Unscheduled care Skye & Lochalsh - PowerPoint PPT Presentation

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

• Standard presentation
• 5 years stats - the facts!
• Unscheduled care stationery

• What is unscheduled care?
• Outline our service
• Can it be exported?
• Questions & Discussion

• Is it an Accident?
• Is it an Emergency?
• Is it a GP case?
• Is it an appropriate/inappropriate attender?

• Needs sorted out - triaged
• Tends to be more acute
• Happens round the clock

• 1800 to 0800 overnight - 14 hours
• 1800 Friday to 0800 Monday - 60 hours
• Public Holidays

• Can mean 4 days in a row – 96 hours

• Less than 50 hours a week
• Still a requirement for unscheduled care

PH

MMH

Glasgow Royal Infirmary

Edinburgh Royal Infirmary

garve

allness

dingwall

inverness

nairn

invermorriston

• allow 2 doctor procedures
• allow a doctor to escort

• used twice in 6 months

• wee hours & weekends Broadford

• self presentation
• referral by NHS24
• 999 ambulance
• GPs
• DNs
• CPNs
• Police………..etc.

• Total contacts 1556

• 8 in wee hours 0000 to 0300

• Very few with service itself
• NHS24 best avoided if you are ill

• Resuscitate
• Evacuate
• Keep what?

• Perform all succesful intubations
• Perform all neurosurgery worldwide
• Perform all open heart surgery worldwide

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

• ATLS
• ALS
• EPLS
• ALSO

• 10 days per year study leave
• 6 weeks per annum in major hospitals

• Generalists comfortable with emergencies

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

• ATLS
• ALS
• PALS

• 6 months anaesthetic experience
• minimum acceptable standard
• annually refreshed

• 10 days per year study leave
• 6 weeks per annum in major hospitals

• To triage
• To resuscitate
• To provide in patient supervision
• To provide locally appropriate care
• To re-integrate hospital with GP community

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

• Doctors will not work 1:3
• EWTD
• Good GP = Consultant salary

• The pool of doctors with 6/12 anaesthetic experience is shrinking - have to provide this experience in future specifically for doctors in these situations

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

• 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