unscheduled care skye & lochalsh who am i? dr leo murray frcsed mrcp mrcgp da ffaem variety of...
TRANSCRIPT
![Page 1: 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](https://reader036.vdocuments.mx/reader036/viewer/2022062315/5697bf9a1a28abf838c92547/html5/thumbnails/1.jpg)
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Unscheduled care Skye & Lochalsh
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Who am I?
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Dr Leo Murray
• FRCSEd MRCP MRCGP DA FFAEM
• Variety of clinical experience
• 10 years running A&E service Ayr
• Then to Skye 1999
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What have I prepared
• Standard presentation
• 5 years stats - the facts!
• Unscheduled care stationery
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What am I going to say?
• What is unscheduled care?
• Outline our service
• Can it be exported?
• Questions & Discussion
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What is unscheduled care?
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What is unscheduled care?
• Is it an Accident?
• Is it an Emergency?
• Is it a GP case?
• Is it an appropriate/inappropriate attender?
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What is unscheduled care?
• Needs sorted out - triaged
• Tends to be more acute
• Happens round the clock
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OOH care round the clock!
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Outline our service
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What are “OOH” hours
• 1800 to 0800 overnight - 14 hours
• 1800 Friday to 0800 Monday - 60 hours
• Public Holidays
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Remember Public Holidays
• Can mean 4 days in a row – 96 hours
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What is left?
• Less than 50 hours a week
• Still a requirement for unscheduled care
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PH
MMH
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Glasgow Royal Infirmary
Edinburgh Royal Infirmary
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inverness
invermorriston
dingwall
allnessgarve
nairn
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Nursing staff round the clock both sites
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Doctor at Broadford round the clock
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Doctor at Portree till midnight
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Frontline ambulances at Lochcarron, Kyle, Broadford, Portree, Dunvegan
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Plus Midwives on call
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[Plus DNs on call]
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Backup doctor available to Broadford
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• for simultaneous distant crises
• allow 2 doctor procedures
• allow a doctor to escort
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Backup doctor available in the North
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• for simultaneous distant crises
• used twice in 6 months
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One vehicle and one driver
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• based weekday evenings Portree
• wee hours & weekends Broadford
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Accept patients via
• self presentation
• referral by NHS24
• 999 ambulance
• GPs
• DNs
• CPNs
• Police………..etc.
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Dec to May MMH and PH
• Total contacts 1556
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MMH PH
796 760
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Self referrals 780
NHS24
referrals
499
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Total NHS24x999 referrals 18
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Total 999 referrals 120
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Total GP referrals 90
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Outcomes
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Discharged
MMH 484
PH 588
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Admitted
MMH 219
PH 46
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Phone only
MMH 41
PH 28
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Transferred
MMH 28
PH 64
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Portree to MMH 46
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Portree to Raigmore 13
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After 2400 at PH?
• 8 in wee hours 0000 to 0300
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injury R shoulder and elbow
acute asthmatic attack
discomfort in chest; previous mi
head injury/laceration
fall scalp lac
head injury
lac finger with knife
alleged assault
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Total Home Visits 99
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Problems?
• Very few with service itself
• NHS24 best avoided if you are ill
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Can this model be exported?
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What Are We Trying to Provide?
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• See and assess
• Resuscitate
• Evacuate
• Keep what?
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• 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.
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Need generally trained doctors with extra resuscitation skills
Rural Practitioners!
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School-leavers
• Perform all succesful intubations
• Perform all neurosurgery worldwide
• Perform all open heart surgery worldwide
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Current plan
• Generally trained doctors
• Work 40 hours
• Pay £90,000
• Provide airway training
• ABLE TO RECRUIT!!!
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Resuscitation training
• ATLS
• ALS
• EPLS
• ALSO
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Skill maintenance in a low volume situation
• 10 days per year study leave
• 6 weeks per annum in major hospitals
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• Generalists needed
• Generalists comfortable with emergencies
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GP trained
• Pre-registration medicine
• Pre-registration surgery
• 1 year in General Practice
• medicine
• paediatrics
• o&g
• other specialties
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Resuscitation training
• ATLS
• ALS
• PALS
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To paralyse and ventilate
• 6 months anaesthetic experience
• minimum acceptable standard
• annually refreshed
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Skill maintenance in a low volume situation
• 10 days per year study leave
• 6 weeks per annum in major hospitals
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• 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
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• 4 appointments
• To provide a sustainable and recruitable roster, since most of the time 1:3
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Think again!
• Doctors will not work 1:3
• EWTD
• Good GP = Consultant salary
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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
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Current plan
• Generally trained doctors
• Work 40 hours
• Pay £90,000
• Provide airway training
• ABLE TO RECRUIT!!!
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• 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
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Questions?
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