MULL & IONA HEALTH AND CARE REVIEW

Transcription

1 Argyll & Bute MULL & IONA HEALTH AND CARE REVIEW Thank you for talking to us, your views are important to us YOUR VIEWS! Community Feedback REPORT FINAL 15 th May 2015 Mull & Iona Health and Care Review Website : Page 1 of 44

2 Background Providing high quality, safe and affordable health service to remote and rural communities across Scotland is challenging. It is a challenge for the present and for the future. Rural GPs have been making changes over the past few years to the way they provide services once their surgeries are closed Out of Hours. But this is just part of the bigger picture. The Mull & Iona Health and Care Review Group was established in October 2014 to ensure a high quality, person centred, sustainable and affordable integrated health and care service (in and out of hours) for the communities on the islands by October The action plan is in line with the Scottish Government s 2020 Vision for Health and Social Care. The review will run for a period of twelve months. Once approved, the Oban Lorn and Isles Locality Management will put in place a plan to implement the recommendation(s). The review does not include day to day operational issues. The review has identified a proposed model for primary care (GP) service for Mull and Iona. Before implementation, it is essential to gather feedback from communities and staff across Mull and Iona about the proposal. In March 2015, the Communications and Engagement Group developed an information pack which was posted to all households on Mull and Iona. The pakcs included information on current services provided on the islands, the proposed model for primary care (GP) service, Frequently Asked Questions (FAQs) leaflet, and the schedule of engagement activities. Approximately 2,000 packs were posted to all households on the islands at the end of March. The information packs included a feedback form Your Views! (Appendix 1). Local people were encouraged to complete and return the feedback form by post using the Freepost envelope supplied. 74 feedback forms were returned by post. Appendix 2 provides the detailed unedited responses for information. People were also given the option to complete the feedback form online through Survey Monkey. The same questions were used to ensure consistency. A total of 18 responses were received and these have been included in the report. The deadline for submitting the Your Views! Feedback Form was Wednesday 15 th April With the postponement of the drop in event on Iona due to adverse weather conditions, and in response to requests for additional events, the deadline for feedback was extended to 30 th April. The Argyll & Bute CHP held a series of engagement activities during late March and throughout April. The Schedule of Community Engagement Activities has been included at Appendix 6. Members of the Review Group Page 2 of 44

3 and Communications & Engagement Group attended the various activities, where we saw and spoke to approximately 300 people. Most of engagement activities took advantage of well established community based events, for example the Community Café in Bunessan or village coffee mornings. For Dervaig and Ulva Ferry, we ran conversation cafés where people were invited to come along for a cuppa and a cake and have a conversation about the proposed model. Compared with previous engagement events, this proved the best and most effective way to meet and speak to as many local people as possible. People were encouraged to write their views, concerns or comments on table cloths. These have also been written up and included in this report (Appendix 4). In addition to these activities, the Review Group held five drop in information sessions in Tobermory (two sessions), Craignure, Bunessan and on the Isle of Iona. The NHS Highland (Argyll & Bute) generic address was provided for anyone wishing to share their experience of the services or indeed provide comments. 6 people used the generic address to provide feedback and 3 letters were received. These have been included (Appendix 3) in the overall feedback report but do not include names to maintain anonymity of the authors. Your Views! Feedback Results The evaluation of the feedback received has provided both a quantitative and qualitative feedback. A total of 92 feedback forms were received. The following provides a brief summary of the quantitative and qualitative feedback. Referring to Question 1, some respondees declined to answer therefore totals may not match the total number of feedback form received (92). In terms of qualitative feedback, given the volume of responses received a summary of the main issues or points provided have been included in the main body of this report. Appendix 2 provides the detailed unedited written feedback received from all responses received ( Your Views! ). Page 3 of 44

4 Q1 Do you understand what is being proposed for primary care (GP) services on Mull & Iona? No of Responses % Yes % No 5 5.6% Don t know 7 7.9% n= % 11 respondees declined to answer this question and 1 person answered this question twice therefore the control total will not match the actual number of responses received (92). If no or you are unsure, what information would be helpful? Details of the other tried and tested hubs in other remote and island communities How many GPs will there be? Are the 4 GP posts full time? How many GPs based in Bunessan? Tobermory? Will it be two each? Practicalities about how the merged practices will work in reality Not everyone clear there will only be one locum GP covering Out of Hours (OOHs) based at the Community Hospital (hub), in Craignure Rota for GPs? Are we now looking at an island wide practice for Mull & Iona? What will the name of the combined practice be? Clarity on charges for taxi or community transport to / from the hub OOHs Will clinics, for example physiotherapy, be only available at the Community Hospital? Q2 Having considered the proposed model for primary care services, do you have any comments or concerns that you would like to share with us? Remember, this is your opportunity to tell us what you think about the proposal. A lot of anxiety about the proposed model Concern about the GPs having to travel between surgeries reducing the amount of time they have available to see patients Concern the amount of travelling between Tobermory and Ross of Mull will act as a disincentive for recruitment Will combining the two practices create sustainable working conditions for the doctors Concern that there will only be one doctor providing Out of Hours service for the whole of Mull A lot of people are very worried travel times in response to emergencies, particularly Out of Hours for people living on the Ross of Mull & Iona Page 4 of 44

5 Concerns about the hub being based in Craignure Travel is a key issue for a lot of people Clarity required on who is responsible for organising community transport or taxi service, will this be available for the return journey, who will pay for this Not all volunteer drivers are willing to transport people who are ill and need to be seen by a GP based at the hospital Travel times in an emergency will put people s lives at risk - added risk during summer with tourists then risk of the Ross being cut off when the road through the Glen is closed Travel times Out of Hours is worrying Inadequate ambulance provision cited as a major concern- people on the Ross would like to see any additional provision based in Bunessan Role of Community First Responders seen as a real benefit although some people are still unclear about their actual role People on the Ross of Mull & Iona want a doctor permanently based in Bunessan; likewise people in Tobermory want a GP based permanently there People are looking for more detail about how the combined surgeries will operate, both daytime and Out of Hours Role of NHS 24 needs to be explained Many people want continuity of care from the same doctor; practice manager & other practice staff Some people still want to see a commitment for home visits, anytime of day or night Q3. Do you have any other comments, ideas, concerns or questions? Do you have any thoughts on what the practice consulting hours should be i.e. when you can get an appointment to see your GP? There were many comments provided. In summary these included : Iona people would like to see a practice nurse visiting the island as was the case years ago (for taking bloods, blood pressure, well woman clinics, immunisations, etc) possibly on a separate day to the GP Some people would like to have seen other options, not just the proposed model put forward Feeling the proposed model is a further retrospective step in NHS services provided on the islands Combination of having appointments and drop in surgery times favoured Impact on the social economic and environmental health of the community with particular regard to a larger more balanced population and improved community resilience model seen as a backward step to make living and working in the area much less attractive to many and for some probably unacceptable proposal looks very damaging to the ambition to have a healthy and vibrant local economy Page 5 of 44

6 Summary A total of 99 responses have been received, either by post, online using Survey Monkey, ing to the generic address or by letter. This represents a reasonable response. Based on the feedback, a number of key themes / general points have emerged. A small number of people have stated they feel the proposed model for primary care (GP) services is good, acknowledging the benefits, but equally a similar number of people are opposed with the proposal. Of particular note, the majority of people are concerned about how the proposed model for primary care (GP) service is going to operate, not everyone is happy that Out of Hours the GP will be based in Craignure and there are genuine concerns expressed about travel times in an emergency. The table below lists the key themes / general points that emerged from the feedback received. Page 6 of 44

