Unscheduled care Skye & Lochalsh

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 is unscheduled care?

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

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

8. OOH care round the clock!

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

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

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

12. What Are We Trying to Provide?

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

14. Generalists needed • Generalists comfortable with emergencies

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

16. 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.

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

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

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

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

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

25. Resuscitation training • ATLS • ALS • PALS

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

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

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

29. 4 appointments • To provide a sustainable and recruitable roster, since most of the time 1:3

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

31. 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

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

33. 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

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

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

37. PH MMH

38. Glasgow Royal Infirmary Edinburgh Royal Infirmary

40. garve allness dingwall inverness nairn invermorriston

42. Nursing staff round the clock both sites

43. Doctor at Broadford round the clock

44. Doctor at Portree till midnight

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

47. Plus Midwives on call

48. [Plus DNs on call]

49. Backup doctor available to Broadford

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