Orkney News Archive: Radical NHS plans unveiled

Radical NHS plans unveiled
(Story dated: Thursday, July 1, 2004)

One of the most radical shake-ups of the NHS in Orkney - with the way open for a GP-led hospital, nurses-only, based on the outer islands and a switching round of wards - was unveiled in Kirkwall this afternoon.

The options for change could signal the end of resident GPs on all the North Isles.

Instead, there could be a six-doctor practice based in Kirkwall, with GPs scheduling surgeries with nurses who would be based on the islands.

Within this option, Evie and Rousay would be merged with Dounby and become a three-doctor practice, and South Ronaldsay would become a two-doctor practice, based in St Margaret's Hope, with a nurse out on Hoy.

This is the most radical option, with five others mooted, including maintaining the status quo.

Others include setting up two three-doctor practices on Sanday and Westray, or a five-doctor practice, based on either of the islands.

NHS Orkney officials say that the out-of-hours cover would be provided by nursing staff, Scottish Ambulance Service staff, or a doctor, as appropriate, possibly co-ordinated through NHS 24.

"It is obvious that some of these options appear radical but we feel, at this time, we need to consider all such options especially if they have been proved to work elsewhere," the service redesign document states.

A number of factors has influenced the need for change:

the difficulty in recruiting and retaining GPs;
compliance with European Working Time Directive;
the new consultants' contract, limiting hospital consultants to an average 48 hour working week;
a pay revision;
an ageing population in Orkney.

NHS Orkney wants to hear from the public on how future health services should be reshaped.

They are, in particular, looking for responses by August 13, to these questions:

How do you feel about initially accessing medical advice by talking to a nurse, or remotely by telephone or video conferencing because there is not a doctor available in person?
Are you content to be looked after by a GP when you are admitted to hospital, or would you prefer to be looked after by a doctor who works in the hospital permanently?
What are your views on the proposal that NHS Orkney employs an additional consultant surgeon and consultant anaesthetist at the hospital, allowing more operations to be carried out locally?
Do you have any concerns over the proposal to reconfigure the hospital so we might make better use of the resources it contains?

A series of public meetings will be held, where you can voice your opinion:

North Walls Junior High School, Hoy - July 5, at 7.30pm
Rousay School - July 6, at 7.30pm
Community hall, Eday - July 7, at 7.30pm
Community centre Shapinsay - July 9, at 7.30pm
Memorial hall, North Ronaldsay - July 10, at 12.30pm
Community hall Sanday - July 11, at 2pm
Community centre Stronsay - July 11, at 7.30pm
Stromness Academy - July 12, at 7.30pm
St Magnus Centre, Kirkwall - July 13, at 1.30pm and 7.30pm
Pierowall Junior High School, Westray - July 14, at 7.30pm
Hope Primary School, South Ronaldsay - July 15, at 7.30pm
Papa Westray, church hall community room - July 26, at 7.30pm.
27th July, Dounby Community Centre ( large hall) 7.30pm
28th July, Flotta Community Hall. 7.30pm
You can also respond by letter to: Local Health Council, One Stop Shop, School Place, Kirkwall, KW15 1NY or by e-mail to consultation@orkney-hb.scot.nhs.uk. The full consultation document is available here.

Currently, patients with medical (non-surgical) conditions are admitted to the Balfour Hospital under the care of GPs.

The GPs in medicine, work with doctors, training to become GPs or consultants,called junior doctors.

There are no medical consultants permanently in Orkney and patients requiring specialist medical services are transferred to Aberdeen.

Option one details a GP-led Balfour medical unit, with junior doctors, and remote medical consultant support from Aberdeen, Shetland or Inverness. The disadvantage to this system is that GPs are less qualified than consultants to provide a medical service.

A further two options are suggested.

The first could see one medical consultant providing both clinical and managerial leadership for the hospital, supported by a GP team and junior doctors.

The second could see three medical consultants, supported by junior doctors, but this would mean the loss of the GP contribution to acute medicine and would be a major shift from the present ,primary care-led, philosophy.

To comply with European working time regulations, NHS Orkney has to look at the way their current surgical and anaesthetic services are run.

At present, there are two consultant surgeons and two consultant anaesthetists, carrying out routine and emergency surgery in the Balfour Hospital.

NHS Orkney has to look at reducing their workload or developing an alternative model.

There are two options - maintain the status quo or employ a third consultant surgeon and a third anaesthetist.

The redesign is looking at making better use of staffing on the wards of Balfour Hospital.

There are only two options, the first of which looks at switching around the wards to better suit the number of patients using them.

It suggests amalgamating the female and male wards into the current St Ninian ward (elderly care which has 30 beds).

The elderly ward would be moved into the female space with 18 beds and the 12 rehabilitation beds, in Piper ward, would be moved to the male ward.

"The reconfiguration of wards would give us the potential to reconfigure staffing numbers and skills, enabling us to support the staffing of enhanced services, as well as provide increased quality of care and flexibility to existing services within services, such as day surgery, elderly care and assessment, emergency room, high dependency unit and enhanced dementia service.

Option two is for no change.

"Once we have received comments from members of our staff and the public we will present the board of NHS Orkney with fully costed options, which will form the basis for the future service provision in Orkney," the document concluded.