September 18, 2008

Drawing and Defining the Boundaries of Out-of-Hours Medical Services in Tayside

SANDY Watson, NHS Tayside chairman, in his response to Allyson Pollock is somewhat "economical with the truth".

First, he stated that "market mechanisms were abolished in Scotland many years ago". Leaving aside the hospitals in Scotland that have in recent times been built utilising the PPI/PFI mechanism, there is the private medical facility operating in Stracathro Hospital within his own board's geographical area that he appears to have overlooked.

Secondly, in his attempt "to correct the statement that NHS Tayside cannot afford to provide 'a full out-ofhours service' " (to the local community in the Aberfeldy/Rannoch area), Mr Watson claims that, "in Highland Perthshire, the average spend per capita on out- of-hours provision is the highest in Tayside". In choosing "Highland Perthshire", he has shifted the goalposts: it is not "Highland Perthshire" that is under discussion; it is the provision of out-of- hours services in the Aberfeldy/Rannoch area that is the cause of so much concern to the local community. It is only by going beyond the geographical area under discussion that Mr Watson is able to include such facilities as the primary care emergency centre at Perth Royal Infirmary and the minor injury and illness unit at the new multi- million-pound Pitlochry Community Hospital. These are obviously outwith the Aberfeldy/Rannoch area and render meaningless any financial comparisions he seeks to draw.

Finally, the NHS Tayside chairman is eager to dismiss any suggestion that his board cannot afford to provide a full out-of- hours service to the Aberfeldy/Rannoch community. Aberfeldy (and Auchterarder), both rural communities under the control and management of Mr Watson and his management team, do not have minor injury and illness units attached to their community hospitals; these units provide an essential out-of-hours service to their communities. In a letter of September 3 to Roseanna Cunningham, MSP, Mr Watson stated: "There are no plans currently to expand opening hours (of) minor injury and illness units to Auchter arder and Aberfeldy as this will further add to cost and dilute further the attendances at other sites." So, quite clearly, Aberfeldy (and Auchterarder) do not have "full outof-hours services" in their areas and the cost of providing these services was a major consideration.

I think that Mr Watson and his management team need to reconsider their policy regarding the out-ofhours services provided to the rural communities within Perthshire and Kinross.

Bill Stewart, Earnville, Dunning, Perth.

I WAS surprised by the lack of evidence provided by Professor Allyson Pollock in her unusually unbalanced article on the out-of- hours care ser vice in Kinloch Rannoch (The Herald, September 12).

She states that the community has no access to out-of-hours care, which is clearly not true as residents are covered by the same Tayside out-ofhours service available to every other person in the region.

She equates the registered charity First Response to the privatisation agenda in England. This organisation is, in fact, a not-for-profit charity that organises and trains unpaid volunteers in first aid. They are akin to the RNLI or mountain rescue services.

Her view that it is the community's "right" to have a resident doctor in the village ignores the fundamental public health issue of the best use of limited healthcare resources. For obvious reasons, rural healthcare is more expensive than urban, so while annually we spend GBP239 per patient in Kinloch Rannoch on daytime core GP services, the average for Dundee is only GBP72. This means every person in Kinloch Rannoch costs NHS Tayside more than three times as much as every person in Dundee. Every additional GBP1 spent in Kinloch Rannoch is money that could be invested improving healthcare in Tayside's more deprived areas. And given that the SNP government's priority is to tackle inequalities in health, this spending is hard to justify.

Until 2006, the GP working in Kinloch Rannoch was on call continuously for 336 hours or 14 days without a break. It is unacceptable to expect anyone to have to provide this level of service and is equally no longer acceptable for patient care. When considering rural healthcare, we should not try to replicate urban solutions; instead we need innovative solutions. This means the community working in partnership with the health board and a Scottish Ambulance Service appropriately resourced to respond rapidly to the very rare life-threatening emergencies.

Dr Andrew Buist, Deputy Chairman, Scottish General Practitioners Committee, 14 Queen Street, Edinburgh.

Originally published by Newsquest Media Group.

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