7 Key Themes / General Points 1 A number of people agree with the proposed model for primary care (GP) service for Mull & Iona, they see the benefits, is workable / feasible 2 There is a large cohort of local communities who are extremely anxious about the proposed model, i.e. people are worried about GPs having to travel between surgeries reducing the amount of time they have available to see patients, will this also act as a disincentive for recruitment; some query if the combined practice will provide sustainable working conditions for the doctors; concerns expressed about only having one doctor providing Out of Hours service for the whole of Mull 3 A lot of people are very worried travel times in response to emergencies, particularly Out of Hours for people living on the Ross of Mull & Iona; concerns about the hub being based in Craignure 4 Travel is a key issue for a lot of people; clarity required on who is responsible for organising community transport or taxi service, and who will pay for this. Not all volunteer drivers are willing to transport people who are ill and need to be seen by a GP based at the hospital; travel times are cited as a major concern with some suggesting it will put people s lives at risk; added risk during summer with tourists then risk of the Ross being cut off when the main arterial route through the Glen is closed; travel times Out of Hours is worrying 5 Inadequate ambulance provision cited as a major concern but having discussed the review of the service at the community engagement events, people are pleased the current service is looking to be enhanced. People on the Ross would like to see any additional provision based in Bunessan; role of Community First Responders seen as a real benefit although some people are still unclear about their role 6 People on the Ross of Mull & Iona want a doctor permanently based in Bunessan; likewise people in Tobermory want a GP based permanently there; travelling between surgeries is not a good idea 7 People are looking for more detail about how the combined surgeries will operate, both daytime and Out of Hours; role of NHS 24 needs to be explained; many people want continuity of care from the same doctor; practice manager & other practice staff 8 Iona people would like to see a practice nurse visiting the island as was the case years ago (for taking bloods, blood pressure, well woman clinics, immunisations, etc) possibly on a separate day to the GP 9 Some people would like to have seen other options, why was only one put forward? 10 Feeling the proposed model is a further retrospective step in NHS services provided on the islands 11 Some people still want to see a commitment for home visits, anytime of day or night Page 7 of 44

8 12 Combination of having appointments and drop in surgery times favoured Discussions at the community engagement activities have echoed these key themes. Given the level of concern expressed, it is recommended that the Mull & Iona Health and Care Review Group evaluates the proposed model during the first year of implementation. This could be carried out at three monthly periods or just at the six month stage. Knowing that people can provide feedback based on how things are going, this will appease some of the anxiety expressed and will make people feel they are still being listened to. The Communications & Engagement Group would be best placed to support this critical piece of work. At the meeting on 23 rd April, the Mull & Iona Health and Care Review Group was presented with the list of key themes / general points as it was anticipated that any further responses received were unlikely to change the views already expressed. The full Your Views! Feedback Report will be presented to the Mull & Iona Health and Care Review Group on 21 st May. Feedback prior to implementation is crucial to ensure the local population is given the opportunity to have their voice heard, this is in line with Statutory Guidance CEL (4) All feedback received has been very important and of great value. Many thanks to all those who returned their completed Your Views! feedback forms or responded using other methods to do so. Once ratified by the Mull & Iona Health and Care Review Group on 21 st May, this report will become a public document. Caroline Cecil Public Involvement Manager NHS Highland (Argyll & Bute) 11 th May 2015 Page 8 of 44

9 APPENDIX 1 MULL & IONA HEALTH & CARE REVIEW YOUR VIEWS! We are keen to hear how you feel about the proposed primary care (GP) service model for Mull & Iona Why? The Argyll and Bute Community Health Partnership (CHP) needs your views to make sure the proposed model of care for primary care (GP) service meets your needs. Last year, we asked you to share your experience of the current service and feedback from you has been taken into account when developing the proposed future model. Now we need your views on the proposed model, they are important to us and of great value. How can you do this? Complete this feedback form and return it to the FREEPOST address on page 2 complete the feedback form online at us your story / views to nhs.abchp@nhs.net Your feedback will be confidential. By that we mean : we will not name you in the document, we will create a report of the views we receive if you share your views but you do not want these to be part of the public record of the feedback we receive, we will respect that and your views will not be included Q1 Do you understand what is being proposed for primary care (GP) service on Mull & Iona? Yes No Don t Know If no or you are unsure, what information would be helpful? Please turn over Page 9 of 44

10 Q2 Having considered the proposed model for primary care (GP) services, do you have any comments or concerns that you would like to share with us? Remember, this is your opportunity to tell us what you think about the proposal. Q3 Do you have any other comments, ideas, concerns or questions? (Please continue on a separate sheet if necessary) Do you have any thoughts on what the practice consulting hours should be i.e. when you can get an appointment to see your GP? We welcome your more detailed comments, ideas, concerns or questions. Please attach them to this sheet Please return this feedback form no later than Wednesday 15 th April 2015 to : Caroline Cecil Planning & Public Involvement Manager FREEPOST RRYT-TKEE-RHBZ NHS Highland (Argyll and Bute CHP) Blarbuie Road, LOCHGILPHEAD, Argyll, PA31 8LD If you need help completing this form or to receive a copy in a different language / format (e.g. large print) contact Caroline or caroline.cecil@nhs.net Thank you Page 10 of 44

11 MULL & IONA HEALTH AND CARE REVIEW FEEDBACK APPENDIX 2 The following provides detailed unedited written feedback received from all forms received by post, online survey monkey and . Each has been given a unique reference as part of the overall analysis of responses. Q1. Do you understand what is being proposed for primary care (GP) service on Mull & Iona? No of Responses % Yes % No 5 5.6% Don t know 7 7.9% n= % If no or you are unsure, what information would be helpful? To share with you the proposal of such a scheme, considering they are at opposite ends of the Island with Salen in the middle. What are the pros & cons of having such a system given their totally impossible geographical locations. Why join them? [mi06/31mar15] There are many thousands of visitors to Mull at any one time. How can one doctor on call manage to look after patients a 2hr journey away. A GP might visit a febrile child at 6pm & want to review at 10pm in Fionnphort while managing a chronically ill patient at home in Dervaig. I think at the very least a GP will require a driver. Will this be provided? Will there be 2 ambulances? Would a patient in Edinburgh be happy if there nearest GP was in Dundee??? [mi17/02apr15] I understand that Tobermory and Bunessan will be one practice but, as an ex- GP and Regional Advisor cannot see how it will work with a 2 ½ hour + travel time between the two. Also the fundamental principle of GPs knowing their patients cannot work at such distances apart. [mi18/02apr15] Yes, although am interested in whether we are now talking about a whole-island practice. The paper information + conversations have been helpful. [mi29/04apr15] No. How many GPs will there be? [mi31/07apr15] Don t know. The locations of the other remote and island communities where it has proved successful (Quoted 3 times!) That way one could see road-tested issues and problems. [mi35/07apr15] No. Not everyone will understand that there will be only one GP / locum on call out of hours for the whole of Mull + Iona, and that this doctor will be based at the hospital. 4 GPs for the combined Tobermory + Ross practices : - How will Page 11 of 44

12 this be split? 2 each? Or one for the Ross + 3 for Tobermory? Will there be a stipulation about where they should be resident? [mi38/07apr15] Don t know. We understand most of it, but don t know what is meant by under review when it comes to Ambulance Service. Having benefitted from the service, we would hope that 2 ambulance emergency vehicles are being considered. (It took an hour to reach us the time we needed the help. Though I m not complaining! They were great But another person might have needed the help, too!!) [mi39/07apr15] Yes, Don t Know. I don t think the proposers know what they mean either!! [mi40/07apr15] May I say I attended the Tobermory event on Thursday 2/4/15 + was pleased to be able to voice my appreciation + confidence in care on Mull to the 3 or 4 representatives there [mi41/08apr15] There is no detail about rota of 4 doctors. What is the name of the combined practice to be called you need to get local people behind the merger competition for a name? Couldn t be worse than a Community Hospital with no identity either! [mi46/09apr15] If my elderly mother or family are ill how long is it going to take the Doctor to get to us. Tobermory is over 50 miles away on single track roads [mi53/13apr15] A shake up of what we know and loved about our wonderful island is to be no more! [mi57/15apr15] It would be interesting to have known the other tried + tested hubs in other remote + island communities, so one could investigate further. [mi62/15apr15] At present, the two doctors of the Tobermory practice cover Tobermory and much of north Mull. The explanation of how linking the practices will change this is either woolly or non existent (other than sharing case notes how relevant is this given the distances involved? Please explain. [mi63/15apr15] I would like to know more about support staff in particular practice nurses, dispensing nurses. [mi68/16apr15] There is a big population in Tobermory & Bunessan now & Drs at each end of the Island are desperately needed Day & Night [mi71/21apr15] Don t know. Will I have a named G.P.? [mi72/23apr15] It isn t clear whether the current clinics/services (Physio/Public Health/Psychiatric nurse etc) will be removed from Tob surgery and re-sited to the Community hospital, or if those services are just centred at the hospital and clinics will still run at Tobermory? Are the 4 proposed GP posts full-time posts? If not what would the full-time equivalent GP posts? Who covers the cost of the OOH transport to hospital if a taxi/community transport is required. [mi/06apr15sm07] Yes. Clarity on the charges for using the community taxis/community transport for hospital visits. [mi/21apr15sm16] Q2. Having considered the proposed model for primary care (GP) services, do you have any comments or concerns that you would like to share with us? Remember, this is your opportunity to tell us what you think about the proposal. What I (and probably everyone else) want, need and require is a doctor who will visit us in our homes, at anytime of day or night, 7 days a week, on request, in Page 12 of 44

