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GP practices in Scotland should receive individual and regular data about how many of their patients attend A&E and how many self refer, to help develop alternative services in the community, according to the conclusions of a review into government health and care indicators and targets.
The recommendation from Sir Harry Burns comes in his report published on 15 November 2017, and commissioned by the Scottish government, which argues that indicators and targets alone only tell one part of the patient journey.
Burns said more data needed to be collected to see the targets in context and make better use of information.
His recommendation around the A&E four-hour wait target and additional practice data was welcomed by Community Pharmacy Scotland (CPS), which represents community pharmacy owners.
The CPS said the move might boost its Pharmacy First campaign, where the public is being encouraged, where appropriate, to consult a pharmacist before seeing their GP or attending A&E.
Matt Barclay, CPS’s director of operations, said: “In Scotland community pharmacy is recognised as an important part of the primary care team and we are looking to embed the Pharmacy First message with the public to support them and the wider NHS team by diverting appropriate consultations into community pharmacy.”
Burns recommended that new information on the number of an individual practice’s patients attending A&E would “give insight into opportunities to develop other services such as new, holistic approaches to social support or mental health support in association with primary care”.
Figures should also be collected for the number of practice patients who self-referred to casualty and, he recommended, that where numbers are significant, additional support for those practices should be considered.
Referral target recommendation
Burns is also keen to scrap Scotland’s national 18-week patient referral target for treatment.
Setting a guaranteed referral timescale did not suit all patients and may not always meet clinical priority, according to the report. In future the 18-week target should be left to local discretion, it recommended.
Releasing his report, Burns, director of global public health at the University of Strathclyde’s International Public Policy Institute, said that Scottish indicators and targets have improved some aspects of health and social care.
“However,” he added, “existing measurements often only tell a part of the story. If we really want to understand why some parts of our system appear to function better than others; we need to look across the whole journey of care, not just take a snapshot of isolated bits of it. Health is the product of a complex system and we should measure how we manage it appropriately.”
Scottish health secretary Shona Robison confirmed that current targets will remain and be built upon — informed by the principles in the report “that we must shift the emphasis to ensure we have a more sophisticated approach which helps drive improvements in health across the population”.
