Overview
The Lothian Unscheduled Care Service (LUCS) provides out of hours primary medical services to the NHS Lothian population during times when GP practices are closed (i.e. weekends, evenings, nights and public holidays). We offer a home visiting and appointment only service at Primary Care Emergency Centres (PCEC) from five geographical locations across NHS Lothian (Midlothian Community Hospital, East Lothian Community Hospital, The Royal Infirmary of Edinburgh, The Western General Hospital and St John’s Hospital), with initial assessment and triage being undertaken by NHS24 (111), which is a nurse-led 24-hour helpline operated by the national special Health Board that is NHS24.
Information Sharing
In order to provide high-quality, safe and effective care to the NHS Lothian population, it is often useful for ‘in-hours’ primary care colleagues to share information with NHS24 and LUCS. There are several ways to do this:
- Palliative Care Summaries
- For patients receiving palliative care, information can be shared with patient consent (see below) using the Key Information Summary (KIS) palliative care template (PCS). If the patient mentions that they are receiving ‘palliative’, ‘terminal’ or ‘end of life care’ when their call is answered by NHS24, they will receive an expedited outcome. Their PCS will be immediately visible to NHS24 and LUCS.
- Anticipatory Care Plans
- For patients who have care needs which can be anticipated (such as those with multi-morbidity or chronic conditions such as COPD) and who have an anticipatory care plan (ACP), information can be shared with consent using the Key Information Summary anticipatory care free-text box. The following NHS Lothian intranet site provides additional information on ACPs:Anticipatory Care Planning (ACP) (scot.nhs.uk) . NHS24 and LUCS are able to immediately access the contents of the patients ACP.
- Special Notes
- For patients where specific, potentially time limited, information is likely to be valuable to either NHS24 or LUCS, a special note can be sent with patient consent using the Key Information Summary. It is important that special notes are given an appropriate expiry date, so that once no longer relevant, they stop being visible to NHS24 and LUCS. A special note can be ‘never expiring’ if it is deemed that the information it contains will always be relevant for that patient (such as persistent communication or hearing difficulties).
Planned Review Service
LUCS also offers a planned review service (PRS), which aims to support ‘in-hours’ colleagues provide ongoing urgent primary-based care to patients during the out of hours period. A planned review service referral pro-forma is available on SCIGateway under the ‘Out of Hours Hub (WGH)’ domain.
The planned review service is phone based initially, so it is important that the patient is told that one of the out of hours doctors from LUCS will phone them as close to the time specified in the referral sent to us. After the LUCS GP phone assessment, we may decide that a home visit or a PCEC appointment is required (with or without LUCS transport being arranged) for further assessment and a decision on ongoing management. We may also plan to re-contact the patient by phone during the unscheduled care period if deemed appropriate.
Consent
Although best practice is to discuss all planned information sharing with patients, consent can be over-ridden for all parts of the KIS (special notes, ACP and PCS) if indicated. This is recorded by using the ‘KIS Consent Declined’ tick-box, then the ‘Override Consent’ tick-box, and selecting the relevant drop down-menu choice (legal requirement; vulnerable person; risk to self; risk to others). It is also possible to record whether the patient is aware of consent being over-ridden by using the ‘Patient Aware of Override’ tick-box and adding additional explanatory free-text notes.
Over-riding consent is important where staff or patient safety is at risk (i.e. with patients known to be violent or aggressive), or in patients who are deemed to be vulnerable. Consent can also be over-ridden because the patient is unable to give this on the grounds of capacity (i.e. dementia, learning disability, young children at risk), but where information sharing is likely to be in their best interest.
