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Unscheduled care Skye & Lochalsh

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 is unscheduled care?. What is unscheduled care?. Is it an Accident? Is it an Emergency? Is it a GP case?

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Unscheduled care Skye & Lochalsh

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  1. Unscheduled care Skye & Lochalsh

  2. Who am I?

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

  4. What is unscheduled care?

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

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

  7. OOH care round the clock!

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

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

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

  11. What Are We Trying to Provide?

  12. See and assess • Resuscitate • Evacuate • Keep what?

  13. Generalists needed • Generalists comfortable with emergencies

  14. Same as you need for “Hospital at Night” • Same as Raigmore need all the time!

  15. 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.

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

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

  18. Resuscitation training • ATLS • ALS • EPLS • ALSO

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

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

  21. Resuscitation training • ATLS • ALS • PALS

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

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

  24. To provide A&E service • To triage • To resuscitate • To provide in patient supervision • To provide locally appropriate care

  25. 4 appointments • To provide a sustainable and recruitable roster, since most of the time 1:3

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

  27. 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

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

  29. 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

  30. We provide additional cover at Portree • So require more than 6

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

  32. PH MMH

  33. Glasgow Royal Infirmary Edinburgh Royal Infirmary

  34. garve allness dingwall inverness nairn invermorriston

  35. Nursing staff round the clock both sites

  36. Doctor at Broadford round the clock

  37. Doctor at Portree till midnight

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

  39. Plus Midwives on call

  40. [Plus DNs on call]

  41. Backup doctor available to Broadford

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

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