13 an emergency, as used to happen in the past. Why is this service not to be provided? These new arrangements are tinkering at the edges. [mi01/31mar15] Re your proposal to despatch a taxi or Community Transport from Tobermory to the Ross of Mull to transport patients to Craignure. Are you aware that there is a Taxi Service at Bunessan and a Community Transport Service in Bunessan? [mi02/31mar15] Not sure that merging Tobermory and Ross will provide sustainable working conditions for doctors (eg. Young families) hence may impact upon possible recruitment. Also weather will impact upon travel between the two thus depleting service at a high user time of year?? (Based at Salen myself so giving this as independent view) [mi03/31mar15] After reading the proposed model, I think it s an excellent idea. We still get the cover we need from our local surgery & using the new hospital for the OOHs is fantastic (& central) [mi04/31mar15] 1. Its difficult to know if this is the best model when no others are proposed. 2. It appears that the only benefit of this system is to save money by reducing the number of practice managers from 2 to If both GPs based at one site leave will a GP be expected to move from the other site until the leavers are replaced? 4. Who dispenses medicines at the Bunessan surgery? [mi05/31mar15] Without knowing how you propose to operate such an impossible scheme, I cannot comment. What possible advantage do you imagine there would be by merging them. At a guess at least ½ the population is in the North (Tobermory + Dervaig), the Southern ½ being split between Salen & Bunessan 2/3 + 1/3, pure guess work. [mi06/31mar15] RUBBISH [mi07/31mar15] - concern would be for elderly patients with no transport or those who are severely disabled who cannot easily get to a GP in Craignure as not local to their home. - will there be adequate or increased Community Transport for such people (with accessibility too?) - Also wonder if there will be an adequate surgery still run on Iona for residents? [mi09/31mar15] We are well satisfied with the present working of Salen Surgery and appreciate the relationship between doctor & patient that exists in this community. But I am worried about Out of Hours care and fervently hope it will not be needed. A visiting ophthalmic optician would be beneficial to the housebound. [mi10/31mar15] If the proposed model has worked well in other remote areas, it s worth going forward with the proposal. [mi11/01apr15] Will the doctors realise there are 50 miles between Bunessan and Tobermory? 30 miles between Craignure and Bunessan? [mi12/01apr15] It sounds possible but I think the distance a G.P. has to travel from Craignure is too far it would be ideal to have a G.P. living in Bunessan [mi13/01apr15] I think the service is very good [mi14/01apr15] I would hope & suggest there would be a resident doctor in Bunessan to provide continuity of care for patients & stability for him / her. The same for Tobermory. Even if the residents sometimes served as locum to the other surgery. Otherwise it seems like 4 locums & a lot of travelling & Doctors not getting to know patients [mi15/01apr15] It sounds as though it will work! [mi16/01apr15] Page 13 of 44

14 It is not clear who will cover emergencies DURING the day ie will there always be a Dr available in the South of the island. How many whole time equivalent GPs are they hoping to employ. Is there a plan to make Tobermory a dispensing practise. This will make Tob. Pharmacy unviable. This should be highlighted to Tobermory. [mi17/02apr15] See Q1. Regarding patient notes how easy will it be for a doctor in an emergency to see notes written or computerised? What happens when two calls for acute chest pain come in at the same time 2 ½ hours travelling time apart? [mi18/02apr15] No [mi19/02apr15] In real emergencies (of which we, aged 91 & 86 have had 3) everyone should know not to waste valuable time ringing NHS 24, but to call either Craignure Hospital or ambulances, the numbers of which should be widely made known. [mi21/02apr15] The proposal to have out of hours GP care over 1 hour drive away must to thrown out as the ambulance is over 1 hour away this leaves the Ross of Mull & Iona & Erraid in an unacceptable & dangerous situation. The road through the glen can be unpassable due to ice & snow any time through the winter. The road is gritted early morning & is already inadequate. [mi22/04apr15] 1. The proposal seems the best that can be reached considering the problem as a whole and in general I have no problem with it. 2. The Community Transport from the Ross this needs to be better defined and thought about. Is it for residents only of for tourists as well? What if a family member is staying with a resident is it for them or not? [mi23/04apr15] I wonder about the ambulance service come summer & hordes of dawdling tourists on our roads, it may take an ambulance well over an hour to come from Craignure to Bunessan / Iona & back. [mi24/04apr15] My only real concern is continuity which is so important. It is vital that one of the 4 doctors lives near Bunessan and has their main responsibility here. 4 doctors, 50 miles away, serving the Ross on a rota would not be good. [mi25/04apr15] As a volunteer driver for the Ross of Mull & Iona Community Transport (frequently) I am NOT willing to drive ill patients to an out of hours service in Craignure. The population in the Ross & Iona triples during the summer have you looked at that? [mi26/04apr15] If it all works as planned then I would be happy with the service. As always change takes time to get used to so there may be some teething problems. [mi27/04apr15] Continuity of care e.g. if you have symptoms over a period of time and you see different doctors it / illness may not be picked up as quickly. Find that even when there are just a few doctors things are forgotten so the thought of dealing with multiple doctors causes me concern. Also can see how it will work for the doctors re travel & choosing where to live. [mi28/04apr15] Co-ordination of OOH across islands seems a good idea I am still concerned about accessibility of out of hours cover from the Ross of Mull (travel times). Am concerned about ambulance response times both in and out of hours. I think there needs to be an alternative to the ambulance being used for short journeys (eg surgery to helicopter) [mi29/04apr15] Seems o.k. so far [mi30/07apr15] Page 14 of 44

15 You chose to lose 2 exceptional GPs Dr Chapman and Dr Lavery. We are now left with 1 GP who has not shown any commitment to any islands. Please do not combine the practices. [mi31/07apr15] I would prefer to have 2 permanent doctor s in Tobermory, who will get to know their patients. If doctors from Bunessan end up sometimes working in Tobermory, they will be treating strangers, not always knowing background of patient. I am also concerned with out of hours emergency service the journey to from hospital (OOH doctor) to Tobermory is 30mins, and if voluntary 1 st responder not available the patient may die, whilst waiting. [mi32/07apr15] Our concerns are the time it will take an emergency GP to attend in out of hours. Especially when it is impossible for patient to get to hospital. If a taxi is booked from Community Transport Ross of Mull it will take hours to come to Tobermory before returning with patient to Craignure. Extremely worrying that a community first responder member of the public a volunteer may be sent to save a life instead of a trained medical personnel. [mi33/07apr15] I can t see how it will work with doctors sharing practices at either ends f the island. Things are not going to be the same for us on this island. [mi34/07apr15] None of the geostrategy diagrams show that other VITAL medical link, the Helicopter. There should be urgent consideration for the provision of a helipad at Bowman Court, enabling patients with critical medical procedures necessary to be speedily evacuated from there, and not to be taken to Glen Forsa Airfield. Are weekend locum GPs accommodated at Bowman Court? And what provisions are in place for locums unable to get to the island due to transport problems, such as ferry cancellations or road closures? [mi35/07apr15] I strongly believe that Out of Hours cover should be provided by a medical professional stationed on the Ross of Mull. This would greatly reduce response time to a casualty on the Ross and Iona. We have a large number of tourists for much of the year. As a volunteer Coastguard Rescue Officer, I have first hand experience of a locally based doctor making a great deal of difference to a casualty situation, by getting to the scene as quickly as us. [mi36/07apr15] Travel time from the Ross of Mull, through the Glen, which is frequently icy and not gritted, when in an emergency, is very unsatisfactory to have to be dealt with in Craignure, out of hours or weekends. When a doctor is required immediately. A very worrying situation it takes ¾ hour in an emergency that is too long. [mi37/07apr15] There is no way that one doctor can provide cover for an area the size of Mull (not even including the islands of Gometra and Iona)! Should a doctor be called to Iona, there will effectively be no cover whatsoever for the large population of Tobermory, which would be over two hours away, should an emergency arise, which needs the expertise of a doctor. [mi38/07apr15] The proposal sounds very clear!! : the lengthened surgery times, the 4 rotating GPs, the centre being at Craignure. As I ve already mentioned, I think we need 2 ambulance vehicles with the 2 equipped fully for emergencies and 2 skilled paramedic teams. (The island is too long & too populated for just one!) [mi39/07apr15] There is nothing wrong with the current system, it has worked well for >40 years and if we had dedicated full time GP s it will do us just fine. Why would the merging of two separate practices 50 miles apart be an improvement? An why would this appeal more to prospective new G.P s? What possible advantage is Page 15 of 44

