At the public meeting at the end of November the representatives of Higland Health Board announced that the Out of Hours contract had been awarded to Tighnabruaich surgery.
Without in any way criticising the Tighnabruaich GPs, I find this a very strange decision. I felt that the bid I put in to continue to provide Out of Hours cover was a good one. We would have had a local service, provided mostly by GPs who know the patients, and able to provide a rapid response to medical emergencies.
I have now received some of the information I requested using the Freedom of Information (Scotland) Act which includes the minutes from the Health Board meeting at which the decision was made. This shows the scores awarded to the three viable options.
Strachur (cost per patient £116)Cost Effectiveness = 2/5
Response Time = 3/5
Sustainability = 2/5
Public Acceptability = 3/5
Ambulance Cover/Response = 3/5
Total = 13/25
External provider (cost per patient £382)
Cost Effectiveness = 1/5
Response Time = 3/5
Sustainability = 2/5
Public Acceptability = 1/5
Ambulance Cover/Response = 3/5
Total = 10/25
Tighnabruaich (cost per patient £33)
Cost Effectiveness = 5/5
Response Time = 2/5
Sustainability = 3/5
Public Acceptability = 3/5
Ambulance Cover/Response = 3/5
Total = 16/25
I feel the Strachur bid has been marked down unfairly in several areas:
Response Time = 3/5Being based in the middle of the practice area, our response times could not be faster. In fact, our response times to category red calls (999 level emergencies) are comparable to 999 ambulance response time targets of 20 minutes, which far exceed the contractual requirement to respond to emergencies within one hour. This is particularly important in view of the problems with ambulance response times in the Strachur area.
Expected score 5/5
Sustainability = 2/5Again, it is difficult to understand why we scored so low for sustainability and why Tighnabruaich should score higher (it is no secret that Dr Carle in Tighnabruaich is a lot closer to retirement age than I am!).
However, the minutes of the meeting show that Tighnabruaich had been asked to guarantee a three year contract (the minutes state: "Letter received confirming 3 year contract support if approved". I was not approached to see if I would be willing to support a three year contract. This gave an unfair advantage to the Tighnabruaich bid.
Expected score 3/3
Public Acceptability =3/5
There is no justification for such a low score. It basically says that our patients would be just as happy to be covered from Tighnabruaich as from Strachur. I can't imagine how anyone could imagine this to be the case.
Expected score 5/5
Ambulance Cover/Response = 3/5
This score was the same for all of the options. However, the Strachur bid included an offer to respond to 999 calls in the area (as at present). This significantly improves the ambulance 999 response times, as a GP based in the practice area can respond to 999 emergencies faster than ambulances based in outside the practice area.
Expected score 4/5.
So, I would have expected the Strachur bid to have scored:
Cost Effectiveness = 2/5
Response Time = 5/5
Sustainability = 3/5
Public Acceptability = 4/5 or 5/5
Ambulance Cover/Response = 4/5
Total = 18/25 or 19/25
I'm going to write to the Health Board to ask for clarification of why we scored so poorly and why the Tighnabruaich bid appeared to have an unfair advantage by being given an opportunity to improve their score.
