In a previous blog post we heard about the Being Here Initiative which is now seeing results success throughout NHS highland.
As we face and must meet the challenges of an ageing population and modern demands for healthcare services, the current model of healthcare provision in remote and rural areas is not sustainable.
That is why we asked NHS Highland to develop a proposal to look at new models of healthcare delivery that will support patients and healthcare staff.
The Scottish Government is providing funding of £1.5m in total over four financial years 2013/14 – 2016/17 for testing new ways of working in four areas across NHS Highland (Campbeltown, West Lochaber, Isle of Islay and Mid Argyll).
The steering group has established four work streams which are looking at recruitment and retention, learning and development, community resilience, and the ‘Rural Parliament’ approach, as well as on-going stakeholder engagement through learning and network events.
Progress to date:
There has been progress in a number of areas:
The programme has supported an ambitious creative recruitment exercise to attract health professionals to live and work in remote and rural areas of NHS Highland. This included a high profile advertising campaign and launch of a micro-site. A number of successful appointments have now been made which has resulted in some stability in the test site areas in Argyll and Bute enabling their models to progress towards a better integrated service. The rural support team in West Lochaber has been successfully formed with a number of key positions filled which will also enable an alternative less GP-focussed model to be progressed.
There has been much activity around training and education given that absence of remote and rural specific training programmes for GPs has been evidenced as an indicator in job attractiveness and quality of service provision. In Argyll and Bute a refresher training programme for GPs in acute care competencies was developed and ran in January 2015. 23 GPs from across Argyll and Bute attended with positive feedback from attendees and speakers. This is being aligned with existing NES activity.
- In West Lochaber, the new model of delivering healthcare for the Small Isles commenced in 3 January 2015. It consists of a combination of improved community resilience and development of local skills to deal with healthcare needs, alongside a visiting service provided through NHS Highland’s new rural support team, initially led by two GP’s based on Skye. Telehealth facilities have been installed in the Small Isles Medical Practice on Eigg and it is planned to have iPads available on Canna, Muck and Rum to allow patients to access telecare by which they can speak to their GP just like in a face-to-face consultation. The rural support team includes GPs, nurse practitioners and paramedics.
- NHS Highland has successfully chartered a boat service to provide a bespoke service picking up GP’s from Skye and transporting them to any of the Small Isles as required for the visiting service. Appointments have been made to Remote and Rural Health and Social Care Support Worker posts and training is underway. These posts will provide 1-2 hours per week of health and social care related support to any residents on the Islands who require support. NHS Highland has also been exploring the Nuka model of health care in Alaska and is testing the development of a Health Panel on the Small Isles. IT facilities have been developed to ensure effective remote access to the Small Isles from Broadford and Sleat Medical Practices and MacKinnon Memorial Hospital on Skye.
- In Acharacle, NHS Highland has continued to progress implementation of the Rural Support Team to deliver primary care services in and out of hours for the practice areas. Further recruitment has taken place including a joint post with Scottish Ambulance Service.
- In Islay, new service models are being implemented; the work being driven and led by the locality and GPs to put all necessary elements in place for a sustainable, high quality and affordable in and out of hours health service for the Island. Work is on-going to move towards an integrated nursing team for the island. This would see nursing staff working across both the hospital and community to ensure seamless care for patients and develop a flexible sustainable nursing workforce. The next step will be to include social workers, Allied Health Professionals, generic support workers and home carers to develop a larger integrated care team.
- In Kintyre and Mid Argyll progress has been delayed due to difficulties with recruitment but GPs have now been recruited which will allow new models to commence from 1st April. Proactive communication with local communities will take place during March.
- In Mid Argyll the project is now progressing with the amalgamation of Lochgilphead Medical Practice and Inveraray Practice. Three GPs have now been recruited. Out of Hours will be provided from Lochgilphead with support from nurse practitioners based in the hospital and the community nursing team. The GP service at Inveraray remains fragile with a long term locum GP in place. The Scottish Ambulance Service are looking to put in place a fast response care for 6 months covering Kintrye and Mid Argyll to support the service once the pilot is established.
- In Campbeltown agreement has been broadly reached with all 3 practices to establish a single out of hours GP service and a single GP practice led community hospital inpatient and A&E service. Campbeltown Practice has successfully recruited 1.5 WTE GPs to support this model. Further work is now progressing with the Scottish Ambulance Service and with local communities in relation to out of hours response in rural Kintyre.