16 there for merging these two practices?? This makes no sense at all. [mi40/07apr15] Perfectly feasible workable proposal. Do not foresee our current outstanding care being compromised. [mi41/08apr15] The transport from the Ross of Mull should be provided by the Ross of Mull Transport Bus & there should be no charge or fee for transport to Craignure or Oban as we have fund raising arrangements in operation on the Ross. [mi42/08apr15] No [mi43/08apr15] I don t have any comments or concerns. I ve been on the island for thirty years and anytime I needed a G.P. I either go to the surgery, or if needed a house call. I get first class attention, up to now all the staff at the surgery are very nice and helpful. [mi44/09apr15] More womens services on the Ross of Mull + Iona. I have just had cervical screening reminder (2 nd one). I have been trying to make an appt. since December. I was given 24hrs warning of an appt in Feb. but I was away. There was nothing for March and no awareness of when the next one might be! It was suggested I make an appt. at the Lorne Practice in Oban. [mi45/09apr15] Two geographically and culturally isolated communities are not natural partners most important to get practice ancillary staff on board and trained properly, preferably people with local knowledge and some common sense. You have self reliant communities in place. [mi46/09apr15] My main concern is that the Out of Hours service at Craignure will be too far from us in Fionnphort. 1 ½ hrs is too long to wait for an emergency. I would like to see a Paramedic Response Service based on the Ross of Mull it may save lots of money in helicopter flights!! [mi47/13apr15] Doctors travelling from Tobermory to Bunessan, and Fionnphort and Iona and vice versa is a complete non starter. Especially in the case of an emergency. In summer it would be even worse, with visitors. [mi4813apr15] If doctors have to go from Iona to Tobermory, it could take 3 ½ hrs. Is it a normal response time. The same if a doctor has to travel from Tobermory to Iona. Then what happens if the doctor is already on an emergency [mi49/13apr15] Does this mean that the four new GPs will work at either surgery ie Tobermory + Bunessan. So will we not see the same doctors each time we visit the surgery. Does this mean that doctors from Tobermory will travel to do surgery in Bunessan and vice versa. Why share the surgeries? The doctors can still work from the hospital, but I don t understand why the doctors should have to travel length of the island to do a surgery and would the doctors be happy to do this? Given the mileage and time involved [mi50/13apr15] I would like clarification on staffing and training of existing staff at Craignure Hospital. With extra staff and / or training of existing staff, more treatments could be offered at Craignure thereby reducing the need for air ambulance use. I would imagine this could save money & increase functionality available [mi51/13apr15] The proposal seems reasonable. It is good to have this information to hand. I think the original corresspondance sent out the the local community from NHS Highland re : the GP s opting out of the out of hours service was grossly irresponsible. The cold tone of the letter and lack of information with it left the local community feeling anxious and vulnerable. This resulted in a negative Page 16 of 44

17 feeling towards the GP s who have since ended up leaving their posts as a result. A great disappointment which could have been avoided. [mi52/13apr15] Ross of Mull and Iona must have a permanent Doctor present. We have a rising and ageing population with hundreds of tourists visiting daily for about 8 months of the year. [mi53/13apr15] I am not sure hoe GP s will manage to share responsibility at two very distant practices, Tobermory & Ross. Perhaps there will be plenty of them but residence will be an issue [mi54/15apr15] Having read all about it. I think it should work very well [mi55/15apr15] Do I really want to be taken to Craignure by Community Bus NO they are volunteer drivers unpaid will they really wish to be on call day & night. NHS 24 does not work when you are an hours drive to Craignure we need a GP on site I wonder how many people involved with this have actually driven from Craignure to the Ross of Mull in the middle of the night? [mi56/15apr15] We run a busy campsite. Yes NH 24 works for some but out of hour calls have sent a doctor to my house. Had the consultation with patient in my front room. Had to phone with my house phone. Wait for ambulance or helicopter in my house. What is wrong with sending them up to a perfectly good surgery which has all [mi57/15apr15] I don t see any doctor wanting to work in Bunessan and Tobermory; they are 55 miles apart and the journey in winter when the road through the Glen has often not been gritted, and in the summer the single track road can be blocked by tourists. With one doctor working at the Hospital and one on Iona, who will be at Bunessan in a crisis? This proposal might work in some places, but not on Mull and Iona. [mi58/15apr15] Sharing a doctor with Iona & the hospital is too telegraphic. It needs to be either / or [mi59/15apr15] Distances to be travelled by Doctors on single-track roads, will be a draw-back to the operation of the proposed MODEL [mi60/15apr15] For doctors to move and work here, It really has to be sold as a life style, for someone who enjoys a very rural place. [mi62/15apr15] Chief concern is the distances to be covered and the implication that the 4 GPs could be based anywhere on the island. Distances in Mull are not to be measured in miles but hours. This will dilute the personal contact that has been so valuable a part of medical care and medical decision-making hitherto. The sharing of case notes is no substitute for this particularly when demands from patients to see their own records may inhibit a GP from frankness in writing up notes. [mi63/15apr15] Everything about this is wrong. I could consider leaving the island as I do not believe that we will have a good service! [mi64/16apr15] I feel that this proposal is ridiculous and will put lives at risk. It is unbelievable that Tobermory & Ross of Mull will merge with 4 Gps?! Why not 2 in Tobermory 2 in Ross of Mull NO merge! [mi65/20apr15] Leave it as before with our won GPs than to be sharing with Ross of Mull. [mi66/20apr15] I agree that a coordinated approach to health care is right for Mull, merging GP practices for administrative purposes, pooling of resources, communication and liaison between the surgeries, and with other bodies such as SAS, NHS24. However, I feel strongly that in hours GP care should remain local to the Page 17 of 44

18 existing surgeries, with two GPs routinely covering in hours care, so that they get to know their patient group and patients get to know them. This has worked well on the Ross of Mull with Bunessan surgery. I also think it is important that the GP s are resident within the community, and are part of the community. If the out of hours non emergency and emergency care procedures are clear, they should not feel permanently on call. On the practical side, winter weather in Glen More could present problems for the GPs getting to the Ross of Mull if they were to live close to the Craignure hub for example. Non emergency out of hours care I agree would sensibly be covered by one duty contact for the whole island, and the logical, most central location for this would be Craignure, but equally could be where the duty GP is based. [mi67/20apr15] I think the access to OOH, both practical and perceived, is very difficult. Needs consideration re low threshold access for example unwell children seems a gap which could possibly be addressed by Practice Nurse services? [mi68/16apr15] People should not have to get authority from NHS 24 to get a taxi fare paid to get to Craignure. This will put folk off getting the care they require. No Dr can be expected to travel between Tob-Bunessan. They will be in no fit state to give proper care after that long drive. This road is very often impassable in winter and an extremely time consuming journey in the best of weather. More valuable time wasted. Tobermory Surgery was a very well run practice by people who cared. Sadly not now. More and more of their responsibilities shed onto the ambulance, life boat, hospital. [mi69/21apr15] It concerns me that we may not have a GP resident in the Ross of Mull also the time it would take to come from Craignure in an emergency [mi70/21apr15] I do not agree with the proposal I have lived in Mull all my days & I feel? things are going back instead of forward. We need to have a Dr living in that house in Bunessan [mi71/21apr15] I can see the point of the hub and spoke model, but merging two practices that are 2hrs drive apart seems crazy, why not have 2 practices with 2 doctors each? Your brochure pushes the benefits of the hub and spoke but doesn t make a case for merging the practices. [mi72/23apr15] I can see the advantage of combining practices to provide? support but feel a whole island practice would make sense. The biggest issues are distances to travel, contacting the doctor (telephone availability) sharing in hours telephone answering would help this? Also use of bleeps which have better coverage [mi73/23apr15] I have deliberately waited until now to give myself ample time to listen, read and reflect on the proposed model. My view if that it really is a fait-a-compli. There is no money to provide anything better. This is also the view of many, many of my fellow residents on the Ross of Mull. They se this whole process as a P.R. farce. Emergency, out-of-hours cover as proposed in the model, frankly inadequate and will put people s lives at risk. One hour is too long to wait in a life / death situation. We run a B&B in Fionnphort. Should one of our guests be taken ill in the night, they would have to wait at least an hour for help to arrive. The area could become known as a blackspot for holiday makers, because of inadequate emergency cover. The redeeming feature would be a paramedic based on the Ross of Mull. Not necessarily an ambulance. Bute a trained paramedic, with a car. [mi74/07may15] I am looking forward to this- think it will work well- [mi/27mar15sm01] Page 18 of 44

