Am Bratach No. 316
February 2018

NHS gives way on out-of-hours

Following a well-attended public meeting at Strathy on January 12, NHS Highland have conceded that out-of-hours care will be provided to patients of Tongue and Armadale practices by a locally-based clinician, rather than from Caithness as was originally proposed.

Speaking after the meeting, Dr Antonia Reed, NHS Highland’s clinical lead for out-of-hours services said: “While developing sustainable and affordable models of care for areas of low activity remains challenging, we were heartened that a positive joint approach was agreed to be the best way of meeting those challenges. In particular, this model would aim to keep a clinician in the area overnight, with a multi-disciplinary model involving GPs and advanced nurse practitioners. We still have challenges around recruitment and skills maintenance, and we would aim to address these by developing a hybrid model which involves advanced nurse practitioners working in daytime practice as well as out-of-hours. We agreed that this makes for more attractive roles, with a lower risk of isolation and loss of skills.”

One concern put forward at the meeting was the availability of advanced nurse practitioners, and their exact level of training. It emerged that four of these practitioners were envisaged as part of the team, two currently in place, and four to be interviewed for the two remaining posts. The meeting was informed that while an advanced practitioner was not the equivalent of a doctor, they would have a specific link to senior clinical support at all times, would maintain their skill levels by working routinely within local medical practices and would be carrying the same kit as a doctor when on out-of-hours duty. This would include antibiotics, pain relief, nebulisers, a defibrillator, catheters, sutures and certain controlled drugs.

Another concern raised at the meeting was a proposal to base the clinician on duty at Sinclair Court, the community care facility in Portskerra. It was queried why this was being mooted when there were only minimal surgery facilities there, while fully equipped surgeries, with pharmacies and dispensing facilities, existed in both Armadale and Tongue. An assurance was given that these surgeries would be available to the multi-disciplinary team for out of hours appointments and treatment of patients.

Ngaire Mingham, a retired nurse from Tongue who attended the meeting, summed up the general feeling of the night. “It’s not what we would have preferred”, she said. “What we would prefer is the status quo, but that’s obviously not an option. The locum cover is prohibitively expensive, and it’s not sustainable. So, what is being suggested — the direction of travel is towards advanced practitioners, and I’m accepting of that. We did feel that the NHS has listened and that they have taken on board the concern that Thurso cover is not acceptable.”

However, Mrs Mingham warned that a repeat of previous mistakes must not be allowed to happen. “At the meeting, I asked them to proceed slowly so that they have things in place first, not do that premature thing that they did in November, pulling everyone out. My beef with it is that it is a manpower planning issue.What were they expecting to put in place?”.  

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