Praise for remarkable turnaround of NHS Forth Valley's Out of Hours service

The out of hours service was struggling with a lack of staff, unfilled rotas and no clear management when it was forced to make changes as part of a Scottish Government review, which started in November 2022.

With so many posts unfilled, the service struggled to meet the high demand, which often had a knock-on effect on Forth Valley’s under-pressure emergency department and ambulance service.

Members of the board heard this week that over two years many changes have been made, with successful recruitment to salaried posts and much better engagement with local GPs who can provide cover when needed.

The improvement plan to redesign the service was overseen by Sir Lewis Ritchie, an expert in out of hours services, who oversaw the changes at first every month, then every quarter.

In December 2024 Sir Lewis advised that OOH had achieved “substantive and significant improvements” and formally wrote to NHS Forth Valley confirming that the service was no longer under scrutiny.

The board heard that not only was the service now much better for patients – with more than 98 per cent being seen and treated within the target six-hour window – the improvements have also had a very positive effect on staff wellbeing.

Manager Andrew McCall told members it was a “privilege and an honour” to lead the service and tell the board about the “journey” the team had been on.

At the time the review was ordered, there were major problems recruiting staff and no dedicated management, which made getting a full rota almost impossible.

“All of this was having a negative impact on the wellbeing of the team, just to keep the service afloat,” Mr McCall said.

Over the next two years, improvements were made, including recruiting Mr McCall to a dedicated management post and filling all vacant positions, including GPs and other healthcare professionals.

“Our rotal fill is now consistently more than 95 per cent and we have seen the wellbeing of staff improve,” he said.

“Staff wellbeing is important because if our team don’t feel valued then we can’t deliver a high quality service to patients.”

The board also heard from one member of staff, Angela Rae, a highly qualified Advanced Nurse Practitioner who specialises in paediatrics.

Although unable to attend in person, she provided testimony about the positive workplace she found when she joined the team just over a year ago.

She said: “I feel so privileged to be part of an amazing team of people. The team have been so supportive of me and I have learned so much within my first year working there.”

Board members also heard from a worried mum, Wanda Campbell, from Polmont, who had called 111 when her 20-month old daughter became ill with a nasty cough.

In a video recording, she explained that after speaking to a consultant on the phone, the family were booked in for a GP appointment in out of hours in Stirling.

“From when I called to when we were seen was less than four hours. It was a super-smooth and quick process and really, really easy,” Wanda said.

In the end, her daughter did not require any medicine but the family felt reassured that the doctor had “taken it seriously” and examined the baby thoroughly.

Wanda was grateful that they did not have to wait until the next day to get a GP appointment or take her daughter to a busy emergency department.

She said: “From when we got to Stirling to when we left Stirling was probably less than half an hour.

“I’m really grateful to the out of hours service, that we were seen on the same day.”

“The GPs are doing brilliant work – the nurses are working tirelessly. Everyone who we encountered during our experience was very friendly and positive and showed us nothing but kindness.”

The chair of the board, Neena Mahal, said she and the chief executive had been impressed with “just how slick it was” when they visited the service recently.

But she had also noticed that several staff had spoken positively about the change in culture and the impact that had made on their wellbeing.

She said: “If you change the culture and you value your staff, it makes a huge difference and that came across really strongly when we visited.”

Professor Frances Dodd, nurse director, said she also wanted to thank Mr McCall and the whole team for their efforts.

She said: “The board really appreciates the effort that’s gone into making such a significant difference both to creating a sustainable workforce but also a sustainable service for the people of Forth Valley.”