Remote Practitioners Association Inverness 11 th November 2010 Shirley Rogers Stephanie Phillips Paul Gowens

Consultation Strategy consultation in 2009: Over 2,000 organisations contacted Over 1,000 GP practices and health centres 72% of GPs who responded were from rural areas 59% of patients who responded were from rural areas Key issues – transport, access to healthcare and role SAS can play Overwhelmingly positive response to strategic direction set out, particularly from patients

RPAS Response SAS / NHS 24 not effectively using BASICs GPs in remote & rural areas Patients not being routed to the most appropriate care in the community but taken to distant A&E Reliance on GPs / community hospitals as ‘place of safety’ delays urgent transport to secondary care Staffing levels vulnerable in remote & rural areas – still single-crewing

RPAS Response Air and road ambulance services need to be better integrated Late notice PTS cancellations with no alternative transport available – reduction in volunteer network for support Support for first responders and more integrated healthcare professional response – needs to be joined up and not seen as alternative but enhancement

Vision Strategic aims Goals Our vision

What are we trying to achieve? Improving access & referral to care Better understanding and meeting clinical need Getting the right response to patients –Emergency, urgent, non-emergency –Right skills and right response first time Working with partners –NHS –Transport –Voluntary sector

Progress Developing single common triage tool with NHS24 and other OOH / A&E providers Developing MOU with BASICs and Sandpiper Trust to improve response and levels of use Working with NHS Boards to develop joint response to vulnerable communities in line with Strategic Options Framework Reviewed PTS eligibility criteria to reflect clinical need Working with transport organisations & NHS Boards to ensure alternatives in place Completed review of PTS service using LEAN and working with NHS Boards to test outcomes

Progress Development of careers framework which supports continued development of enhanced skilled paramedics and more generic roles Successful roll out of EMRS service across North of Scotland Rolling out smart phone technology, vehicle tracking, and improving links with first responders and GP responders Able to access emergency care summary in ambulance and live transfer of patient report form to A&E Introducing mobile technology to PTS fleet Elimination of rostered single-crewing in key rural divisions

Progress Continuing to roll out new service models –Retained ambulance service operating in Lerwick –Community paramedic schemes across Scotland –Working alongside A&E, OOH services –70% reduction in A&E attendances for see & treat –60,000 A&E attendance avoided last year treating patients at home –Anticipatory care models developing in North of Scotland –Over 1,000 first responder volunteers running over 120 schemes across Scotland –PTS staff trained to intermediate First Person On Scene standard

Collective challenges Sustainability of rural general hospitals will impact on SAS and GP community – how can we work together to offer appropriate response? How can we work together to keep patients in community and treat safely at home? How can we make better use of telehealth links in community hospitals / health centres? How can we use technology better to ‘track’ and deploy available healthcare resources?

Collective challenges How do we get agreement on appropriate use and expectations of ambulance resources – road and air? How do we avoid skills atrophy and learn from each other? Increasingly blurred lines between anticipatory care, urgent and emergency response and primary care – how do we stop patients falling between the lines? Lack of funding shouldn’t inhibit creative solutions

Collective challenges Questions?