Unscheduled care Skye & Lochalsh

Who am I?

Dr Leo Murray FRCSEd MRCP MRCGP DA FFAEM Variety of clinical experience 10 years running A&E service Ayr Then to Skye 1999

What have I prepared Standard presentation 5 years stats - the facts! Unscheduled care stationery

What am I going to say? What is unscheduled care? Outline our service Can it be exported? Questions & Discussion

What is unscheduled care?

What is unscheduled care? Is it an Accident? Is it an Emergency? Is it a GP case? Is it an appropriate/inappropriate attender?

What is unscheduled care? Needs sorted out - triaged Tends to be more acute Happens round the clock

OOH care round the clock!

Outline our service

What are “OOH” hours 1800 to 0800 overnight - 14 hours 1800 Friday to 0800 Monday - 60 hours Public Holidays

Remember Public Holidays Can mean 4 days in a row – 96 hours

What is left? Less than 50 hours a week Still a requirement for unscheduled care

PH MMH

Glasgow Royal Infirmary Edinburgh Royal Infirmary

garve allness dingwall inverness nairn invermorriston

Nursing staff round the clock both sites

Doctor at Broadford round the clock

Doctor at Portree till midnight

Frontline ambulances at Lochcarron, Kyle, Broadford, Portree, Dunvegan

Plus Midwives on call

[Plus DNs on call]

Backup doctor available to Broadford

for simultaneous distant crises allow 2 doctor procedures allow a doctor to escort

Backup doctor available in the North

for simultaneous distant crises used twice in 6 months

One vehicle and one driver

based weekday evenings Portree wee hours & weekends Broadford

Accept patients via self presentation referral by NHS24 999 ambulance GPs DNs CPNs Police………..etc.

Dec to May MMH and PH Total contacts 1556

MMH PH 796 760

Self referrals 780 NHS24 referrals 499

Total NHS24x999 referrals 18

Total 999 referrals 120

Total GP referrals 90

Outcomes

Discharged MMH 484 PH 588

Admitted MMH 219 PH 46

Phone only MMH 41 PH 28

Transferred MMH 28 PH 64

Portree to MMH 46

Portree to Raigmore 13

After 2400 at PH? 8 in wee hours 0000 to 0300

injury R shoulder and elbow acute asthmatic attack discomfort in chest; previous mi head injury/laceration fall scalp lac head injury lac finger with knife alleged assault

Total Home Visits 99

Problems? Very few with service itself NHS24 best avoided if you are ill

Can this model be exported?

What Are We Trying to Provide?

See and assess Resuscitate Evacuate Keep what?

How to provide local intermediate care - i. e How to provide local intermediate care - i.e. care provided across specialty boundaries which can be provided to a good enough standard, rather than care requiring specialist attention.

Need generally trained doctors with extra resuscitation skills Rural Practitioners!

School-leavers Perform all succesful intubations Perform all neurosurgery worldwide Perform all open heart surgery worldwide

Current plan Generally trained doctors Work 40 hours Pay £90,000 Provide airway training ABLE TO RECRUIT!!!

Resuscitation training ATLS ALS EPLS ALSO

Skill maintenance in a low volume situation 10 days per year study leave 6 weeks per annum in major hospitals

Generalists needed Generalists comfortable with emergencies

GP trained Pre-registration medicine Pre-registration surgery 1 year in General Practice medicine paediatrics o&g other specialties

Resuscitation training ATLS ALS PALS

To paralyse and ventilate 6 months anaesthetic experience minimum acceptable standard annually refreshed

Skill maintenance in a low volume situation 10 days per year study leave 6 weeks per annum in major hospitals

To provide A&E service To triage To resuscitate To provide in patient supervision To provide locally appropriate care To re-integrate hospital with GP community

4 appointments To provide a sustainable and recruitable roster, since most of the time 1:3

Think again! Doctors will not work 1:3 EWTD Good GP = Consultant salary

Think again! The pool of doctors with 6/12 anaesthetic experience is shrinking - have to provide this experience in future specifically for doctors in these situations

Current plan Generally trained doctors Work 40 hours Pay £90,000 Provide airway training ABLE TO RECRUIT!!!

6 weeks skill maintenance, 2 weeks study leave  6 weeks plus 2 weeks plus 6 weeks leave = 14 weeks away  38 weeks x 40 hours = 1520 hours  365 days x 24 hours = 8760  So need 6 doctors

Questions?