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Unscheduled care Skye & Lochalsh
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Who am I?
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Dr Leo Murray FRCSEd MRCP MRCGP DA FFAEM
Variety of clinical experience 10 years running A&E service Ayr Then to Skye 1999
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What have I prepared Standard presentation 5 years stats - the facts!
Unscheduled care stationery
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What am I going to say? What is unscheduled care? Outline our service
Can it be exported? Questions & Discussion
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What is unscheduled care?
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What is unscheduled care?
Is it an Accident? Is it an Emergency? Is it a GP case? Is it an appropriate/inappropriate attender?
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What is unscheduled care?
Needs sorted out - triaged Tends to be more acute Happens round the clock
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OOH care round the clock!
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Outline our service
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What are “OOH” hours 1800 to 0800 overnight - 14 hours
1800 Friday to 0800 Monday - 60 hours Public Holidays
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Remember Public Holidays
Can mean 4 days in a row – 96 hours
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What is left? Less than 50 hours a week
Still a requirement for unscheduled care
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PH MMH
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Glasgow Royal Infirmary
Edinburgh Royal Infirmary
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garve allness dingwall inverness nairn invermorriston
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Nursing staff round the clock both sites
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Doctor at Broadford round the clock
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Doctor at Portree till midnight
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Frontline ambulances at Lochcarron, Kyle, Broadford, Portree, Dunvegan
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Plus Midwives on call
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[Plus DNs on call]
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Backup doctor available to Broadford
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for simultaneous distant crises
allow 2 doctor procedures allow a doctor to escort
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Backup doctor available in the North
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for simultaneous distant crises
used twice in 6 months
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One vehicle and one driver
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based weekday evenings Portree
wee hours & weekends Broadford
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Accept patients via self presentation referral by NHS24 999 ambulance
GPs DNs CPNs Police………..etc.
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Dec to May MMH and PH Total contacts 1556
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MMH PH 796 760
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Self referrals 780 NHS24 referrals 499
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Total NHS24x999 referrals 18
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Total 999 referrals 120
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Total GP referrals 90
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Outcomes
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Discharged MMH 484 PH 588
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Admitted MMH 219 PH 46
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Phone only MMH 41 PH 28
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Transferred MMH 28 PH 64
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Portree to MMH 46
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Portree to Raigmore 13
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After 2400 at PH? 8 in wee hours 0000 to 0300
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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
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Total Home Visits 99
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Problems? Very few with service itself
NHS24 best avoided if you are ill
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Can this model be exported?
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What Are We Trying to Provide?
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See and assess Resuscitate Evacuate Keep what?
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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.
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Need generally trained doctors with extra resuscitation skills Rural Practitioners!
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School-leavers Perform all succesful intubations
Perform all neurosurgery worldwide Perform all open heart surgery worldwide
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Current plan Generally trained doctors Work 40 hours Pay £90,000
Provide airway training ABLE TO RECRUIT!!!
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Resuscitation training
ATLS ALS EPLS ALSO
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Skill maintenance in a low volume situation
10 days per year study leave 6 weeks per annum in major hospitals
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Generalists needed Generalists comfortable with emergencies
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GP trained Pre-registration medicine Pre-registration surgery
1 year in General Practice medicine paediatrics o&g other specialties
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Resuscitation training
ATLS ALS PALS
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To paralyse and ventilate
6 months anaesthetic experience minimum acceptable standard annually refreshed
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Skill maintenance in a low volume situation
10 days per year study leave 6 weeks per annum in major hospitals
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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
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4 appointments To provide a sustainable and recruitable roster, since most of the time 1:3
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Think again! Doctors will not work 1:3 EWTD
Good GP = Consultant salary
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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
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Current plan Generally trained doctors Work 40 hours Pay £90,000
Provide airway training ABLE TO RECRUIT!!!
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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
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Questions?
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