PATIENTS will have to travel further for major operations as plans for a radical overhaul of health services were unveiled.
A new NHS blueprint, written by top doctors and endorsed by health secretary Shona Robison, called for "significant change" and warned of the need to make "rapid progress" if standards are to be maintained.
It will see increased investment in routine healthcare delivered in communities, but as part of a trade-off many patients will have to travel to specialist hubs for more complex procedures such as knee and hip replacements rather than their local hospital.
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Health chiefs said there was "overwhelming evidence" the move will improve patient safety by performing operations using experienced teams who carry out the procedures regularly.
The strategy, deliberately timed to be published in the run-up to the Holyrood election, signals that the SNP is ready to ditch its long-standing opposition to NHS centralisation.
The party made a "presumption against centralisation" manifesto promise ahead of its first election win in 2007 and pledged to maintain the commitment five years later.
However, the new document explicitly calls for centralisation in some areas. Nicola Sturgeon had already unveiled plans to invest £200m in regional treatment hubs in Glasgow, Edinburgh, Dundee, Inverness and Aberdeen and vowed to take "tough decisions" to protect the long-term health of the NHS.
Ms Robison said she believed the public would back the plan, saying on balance more care would be delivered locally while patients were happy to travel to get better care at specialised centres for potentially once-in-a-lifetime operations.
She added that the Golden Jubilee National Waiting Times Centre in Clydebank, where 3,000 procedures a year are carried out, produced "happy customers" and that she wanted to mirror the model nationwide. But the removal or scaling back of some services from regional hospitals will prove controversial.
The strategy states: "Evidence shows that specialised procedures, concentrated on a small number of high volume sites, will improve outcomes... In secondary and tertiary care the case for redesign of services is clear and compelling.
"We must review services, specialty by specialty, considering the potential for developing fewer inpatient sites that will provide more highly specialised services, linked into local hospitals which will provide a comprehensive range of outpatients, diagnostics and day case surgery."
The document also warns that soaring demand and a rising elderly population means the NHS will need £120 million of additional investment every year just to stand still and calls for a greater use of technology to boost efficiency.
More patients will see reviews carried out by letter, email or telephone rather than visiting clinics while it says more consultations will be carried out by video link.
The BMA welcomed the document, saying it had been warned for some time that demographic changes, constrained resources and problems recruiting and retaining doctors had made current systems unsustainable.
BMA Scotland Dr Peter Bennie said: "This new strategy provides assurance that these pressures are being recognised. The challenge for all of us with a stake in the future of Scotland’s health service is finding the right way forward to secure our NHS for generations to come. This new strategy should provide a launch pad for these vital discussions.
"New models of care such as more concentrated specialist services and the vision for primary care that the BMA is working with the Scottish Government to deliver can help to address these challenges, but to be successful they also must be properly resourced."
The national clinical strategy blueprint, intended to set out the direction of travel for the next 10 to 15 years, calls for a shift in the balance of care from acute hospitals to primary care, with more care to be delivered within homes. It also says that clinicians should work across more than one hospital to allow specialist input to be delivered to remote and rural locations.
Ms Robison, who launched the document in Dundee yesterday, said the foundation of the strategy was to ensure care was delivered "as locally as possible".
She added: "We want to make sure that the best possible care is available for everyone when they need it. When it comes to needing hospital care, we want the best results for patients. Evidence shows that people who need very specialist treatment often get better outcomes by receiving it from teams doing complex operations more frequently."