Three weeks into contingency measures to protect patient safety during the hours of midnight and 8.00am, the numbers of people presenting overnight at the Victoria Hospital Primary Care Emergency Service (PCES) have remained at their usual levels, with around 11 each night between midnight and 8am.
This was the message to Members of the Fife Health and Social Care Partnership Board today (26 April) at its regular meeting. It comes as the Partnership continues to set out the challenges being faced including the growing difficulties in ensuring clinical (medical and nursing) cover in GP Out of Hours Services.
It was explained that there are 150 GPs with PCES contracts, however only 68 provide regular sessions. This means that GP cover for the PCES service has to be negotiated and arranged on a day to day basis. At the beginning of April, out of 84 overnight sessions (in a 4 week period) 43 were permanently vacant.
Michael Kellet, Director, Fife Health and Social Care Partnership stated: “Patient safety comes first. The Primary Care Emergency Service has had staffing challenges for some time. Before the end of March through careful planning and strenuous efforts of staff we managed to sustain the existing service which involved 3 centres being open for PCES appointments overnight between 12 midnight and 8am. One figure is telling. At the end of March, looking into April only 4 of the 28 overnights were fully staffed with GPs. The clinical advice was clear that in the face of those challenges seeking to maintain 3 overnight centres wasn’t sustainable and would compromise patient safety.
We therefore took action. We discussed with colleagues in NHS Fife and then made the decision that we should put in place the contingency measures from Monday 9 April.
The Partnership’s Clinical and Care Governance Committee were informed of the need to move to contingency on 4th April 2018 and on hearing of the challenges the service faced, the committee supported the plan. Clinical and Care Governance having supported the decision we then set about communicating the decision to staff, to the Board, to local and national elected members and to the public. Ideally, of course, it would have been useful to have given more notice to everyone of the new arrangement but we were in an emergency situation and had to act accordingly.”
Since the contingency arrangements began on 9th April 2018 the demand for the PCES in the overnight period has been as expected with the number of people presenting remaining consistent with normal service delivery – around 11 treatment centre appointments and 5 to 8 home visits across Fife on average.
An arrangement has been made with NHS Tayside to support treatment center attendance in Dundee for patients living in North East Fife – to date this has not been utilised.
Meanwhile, PCES continues to run normally between 18:00 and midnight weeknights and from 08:00 to midnight over weekends and public holidays, with the service available at:
- Queen Margaret Hospital, Dunfermline
- Victoria Hospital Kirkcaldy
- Glenrothes Hospital
- St Andrews Community Hospital
Addressing the Board, Seonaid McCallum, Associate Medical Director with the Partnership stated:
“We have a duty of care to provide safe care for the whole of Fife. We also needed to rapidly support our GPs with an experienced multi-disciplinary team including Urgent Care Practitioners and specialist paramedics. It would have been unacceptable and clinically unsafe to have adequate cover in some areas of Fife and not others. The only clinically safe option was to ensure we entered into a contingency which allowed flexible working with medical staff across fife so that we could respond to clinical need. Moving to contingency measures has ensured we can still see patients at a treatment centre but also respond flexibly to see people at home across Fife in a fair and equitable manner.”