David Ross

Highland Correspondent

A health board will consider the development of "telebooths" as part of an out of hours (OOH) service in rural areas, so patients can talk to doctors at a distance.

It is part of the efforts by NHS Highland to tackle the pressure on provision created by a shortage of GPs.

The exact nature of the booths or where they would be located, is still to be decided. They represent one of the 'principles' for a new model of OOH being mooted in a paper that goes before the board of NHS Highland next week.

Other principles include routine weekend surgeries run by peripatetic staff in rural areas; greater community resilience through emergency responders and community health assistants; limited home visiting apart from end of life care, frailty, mental health crises; robust and integrated IT systems.

They came from two workshops where the current service, and potential future models, were considered by clinicians and managers who seem to accept what was developed would not be "gold plated."

According to the report by Gill McVicar, NHS Highland's director of operations, north and west operational unit, the out of hours service in NHS Highland is :

"a patchwork of piece-meal local arrangements which are increasingly difficult to sustain due to staffing models, lack of GPs working in the system, high use of locums and unaffordable costs. "

Now, the board will be asked to agree on the key principles for a new model, which would provide an out of hours service that is "safe and more sustainable and affordable. "

The paper to the board will explain that "the out of hours primary care service is concerned with delivering urgent care of the sort that people would make an appointment to see their GP about, as opposed to dire emergency care which should be through the ambulance service. "

The document explains the background: "In 2008, the responsibility for out of hours was devolved to localities to allow very local agreements to be put in place and this has been successful to some degree especially in maintaining service, but has led to a fragmented approach, lack of ability to cross cover and it is extremely expensive. In addition, it has been increasingly difficult to attract Doctors into the service and last minute arrangements are significantly more expensive. The different pay rates also makes it inequitable. This is a national problem made particularly acute in Highland by the difficulty of attracting GPs to the more remote parts of the region."

However Mary Scanlon, Highland and Islands List MSP for the Conservatives said the difficulties in recruiting GPs were well recognised as was a the high cost of locums. But was concerned that the proposals might be too radical . She said they should be subjected to wider consultation "before I would be supporting people going to telebooths for medical advice."

She said despite the geography of the Highland , patients were entitled to expect an equality of access to health services as that enjoyed elsewhere in Scotland.