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

inverness

invermorriston

dingwall

allnessgarve

nairn

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. 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?