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

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Presentation Transcript
dr leo murray
Dr Leo Murray
  • FRCSEd MRCP MRCGP DA FFAEM
  • Variety of clinical experience
  • 10 years running A&E service Ayr
  • Then to Skye 1999
what have i prepared
What have I prepared
  • Standard presentation
  • 5 years stats - the facts!
  • Unscheduled care stationery
what am i going to say
What am I going to say?
  • What is unscheduled care?
  • Outline our service
  • Can it be exported?
  • Questions & Discussion
what is unscheduled care8
What is unscheduled care?
  • Is it an Accident?
  • Is it an Emergency?
  • Is it a GP case?
  • Is it an appropriate/inappropriate attender?
what is unscheduled care9
What is unscheduled care?
  • Needs sorted out - triaged
  • Tends to be more acute
  • Happens round the clock
what are ooh hours
What are “OOH” hours
  • 1800 to 0800 overnight - 14 hours
  • 1800 Friday to 0800 Monday - 60 hours
  • Public Holidays
remember public holidays
Remember Public Holidays
  • Can mean 4 days in a row – 96 hours
what is left
What is left?
  • Less than 50 hours a week
  • Still a requirement for unscheduled care
slide16

PH

MMH

slide17

Glasgow Royal Infirmary

Edinburgh Royal Infirmary

slide19

garve

allness

dingwall

inverness

nairn

invermorriston

slide29
for simultaneous distant crises
  • allow 2 doctor procedures
  • allow a doctor to escort
slide32
for simultaneous distant crises
  • used twice in 6 months
slide34
based weekday evenings Portree
  • wee hours & weekends Broadford
accept patients via
Accept patients via
  • self presentation
  • referral by NHS24
  • 999 ambulance
  • GPs
  • DNs
  • CPNs
  • Police………..etc.
dec to may mmh and ph
Dec to May MMH and PH
  • Total contacts 1556
after 2400 at ph
After 2400 at PH?
  • 8 in wee hours 0000 to 0300
problems
Problems?
  • Very few with service itself
  • NHS24 best avoided if you are ill
slide55
See and assess
  • Resuscitate
  • Evacuate
  • Keep what?
slide56
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.
school leavers
School-leavers
  • Perform all succesful intubations
  • Perform all neurosurgery worldwide
  • Perform all open heart surgery worldwide
current plan
Current plan
  • Generally trained doctors
  • Work 40 hours
  • Pay £90,000
  • Provide airway training
  • ABLE TO RECRUIT!!!
resuscitation training
Resuscitation training
  • ATLS
  • ALS
  • EPLS
  • ALSO
skill maintenance in a low volume situation
Skill maintenance in a low volume situation
  • 10 days per year study leave
  • 6 weeks per annum in major hospitals
slide65
Generalists needed
  • Generalists comfortable with emergencies
gp trained
GP trained
  • Pre-registration medicine
  • Pre-registration surgery
  • 1 year in General Practice
  • medicine
  • paediatrics
  • o&g
  • other specialties
to paralyse and ventilate
To paralyse and ventilate
  • 6 months anaesthetic experience
  • minimum acceptable standard
  • annually refreshed
skill maintenance in a low volume situation69
Skill maintenance in a low volume situation
  • 10 days per year study leave
  • 6 weeks per annum in major hospitals
slide70
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
slide71
4 appointments
  • To provide a sustainable and recruitable roster, since most of the time 1:3
think again
Think again!
  • Doctors will not work 1:3
  • EWTD
  • Good GP = Consultant salary
think again73
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
current plan74
Current plan
  • Generally trained doctors
  • Work 40 hours
  • Pay £90,000
  • Provide airway training
  • ABLE TO RECRUIT!!!
slide75
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