19 I am worried that someone will try to make their way to the Community hospital to see out of hours GP and make their condition worse rather then GP calling on them. [mi/29mar15sm02] Will it not be difficult to find GP s that are willing to travel between Bunessan and Tobermory? [mi/03apr15sm05] OOH care being based at the hospital and the introduction of patient travel at late hours. Currently the community transport isn t an on-demand service, t is pre-arranged and during daytime. I wonder whether a separate scheme is required which recruits drivers who would be happy to be part of a rota for out of hours transport. This might also be a better plan for Tobermory, rather than relying on two taxi drivers to do the job. Of course, I don t know the OOH patient figures or the figures for OOH patients who don t have access to a car, so it may not be a problem? It just appears as if it hasn t been thought through that well practically. [mi/06apr15sm07] My main concern is being able to see the same doctor, as has been the case up until now. I don t know if the rotating between Bunessan and Tob means we will not be able to see the same doctor, and this is what most concerns me. [mi/06apr15sm08] Would our surgery become an appointment based one? [mi/06apr15sm09] The proposal requires significant recruitment of GPs and other health service professionals. Are sufficient inducements being given to ensure satisfactory response to adverts. Currently there are serious deficiencies in the Scottish Ambulance Service on Mull, this area needs urgent assessment. The problem of funding revenue for the ambulance service is another issue. The ambulance service should be fully integrated into the plans to ensure that they work well. Why isn t the ambulance service incorporated rather than being a separate organisation. GP s living in the hospital when on call may cause problems. Has some consideration been given to this? [mi/07apr15sm10] As a single mother of 3 children I worry about who will provide out of hours services if I have an epileptic fit.dr Chapman and Dr Lavery would work even beyond the hours they were responsible for.i do not believe the CHP can provide a similar service and I wish they would negotiate a new contract with Dr Chapman and Dr Lavery to come back [mi/08apr15sm11] It seems a good option if it will make an island practice more attractive to a GP to maintain consistency of service. Will there be a review to see how it works for Mull, Iona and Ulva? [mi/10apr15sm12] The hub and spike model proposed for Mull in general and the Ross of Mull in particular will not work because it ignores the geography of the island which dictates access to and from craignure and the time necessary for travelling any distance. This is particularly so in winter when the weather through the glen makes driving a hazard. In the summer there is the problem of the high number of visitors using the roads who have no concept of single track procedure, misuse passing places and cause problems by driving without care at slow speed. The idea of an out of hours doctor on call in Craignure is not workable either for the doctor of the patient. local are confused and worried about this type of provision and want a local doctor to deal with his/her own patients on his own territory, as has been the usual model. We have lost from our surgery in Bunessan a qualified practice nurse, and locums who knew the area and their patients, who found the time to visit and consult with the elderly and provide both out of hours advice and a pharmacy that ensured the needs of the patients and satisfied (until now) a competent and experienced practitioner. se are Page 19 of 44

20 concerned that a syndicate of doctors from other parts of the island will not solve the out of hours problem and only make the system more disparate. we do not have the infrastructure that luing or islay have, with which mull has been compared, so that is also a concern and points to a further misunderstanding on the part of the NHS to the Mull situation. Mull does not have enough support from other sectors of the NHS to supply the overall care outlined in the future care policy we do not have enough ambulances, we would need paramedics rather than volunteer first responders and we have no confidence in NHS24 It would also appear that the many meetings that have been held to discuss our problems have not really been taken into consideration and this Hug and Spike model have been implemented despite our concerns. [mi/14apr15sm13] I was unable to attend the Tobermory drop-in session because of it s timing, but will we still call our local surgery for appointments and will the drop-in and wait service continue at Tobermory? I not that the status quo of home GP visits will continue [mi/14apr15sm14] Is merging Tobermory and Bunessan GP services practical given the distance between them? Based on travel time, the mainland equivalent would be merging practices in Glasgow and Dumfries, or Ft William and Inverness! Staff could be spending 3 to 4 hours per day travelling. Merging Tobermory and Salen would make sense, with Bunessan remaining independent. [mi/16apr15sm15] The proposed model will only work if there are significant changes to other aspects of the NHS such as NHS24. These other services need to adapt and change to provide more appropriate levels of care and advice in order for the new model to work in the best possible way. [mi/21apr15sm16] Frightening proposal. I have 4 children and the proposal is terrifying If nay of them were to take I ll or need a doctor quickly! [mi/21apr15sm17] ask the staff in the surgeries,they are the best positioned to tell you what you needed.do not ask the district nurses.they are not interested or representative [mi/22apr15sm18] Q3. Do you have any other comments, ideas, concerns or questions? Do you have any thoughts on what the practice consulting hours should be i.e. when you can get an appointment to see your GP? We need 2 GP.s. who live & work in Bunessan, 2 GP.s. who live and work in Salen and 2 GP.s. who live and work in Tobermory all of whom are prepared to visit patients out of hours when necessary. [mi01/31mar15] Salen model appears to work well currently. [mi03/31mar15] I think from 8am 6pm is long enough for any doctor. However, for working folk to be able to make an actual appoint rather than waiting in the waiting room for up to 2 hours would be more beneficial. Maybe offer 3 afternoons per week where appt s can be booked. I run my own business & cannot afford to wait in the surgery for hours. [mi04/31mar15] 1. Salen has developed a good system. There are some appointments at specific times most days but an open surgery 5 days / week for emergencies.. There is nothing about dispensing medicines listed under current services provided by NHS a MAJOR GAP. 3. An ambulance service with qualified staff is as important as the GP service. [mi05/31mar15] Page 20 of 44

21 I am quite fascinated to know how on earth you can manage to make this work. I am even more intrigued to know why on earth this has got to this stage & you are wasting time in asking our opinion without a programme & system attached! You say it has worked in other areas but what is the geographical layout of these other areas? I simply cannot believe you are even asking our opions! [mi06/31mar15] YOU ARE DOING THE TORY S GAME! WRECKING THE N.H.S. IF IT ISNT BROKE DON T PUT STICKING PLASTER ON IT [mi07/31mar15] The present system is that you walk in and take you turn. I do hope this system prevails. Having to make an appointment can be so inconvenient. [mi08/31mar15] - Current appointment system in Bunessan works well & also the system newly introduced to Iona. Would there also be a nurse service & any other professionals? - If services / Drs are limited then would so many appt times be available locally? - Where would repeat prescriptions come from & would they take longer to come. Where is dispensing? [mi09/31mar15] Will the surgery be open to collect repeat prescriptions all day? [mi11/01apr15] I think the Ross of Mull and Iona deserve an emergency facility nearer than Craignure Hospital. [mi/12apr15] At present the Iona hours are possible but I m not sure about having scheduled appointments? It worked just going to the surgery and waiting your turn. Also visiting professionals audiology / podiatry should come to Iona as people who need these services are the elderly. [mi13/01apr15] No [mi14/01apr15] Present arrangement is suitable for me. I think the Craignure base for out of hours is a good idea provided there is some extraordinary possibility of calling out a doctor if there are simultaneous emergencies at opposite ends of the island. This could mean a 2 3 hr wait for attendance. [mi15/01apr15] My concerns would be getting urgent help (say in the middle of the night) living on my own. Obviously there is nothing you can do about me living on my own that s my choice but an ambulance or doctor will be a long way away from the Ross of Mull. I also feel we all need to be issued with a card giving details of the numbers we need in an emergency whether it be 999 for a suspected heart attack or stroke etc. or when would we ring 111 is that for NHS 24? I think that needs to be made perfectly clear to all patients. I also would not have any idea what my grid reference would be I didn t see Feb R&A [mi16/01apr15] Appointments between 9 and 6 but must remember to keep GPs they must be able to have a family life with adequate time off. [mi17/02apr15] At Tobermory, with no appointments, the doctors work on until patients have all been seen we may have to wait but are sure to see the doctor or nurse as required. Consulting times seem O.K. but maybe those working on the mainland or at sea will need surgery sessions later in the day. Increasing consulting times would presumably mean that home visits could become even fewer. I hope that a doctor on call from end to end of the island will not be trying to take surgeries on the following morning! NB more loss of consulting time. You may find it less easy to recruit young (or older) doctors for a single practice than for 2 separate ones. NB I am happy to provide details and would welcome feedback if considered appropriate. [mi18/02apr15] No [mi19/02apr15] Page 21 of 44

