However, concerns have been raised that these measures could become permanent, as MSPs of all parties join forces in protest against the move.
The closure has come about due to nursing and medical staffing difficulties across Fife. FHSCP has said that the immediate action was necessary to ensure the continuation of a clinically safe and sustainable service. Whilst the contingency measures are due to be in place for three months, the partnership has said that it is developing longer-term plans for urgent care and will consult the public before making a final decision.
The Scottish Government’s 2020 vision for health and social care specifically addresses improvement to out-of-hours service as a key area. Clair Dobson, the partnership’s west general manager, said that urgent care services were national issues: “This is due partly to increasing demand, particularly from people with multiple long-term conditions and complex care needs, as well as the availability of doctors and nurses.”
A 2017 review of NHS Workforce Planning by the Auditor General for Scotland found that whilst overall staff levels in Scotland NHS are at their highest ever, the answer to future problems will not be to simply grow the workforce further, but to adapt the workforce to the patients’ needs.
Improving workforce planning is critical to addressing pressures facing the NHS. However, the responsibility for this planning is shared amongst the Scottish Government, NHS boards, and three regional bodies, resulting in some confusion.
NHS Scotland is currently undergoing major reforms, in particular seeking to shift towards more community and home-based care. Scotland’s large rural population finds it difficult to access some healthcare services. This problem is made worse by the fact that a disproportionate number of people aged 65 and older live in rural areas.
The number of vacancies for some consultant and nursing positions remains high, and these vacancies are difficult to fill. Impending retirements may increase vacancies — one in three NHS staff memebers is over 50 years old. Recruiting new consultants is also a continuing challenge as it takes more than 10 years to train a new consultant.
Meanwhile, current NHS staff continue to raise concerns about their workload and there are signs that NHS services are in increasing demand. The Scottish government expects the need for health and social services to rise in the future, but is yet to project how it will adapt its skills and workforce to meet this growing demand. The Auditor General finds that the Scottish Government does not appear to have long-term scenarios in place.
Finding a viable, long-term solution to the Fife GP shortage remains urgent. Additionally, this is clearly not a local problem, but one that will need both a local and national approach to be solved.