2. Unscheduled care Skye & Lochalsh

3. Who am I?

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

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

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

7. What is unscheduled care?

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

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

10. OOH care round the clock!

11. Outline our service

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

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

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

16. PH
MMH

17. Glasgow Royal Infirmary
Edinburgh Royal Infirmary

19. garve
allness
dingwall
inverness
nairn
invermorriston

21. Nursing staff round the clock both sites

22. Doctor at Broadford round the clock

23. Doctor at Portree till midnight

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

26. Plus Midwives on call

27. [Plus DNs on call]

28. Backup doctor available to Broadford

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

31. Backup doctor available in the North

32. for simultaneous distant crises
used twice in 6 months

33. One vehicle and one driver

34. based weekday evenings Portree
wee hours & weekends Broadford

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

36. Dec to May MMH and PH
Total contacts 1556

37. MMH PH
796
760

38. Self referrals
780
NHS24
referrals
499

39. Total NHS24x999 referrals 18

40. Total 999 referrals 120

41. Total GP referrals 90

42. Outcomes

43. Discharged
MMH
484 PH
588

44. Admitted
MMH
219 PH 46

45. Phone only
MMH 41 PH 28

46. Transferred
MMH 28 PH 64

47. Portree to MMH 46

48. Portree to Raigmore 13

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

50. 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

51. Total Home Visits 99

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

53. Can this model be exported?

54. What Are We Trying to Provide?

55. See and assess
Resuscitate
Evacuate
Keep what?

56. 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.

59. Need generally trained doctors with extra resuscitation skills Rural Practitioners!

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

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

63. Resuscitation training
ATLS
ALS
EPLS
ALSO

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

65. Generalists needed
Generalists comfortable with emergencies

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

67. Resuscitation training
ATLS
ALS
PALS

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

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

70. 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

71. 4 appointments
To provide a sustainable and recruitable roster, since most of the time 1:3

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

73. 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

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

75. 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

76. Questions?