22 It would be good to be able to book an appointment with a doctor in Tobermory. The current system of only having drop-in surgery has the advantage that one can always see a doctor on the day one chooses but some appointments alongside this system would be more efficient and waste less time. [mi20/02apr15] Very happy with hours as they are. Worried that you might be introducing an appointment system a very retrograde step if so. Also that there will be difficulty in finding 4 doctors willing to service 2 surgeries 60 miles apart & on tourist laden single track roads. It is vital to the patient to be treated consistently by the same doctor who knows their history [mi21/02apr15] I have also counted over 25 people in the Ross (not Iona) who are vulnerable and / or have no access to a car. I am unhappy about a number of Bunessan Surgery & losing continuity of relationship / care. [mi22/04apr15] 1. It is imperative that consideration is given to road improvement to the Ross of Mull. Community Transport drivers taking people who are potentially ill up to Craignure should not be put at risk by pot holes in the middle of the night. Similarly, ambulance services run this risk too. 2. In the winter, Glen More can be extremely treacherous and sometimes impassable this needs to be considered within the project as a whole. 3. As a retired radiologist (who took early retirement) I would be happy to consider some role within the altered service to support the Ross. I have expressed an interest as a First Responder but would also consider a role within the Paramedic Service of at the surgery ( address provided) [mi23/04apr15] We have never needed an appointment to see a doctor & hope this will continue. Consulting hours should be the same as before to avoid confusion. Locums may be lovely but a resident doctor is much to be preferred. [mi24/04apr15] We need a practice nurse in the Ross. If the out of hours GP must be in Craignure then we must have an ambulance & paramedic based in the Ross. People will die otherwise. [mi26/04apr15] I would suggest some flexibility in having some appointment times (especially for working age population) alongside drop-in opportunities. [mi27/04apr15] Before 9.00 would be great. If you work it is difficult sometimes to get to the surgery. You can go in the evening but you often have to wait a long time. [mi28/04apr15] The present consulting hours and mixture of open-access and appointments seem reasonable. The NHS 24 leaflet If You Can t Wait needs to make it clear that this service will also be the cover for the periods between 8-6 during the day when there is no-one to answer the phone in the surgery. [mi29/04apr15] With in 24hrs [mi30/07apr15] 1. Booked appointments please. 2. Mr Willis is a great manager. I hope he becomes manager for all the practices as he is much more efficient and confidential than the previous manager. She was disgraceful. I will leave if she returns. [mi31/07apr15] I hope the system of no appointment necessary will remain. It is hugely successful in Tobermory where residents know that they will always be able to see a doctor if they go to the surgery (even if they may wait 30mins+ to see doctor during) surgery hours. [mi32/07apr15] We are vey happy with the walk in, sit down and wait practice consulting hours in Tobermory. Having to make an appointment to see GP is not an option for us. Why can another bed in each ward at M&I C. Hospital not be added? Page 22 of 44

23 When island numbers rise during holiday season the shortage of beds on island is dangerous. Not always a helicopter or lifeboat available. [mi33/07apr15] I would like to know if we are going to have an appointment system? I am so sad that 2 lovely doctors have been ousted out of Mull by people who have come to the island to live themselves. The end of May will be a very sad day for us. [mi34/07apr15] Some weekend appointments would be VERY welcome for people who find it difficult to get time-off employment, or to take children with non-urgent problems off school. We were horrified that in a time of reduced NHS budgets FIVE separate sheets of heavyweight paper were only printed on ONE side!!! [mi35/07apr15] You say The proposed model has been tried and tested in other remote & island communities where it has proved successful but the island of Mull is very large, & takes 2 hours to travel from the North to the South has this factor been considered??? [mi37/07apr15] There should be a stipulation about place of residence for the doctors at Tobermory + Ross of Mull respectively, since weather and / or traffic incidents can easily cut off these communities, because of single-track access. [mi38/07apr15] The new proposal hours are very much better than now. [mi39/07apr15] What are the alternative models? Who decided this was the best one and based on what criteria..this is for us to decide not some distant committee. The so called GUB appears to have been chosen simply from a geographical standpoint and nothing to do with patient safety or convenience. The main population is in Tobermory and not Craignure. This is simply based on the convenience of the ease of access for staff and visitors arriving from OBAN. 0 The local population see this as an erosion of the services they currently enjoy and are worried no matter how many assurances they are given. There is also no mention of Pharmacy and the services offered by the Pharmacy. I am the owner of Tobermory Pharmacy and have been the observer and advice given throughout the past year or so of G.P. difficulties. Pharmacy is an integral part of healthcare and for your committee to overlook the fact is a bad omen for the rest of their judgements and decisions. (I believe the Head of Pharmacy at H.H.B. has written separately to you on this matter). I have worked for 35 years in pharmacy both hospital and general practice. I have worked with hundreds of Physicians and Medical Practitioners and dealt with many thousands of patients over these years and my experience covers the entire country and beyond. In that time I have never encountered such a has up of a proposal as this hub & spoke nonsense proposed for here. Surely this was intended as an April 1 st joke!! I have enclosed a copy of a rather witty and sadly true illustration of how some prominent businessmen interpret your proposed improvement. (copy of illustrations included at Appendix 5) For the record I think that before any decision is made the local healthcare professionals and remaining G.P. should have their say and be formally included in any decision making process. This should not be a matter for a distant ad-hoc committee of self appointed grandees!! Incidentally not every household has received this document. A significant number of people have stated to me in the pharmacy that they didn t know anything about this until I put the poster in the window!! [mi40/07apr15] Great the way hey are keep up the good work [mi41/08apr15] There should really be two Dr s on duty during surgery hours. as it can be quite busy at times on Ross. so I m told. and the Dr's on duty should be able Page 23 of 44

24 to make house calls locally and not a Dr who is unfamiliar with the patient in question concerns or needs. [mi42/08apr15] No [mi43/08apr15] I have no thoughts re practice consulting hours [mi44/09apr15] A different day on Iona that allows blood to be taken and sent away on either Wed/ Fri. Many people on Iona do not have transport. Getting to Bunessan + back can take a who morning with public transport. Working in hospitality shift work makes it impossible to make an appt. A different day on Iona that allows blood to be taken and sent away on either. (Note at top of form : Ferries ran all day to Iona from Mull yet the consultation meeting was cancelled! When is the re-schedule?) [mi45/09apr15] There have not been appointments at either Bunessan or Tobermory practices open access surgeries should continue as they take into account travelling times from outlying areas. Move evening surgery times back to say so that people from work can attend. Some flexibility is important say if a boat is late [mi46/09apr15] The call out times for ambulance are life threatening [mi48/13apr15] Have at least one week day with later hours to cater for working people. [mi51/13apr15] Out of hour cover is the biggest concern due to geographical area to be covered from the community hospital. [mi53/13apr15] Evening surgery should be popular for those who work away from home [mi54/15apr15] 9.00AM till 11.00AM [mi55/15apr15] What was wrong with the way things were it worked will for Dr Douglas but failed during Dr Astell s time here. One of our locums wanted to take a full time appointment but wanted things run as they were not as you wish them to be. Are we to have an appointment system here we manage quite well now - and I am continually having to go over my past history for a new locum will 4 doctors be any better. [mi56/15apr15] The equipment neaded at there finger tips. Obviously we have no objection to being of help in these emergencies but does going back in time sound familiar. We are lucky that we can go and be seen at surgery times on said day. Most peoples concerns are out of hours care. Also seeing different doctors each time who have no clue why you are there. For long term illnesses. Having to explain each time (:sender from Ross of Mull) [mi57/15apr15] It would be good to have the surgery open every morning and some evenings for those who work. [mi58/15apr15] Out of hours response times for emergencies will be unnecessarily long particularly for Iona [mi59/15apr15] Iona has not had a drop-in meetings YET (10/04/15) [mi60/15apr15] Hitherto there has been no necessity to make an appointment. It has been possible to go to the surgery during consulting hours and doctors on duty will see everyone in the waiting room. This may mean that patients have to wait but it gives the system a flexibility and the assurance that patients can see a doctor when they need to no need to declare yourself an emergency & resort to A&E! Two last questions: 1. What is the advantage of providing Out of Hours service from the Community Hospital? 2. What is to be the continuing role of the Practice Nurse? [mi63/15apr15] Page 24 of 44

