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Review Of Out Of Hours Service For Skye And Lochalsh

Issued: 6 Jul 2010

Mid Highland Community Health Partnership (CHP) – the part of NHS Highland covering Skye, Lochalsh, Ross, Cromarty, West Ness and Lochaber - is considering the best way to provide the Out Of Hours (OOH) service in Skye and Lochalsh.

Alison Phimister, who is Locality General Manager for Skye, Lochalsh, Ross, Cromarty and West Ness, said it needed to be redesigned to ensure that a safe, effective and sustainable service could be provided to people living in this area in the future.

She said a number of options had been identified for consideration and Mid Highland CHP would be working with the Scottish Ambulance Service, community representatives and clinicians to develop these options.

She stressed that there was still a lot of work to be done, including risk and impact assessments and community engagement, and that no decisions had been taken.

Currently, Skye and Lochalsh operates a Primary Care Emergency Centre (PCEC) service across the hospital sites at Broadford and Portree, plus the OOH service in the Glenelg Practice area, which is provided by the local GPs.

The PCEC in MacKinnon Memorial Hospital operates a 24-hour service, with a team of Rural Practitioners (RPs), who work both in and out of hours providing inpatient, accident and emergency and enhanced acute clinical care to patients in the locality. There are two RPs available during the OOH period - one on duty and one as second on call.

The PCEC in Portree Hospital is staffed with a GP or RP from 6pm to 11pm and an on call service is provided from 11pm.

Ms Phimister explained that, since the OOH service was established in December 2004 following the implementation of the new GMS contract, there had been a number of changes which influenced the delivery of a safe and sustainable service.

She said: “The service is reliant on the RPs and GPs and over the years, as a result of GPs being able to opt out of OOH provision, it has become increasingly difficult to find enough GPs willing to participate in the OOH service.

“This is placing an increasing demand on the RP service, which is especially acute during holiday periods.”

Ms Phimister added that a change to the way in which OOH funding was allocated to ensure it was shared out more equally across the whole of the area covered by NHS Highland had resulted in a deficit of about £100,000 per annum in the Skye and Lochalsh OOH budget.

She said: “This means we cannot continue to provide the current model of service unless funding can be found from elsewhere in the locality and this is not likely to be possible in the current financial climate.”

A small working group has been set up to look at the options for future service design. Members include RPs, GPs, Charge Nurses, the Clinical Services Development Manager, the OOH Manager and Mid Highland CHP’s Head of Finance.

Options under consideration include a seven-day unscheduled care service provided by nurses with telemedicine links between the hospitals in Portree and Broadford and a Monday to Thursday unscheduled care service provided by nurses, with a weekend service provided by RPs and GPs using the same telemedicine links.

Another option is a Monday to Friday unscheduled care service provided by nurses, with the weekend service being provided by RPs and GPs, with the telemedicine links, or the number of RPs could be increased to nine to enable them to cover OOH in Portree.

Patient and public representatives have been involved in the working group and the Skye and Lochalsh Health Services Reference Group will be asked to discuss and advise on the next steps for engagement.

© 2010 Highland Public Services Partnership.
Project part-financed by the European Union (European Regional Development Fund) within the INTERREG IIIB Northern Periphery Programme