New role for NHS 24

Sandy Forrest, the recently appointed chief executive of NHS 24, has ambitions to develop the out-of-hours medical helpline beyond its original remit. He tells The Herald today that its nurse advisers could play an important role in extending GP surgery hours by answering calls for doctors and making an assessment of the course of treatment required, as they do for people who contact NHS 24 directly. They could also support patients with long-term health problems and issue reminders to those about to undergo planned surgery. Their taking on of such duties would, presumably, mean fewer doctors would be required during daytime, freeing some up to see patients in the evenings and at weekends.

Introducing flexible opening hours that would enable some members of the public to go to the doctor when it suited them is an ambition of Nicola Sturgeon, the Health Secretary. There is a case for the health service to be more responsive to public need in this regard, with GPs, whose salaries were enhanced and who were able to opt out of out-of-hours cover under their new contract, playing their part in delivering additional flexibility.

Mr Forrest's proposals could, in principle, make Ms Sturgeon's ambition realisable. They have an added potential attraction for him. NHS 24 was created in large part as a consequence of the new GPs' contract. It is an out-of-hours service (more than 90% of staff provide cover in the evenings, at weekends and over holidays) and the impact of unsocial working hours can be seen in the service's high staff turnover rates. It is conceivable that a shift that encompassed, in part, normal working hours could encourage more staff to remain in post and ease the task of recruitment, which is a challenge.

All of this is, at present, theoretical. Several factors must be taken into account before any proposals can be considered ready for implementation. If any organisation should be aware of the risk in undertaking an endeavour with a lack of preparedness, it is NHS 24. In its early days, confidence in the service was badly eroded by a failure to handle calls as promptly as possible, the result of inadequate planning and resources. While it has made considerable progress and enjoys a better public reputation as a consequence, there are areas that require attention, the most important of which are staff recruitment and retention and a sickness rate that, according to the most recent figures, is almost twice as high as in the rest of the NHS.

The helpline needs to attract and hold on to staff who are working at the optimum to provide the best possible service to the public (and secure its wholehearted support). The figures show there is room for progress in these areas, and delivering that should be the priority. It is worth recalling that NHS 24 staff have taken on added responsibilities elsewhere by handling 999 calls deemed not to be urgent by the Scottish Ambulance Service, the purpose being to lighten the load on ambulance crews so they can concentrate on urgent cases.

The 999 link has potential to bring about benefits but it has placed greater demands on helpline staff, who also have targets to deal with more calls more promptly. Are these demands reflected in the staff sickness figures? Is the service geared up, and staffed up, to take on an added burden of work from GP surgeries? There is nothing wrong with ambition, especially when it results in a better service for the public. Before NHS 24 can take on new challenges it must be properly funded and staffed, and it must have a contented workforce.