25 Our own doctors in Tobermory Doctors in Bunessan for that end of the island only. Not happy with this proposal! [mi64/16apr15] I would like to be able to see my GP in Tobermory in the day that I need to see him/her. Not in favour of merge. [mi65/20apr15] Again as it has been that you can go to our local surgery in the morning and evening as before. We have had excellent service. [mi66/20apr15] There should be a variety of consulting hours so that people with varying work commitments can attend easily. Rapid response to emergencies in hours and out of hours is crucial, and I know that you are looking at this in association with the model. With scattered communities, road distances and road conditions on Mull, I feel that Ambulance and paramedic availability should be greater than at present, both for residents, and in the summer when the population is increased by tourists, cover should be further increased. A paramedic associated with each surgery would also assist in providing more immediate car which could make the difference between life and death. I realise that there are plans to train community first responders, but these should not replace paramedic level of care at present there often quite a long waiting time for an ambulance if one is not based locally. [mi67/20apr15] Happy with arrangements but I would like to see Practice Nurse service complimenting to allow local access to wide range of primary healthcare services ie:- well woman, child health, immunisations, health checks, etc. [mi68/16apr15] Have our own NHS 24 based HERE on Mull at the hospital. Local Co-ordinator of local skills. [mi69/21apr15] An evening surgery once a week pm [mi70/21apr15] There is a good house for a Dr to live in Bunessan and I know the surgery. I am well in my eighties live alone & if I take a heart attack or a stroke or even fall going to the bathroom during the night how can I get a local Dr. More than an hour to travel to Craignure. Please keep our Dr in Bunessan full time. [mi71/21apr15] The current system in Tobermory where you turn up and are seen in order without an appointment works well, please DO NOT mess this up. Rotating GP s across the two practices will put doctors applying for the job off, think about it, if you were applying for a job and you were told you would have up to a 4 hours commute every other week, would you take the position? Where has this worked before? Why haven t you given an example? [mi72/23apr15] There is not enough work for a OOH service separate from the GP s who must retain responsibility fro OOH as a GP cooperative which can work well. Pay the GP s adequately to provide PPH for the whole island & they will be able to afford the? GP they need. You will be able to retain GP s if you have a sustainable,??. Please do not set up a separate OOH service as in England this cost 3x as much for a far worse service. Weekend work is minimal you will spend a fortune on locum GP s just pay your resident GP s adequately. Sorry not to return this sooner only had a brief chance to see how the system works but have had a lot to do with the PH in Somerset feel the new plan is going to be a huge amount of money & would be pleased to chat about it sometime. Kind regards [mi73/23apr15] I do not agree with appointment system, I prefer the turn up and wait. Public transport on the Island not suitable for appointments. [mi/29mar15sm02] It sounds fine, as long as there is always an on-call Doctor at the Community Hospital in Craignure. That Doctor should if necessary be prepared to do home Page 25 of 44

26 visits. At the moment a lot of money is wasted as were are told to call an ambulance if we have concerns previously doctor would come to your home if you were unable to get to the hospital. Calling NHS 24 is a lengthy and complicated process, not helpful when you are anxious or feeling ill. It would be good to be able to talk to a doctor direct as you could previously. [mi/30mar15sm03] The practice of delivering prescriptions by post to patients living at a distance should be re-instated. [mi/01apr15sm04] n/a [mi/03apr15sm05] No. Generally it seems like a good service. Happily I don t have much to do with my GP s so I can t really comment on surgery opening times. Of course for working people an evening surgery once a week would be useful, but that would depend on demand. [mi/0apr15sm07] I would be happy to have the same consulting hours as present. [mi/06apr15sm09] The Mobile Phone network has many dead areas on Mull. The network should be upgraded inline with the remainder of the planning. The health board should insist on high quality broadband provision for all of Mull following the installation of Optical Fibre. Surgery hours should be flexible, possibly with a mix of appointments and patient drop-in. Once under way all health service professionals should have an away-day or similar to review progress and problems from their aspect, with thoughts on the long term solution. [mi/07apr15sm10] I would like appointments all through the morning and I would suggest the local pharmacist works much longer hours(and is retrained to work with the doctors as he needs help with his communication skills) [mi/08apr15sm11] The Iona session did not run because the ferry was on more alert. Will it be rescheduled? This is an issue too with the GP service that the doctor does not come over if the ferry is on Amber alert could the service be flexible and come over the next scheduled day? [mi/10apr15sm12] it is stated that the doctor hours will be 8am to 6pm which is 50 hours per week not including Saturday and Sunday, yet surgery hours are only 12 a week.a Saturday morning surgery allowed people who had full time jobs to visit, also taking into consideration that the practice is also out local pharmacy and patients have to see a doctor before they can get appropriate medicine outside surgery hours. [mi/14apr15sm13] whilst having an appointment system works will for some, the drop in and wait surgery times are very useful and, having been in several places with an appointment only system, the drop in and wait availability has been very very helpful. If the new GPs decide they will rotate between Bunessan and Tobermory which might be no bad thing, will the patients be able to meet the team so to speak for older people, it can get confusing to have different GPs. I would like to point out that your proposals for someone who needs to get to the hospital out of hours from North Mull i.e.by using a taxi, - has major flaw when it is realised that, should someone have to travel in their wheelchair, there is no taxi, nor Red Cross driver with a suitable vehicle. This means calling out an ambulance to transport them and, with the present state of affairs with the ambulance on Mull, that ambulance could be on a shout or be on its way back from the far end of the island. I had major difficulties just trying to get an elderly wheelchair bound relative into RESPITE last year (this can be borne out by Page 26 of 44

27 Social Services). Additionally, a taxi from Tobermory to Java is around 90 return a very large chunk of one s weekly pension. [mi/14apr15sm14] Out of hours support will still be a problem even with Craignure hospital as a hub. Why not have a number of retained Paramedics in remote areas, in the same way as there are retained Firemen? They could be members of the existing Coastguard or the reserve Firemen teams. [mi/16apr15sm15] There needs to be put in place a system whereby the Mull and Iona communities can give regular feedback on how the new system is working. Such a system also needs to accept the concerns and complaints of the communities and ensure that these are addressed and feedback given to the communities/people who have raised these concerns. [mi/21apr15sm16] There should be a doctor on call 24 hours, 7 days a week in the Ross of Mull Surgery hours are fine at present [mi/21apr15sm17] ask the district nurses to provide transport for patients.they are bringing their childrenand grandchildren to school and childminders so why not allow them to bring patients to emergency care ot GP Surgeries. [mi/22apr15sm18] APPENDIX 3 S AND OTHER CORRESPONDENCE Page 27 of 44

28 I fully understand the new model but am extremely concerned that there will be an appointment system introduced to see the GPs. Hopefully this will not happen as I am sure most would rather wait maybe an hour or two to see the doctor rather than days. U hope this will not be introduced without some kind of ballot for the patients. We should only have to discuss our problems with our doctor not a receptionist who then decides when we should be seen! [mi/26mar15 ] I live on the Ross of Mull unfortunately when youre holding meetings I am at work.we moved from Hull 6 years ago and were impressed with the then doctor Maureen Douglas.We have both had heart attacks and was surprised to be told we needed a check up every year usually april to check that everything was ok (something that hadn't happened in England).we thought it an excellent idea.since Dr Douglas left this has stopped.i feel that the past months since Dr Astill and Julie left have not worked with locums covering,i may be a solitary case but here is my concern before Julie left she mentioned that my blood sugars were high not a good combination pre-diabetic with heart problems,the first locum said I needed a glucose test and to go back next week to have it done when I went it was a different locum who disagreed that I needed the test how are you supposed to trust these doctors when they contradict each other I now don't go to the doctors unless I am really desperate.on the suggested new programme would the evening surgery be cancelled because for people who work this was handy or would it be classed as out of hours and a trip to craignure needed?not only is craignure 45minutes drive away it is expensive to drive there and public transport doesn't run after 3.30pm.I understand that you probably will feel these issues arnt important [mi/27mar15 1] In terms of consultation, we received your communication at th March. Your first drop in session appears to be at Craignure on the 27th at to I trust that those in the Craignure catchment area got better notice than I did in Tobermory. The point is made several times that the model is "tried and tested in other remote and island communities". We find it hard to believe that any existing model has to cover the geographic area and travel times that exist on Mull and Iona. It is far from clear to me as to how out of hours cover is to be realistically achieved. The various documents make it clear that out of hours cover is to be provided at Craignure by one doctor. Our fear is that whilst the one on call doctor to dealing with an issue at Craignure what happens if another emergency requiring the attendance of a doctor occurs in Bunessan or Tobermory. Is there / will there be a second doctor available as a back up? It appears that the Ross Surgery to be provide evening appointments. What about Tobermory? No account has been taken of the many fold increase in the islands population during the summer months the majority of which are not accommodated around Craignure. The island needs total professional care. Being dependant on First Responders, however good they are, is not acceptable. It is unfair to those individuals to be thought of as first line response. In local communities like ours, it is hardly fair to expect a first line responder to treat a relative with a life threatening condition and/or a condition that the patient did not want known about. They are unlikely to be in the right frame of mind to remember the required procedure at such a time. This is trying to provide a service on the cheap. I find it hard to believe that anyone responsible for our health and well being would accept such a proposition thinking that this so called review is the answer to providing adequate health services to these islands. The review of ambulance services is key to the integration of total service provision and is not mentioned. Until the ambulance service report is published so that we Page 28 of 44

