By Marjory Inglis, health reporter

NHS 24’s medical director has accused The Courier of “misleading” readers.

Dr Drew Smart, the medical director of the national telephone service that is the “gatekeeper” for out-of-hours health services, submitted a lengthy letter in the wake of stories highlighting the situation over the festive period when GP surgeries were closed.

Previously The Courier has reported that over 9000 calls over the festive period were passed directly to health board areas without an NHS 24 nurse assessing the urgency of the call. The situation appeared to give ammunition to those who believe the large investment made setting up and running NHS 24 would have been better invested in strengthening local services.

In the wake of his experience of NHS 24 one local hospital accident and emergency consultant, Mr Mike Johnston, called for the service to be “devolved” to local regions.

Patients had complained of long waits to get anyone at NHS 24 to answer the phone and opted to go directly to accident and emergency departments or local primary care emergency centres, bypassing NHS 24.

In his letter Dr Smart states, “Recent coverage in The Courier of how the out-of-hours service in Tayside operates has, I feel, been misleading for your readers. I would like to clarify how both NHS 24 and the local NHS’s emergency out-of-hours medical services operated over the festive period. Traditionally this is the NHS’s busiest time of year and this year was no different.

“For NHS 24 this was the first year that a full national service was provided.

“In addition, local NHS boards across Scotland have implemented new out-of-hours services brought about by the new GP contract, which has enabled up to 90% of family doctors to opt out of the responsibility of providing round-the-clock care.

“In this unique set of circumstances the sensible route to take for NHS 24, all 15 NHS boards across Scotland (both primary care and accident and emergency departments) and the Scottish Ambulance Service, was to jointly plan our approach.

“Alongside NHS 24’s shift planning and resourcing internally, NHS 24 and local NHS boards discussed and agreed a range of measures which would maximise local flexibility and help to provide a safe and effective emergency medical service for the population.”

“This included the provision of some extra local services and NHS 24 funding additional doctors to be based in local services, who would be available over the expected busiest periods.”

The Courier previously reported that NHS 24 funded extra doctors and nurses locally to cope with the festive rush, quoting Dr Joyce Meikle, a GP at Downfield Surgery in Dundee and part-time medical director of NHS Tayside’s out-of-hours services.

Dr Smart’s letter continues, “These doctors would then be available to receive non-urgent calls handed back from NHS 24 for triage locally.

“NHS 24 dealt with urgent calls immediately by providing nurse telephone consultation, making onward referrals to local services for face-to-face care where necessary in the usual way.”

Questioned further yesterday as to how calls that had not been assessed by a nurse could be classed as non-urgent, an NHS 24 spokeswoman agreed that the calls were taken by non-medically qualified call handlers.

She explained that call handlers who assessed the urgency of calls were trained “in a similar way to call dispatchers at the ambulance service.”

Dr Smart’s letter continued, “Calls which are less urgent are, in busy times, called back within a pre-arranged timescale. This is a clinically safe process.

“Over the festive period a number of these calls were handed over to GP colleagues in NHS Tayside in a pre-arranged nationally-agreed process. This does not represent a failure of either NHS 24 or of NHS Tayside’s local out-of-hours services.

“Because of the anticipated high demand, we do acknowledge that, at times, there may have been difficulties for some people in accessing the services, and for people in remote and rural areas. We believe our joint planning for the festive period helped to minimise that.

“The approach taken across all parts of the health service proved that co-operation and partnership working actually works. We aim to build on this success for the future provision of high-quality patient care round the clock.

“This year’s festive experience will be of enormous help in jointly planning for next year’s winter period.

“NHS 24, along with its partners, remains keen, of course, to hear from people who feel they did not have a positive experience of out-of-hours care during this busy period.”

Complaints should be addressed to NHS 24 at Norseman House, 2 Ferrymuir South Queensferry, EH30 9QZ (telephone 0131 300 4401).

The Courier strenuously denies misleading readers. The reports Dr Smart takes issue with contained information supplied by his own team in answer to direct questions on NHS 24’s performance. There has been no challenge to the accuracy of that information—editor.