29 can see what the total service cover is, no one is in a position to comment on the detail so far provided. The document is headed "Mull & Iona Health and Care Review". How can it be a review if a major element is missing? We thought that we would have been presented a several plans with various options and associated costs. It would appear that you have come up with a single (inadequate) plan that can be provided at least cost. To suggest that the review details "a high quality, safe and sustainable health service" I think is a insult to the community. Please come back with a plan that warrants consideration. If it costs more (which I'm sure it will) then provide details of the costs and the community can then fight the costs with the Government. This report can only be regarded as retrogressive. Until the arrival of the current doctors in Tobermory, we were luckily enough to have our own out of hours cover which did not rely upon one doctor being on duty in Craignure. Why can we not go back to having one doctor on call in Tobermory, another in Salen and another in Bunessan. This system worked well for many many years. If it isn't broke don't fit it and certainly don't replace it with an inferior solution. We trust that this will be directed to all concerned with the review. [mi/27mar15 2] I read your circular CC/LMcC dated 18 March 2015 with some trepidation. For many years I took the minutes of the meetings of the Patient Consultant Group that was run by Dr Douglas who was the doctor in Bunessan for 28 years, so knew all the problems. She often told us of the bright ideas of visitors from the mainland, many of which were as optimistic as your circular. She often refuted their ideas with three factors:- 1) the ambulance usually takes an hour to get down here so any Emergency Case is long dead by the time they arrive. 2.) Though the number of patients listed for her practice is small, the figures increase enormously when all Holiday Cottages and other summer accommodation are occupied. Additionally, it must be noted that 21 bus loads of visitors to Iona can arrive on any one day many have accidents! 3.) the distances in the Practice are enormous a broken leg on Staffa and a heart attack in Carsaig show some of the problems. In her hay day, Dr Douglas had a District Nurse to help but this billet has now been cancelled. May I recommend you move heaven and earth to provide a proper doctor for the Bunessan Practice? I am now an old widower, no longer capable of partaking in public life, so I hope this letter will give you some idea of the chaos you are proposing. [mi/28mar15letter] Thank you for the details of the proposals for the hub and spoke model for Mull and Iona GP service. We understand the proposals which were clearly presented and easy to follow. As far as we can see an acceptable and workable idea. Will the out of hours doctor be based at the Mull and Iona Community Hospital during duty hours or called in if needed if the latter what will the response time be from call our to patient being seen by the doctor? [mi/30mar15 ) I came to Mull in 1972 to start up a new distillery in Tobermory. I am therefore well acquainted with the problems encountered running an enterprise on an island. During this time I have come across many half baked ideas hatched up on the mainland by those with no real understanding of the realities of life here. Without going into detail which would take too long the model proposed for healthcare on this island ranks very near the top of the list of impractical and downright unworkable ideas. The discussion I had in Tobermory recently reinforces my foreboding on what amount to near complete removal of services. [mi/07apr15 ] I am writing this to add more comments than were possible on the feedback form regarding the Mull and Iona Health & Care review. Firstly, the Page 29 of 44

30 community is very much against the proposed Hub and Spoke model which has appeared to be already decided for Mull and Iona. I will argue that this model is unfair both to residents requiring nhs services and the doctors expected to fulfill this provision, on the following counts: o a) the geographical topology of Mull. Comparisons have been made to provision on the Isles of Islay and Luing, however, Mull is different to both. Luing is much smaller than Mull, Islay has superb roads making access anywhere easier. Mull is essentially one long island connected by one main road which is for the most part single track. Roadlets and tracks lead off to isolated or remote areas, the road particularly from Craignure to Fionnphort is 37 miles of potholed road surface, liable to flooded parts, wildlife which must be considered and is unlit. This makes unsafe driving conditions for any doctor in normal conditions, and fluctuating weather conditions affect travel and the time taken to reach even non-isolated parts. For example, a safe drive with no other road users from Craignure to Fionnphort takes from three quarters of an hour to an hour in daylight. Assuming emergency call outs will be night time this will be much much longer, especially if the callout is to somewhere like Carsaig. In addition, the tourist nature of Mull and Iona in the summer months mean that most of the thousands of visitors ignorant of the rules for safe driving on single track roads generally belive it is best to travel at 30mph which can triple the time taken from Craignure to Fionnphort, cause road blocks making it impossible for anyone to pass, and add to general disregard of road safety. If Craignure is the base for an emergency out of hours callout from the Ross it will not work. Emergency call outs require a doctor to be available for local call outs in residence at the Bunessan surgery. The Ross can be cut off by severe weather in Glen More in winter making it impossible to drive through by either doctor from Craignure or patient from Pennyghael. o b) In the summer time the doctor's workload is greatly increased by the number of visitors needing nhs care, it also causes us concern that we believe that call out from Craignure will not work on the Ross in these instances. In addition, Iona is a ferry ride away from Fionnphort making it more problematic to access. Until around 4 or 5 years ago we had for about 28 years an excellent doctor in Dr Maureen Douglas who, living in the next door surgery house managed her surgeries and her call outs from the Bunessan. She understood that people are not ill between 8 and 6pm. The surgery is also a pharmacy and she would always treat emergencies either by going out or by asking if the patient was able to call at the surgery. Most residents do not make emergency calls unless there is a genuine emergency, and if there is the odd eccentric who does they are generally known and can be dealt with appropriately. However, the population on the Ross has increased and it does not seem fair that one doctor should bear the responsibility. Neither does the "New Breed" of doctor wish to work weekends. This has been Page 30 of 44

31 damaging to the nhs as evidenced by the crisis in A&E and the lack of provision on Mull. However, there must be some sort of shift system that could be worked out that would stagger working days to cover a timetable that would allow some weekends free with some weekends covered. This is how other professions/occupations work. It is also unfair to expect a doctor who has worked all day to cover a night call out, this could be accounted for in a shift timetable operated locally not centrally in a Hub. Dr Douglas managed the surgery and the area both Ross and Iona locally, the surgery provided both HUB AND SPIKE! o c) Recruitment is a problem. The needs of an island practice must be met by the maturity and skills of the recruited doctor. It was a disastrous move to give a first time GP position on Mull to a young inexperienced doctor wishing to start a family. There is very little privacy in a close community such as the Ross and it must be extremely hard for a younger person to develop friendships when everyone is your patient and confidentiality and trust is expected of all. It has been shown that mature locums have always had more success in this situation. We are not against having provision by locums as they generally have the experience, maturity and patience to cope with the demands of island life. The locums we have had recently on the Ross have been very much welcomed as doctors and socially. They have found the time to visit patients at home as routine and have been caring an compassionate. o d) the fact is that Craignure Hospital is not meeting the function we believed it to carry out. Very many of the islanders raised thousands of pounds to have it built to replace Dunaros as a respite centre. These major points have already been addressed fully in meetings regarding this topic and have not been resolved to any satisfaction, causing residents a great deal of concern. It was expected that as a progressive care centre it would offer respite to those patients/carers in need. It should also remove the need for a terminally ill patient to have to endure the ferry crossing to Oban hospital for treatment which may in fact be unecessary. This is problematic because what is necessary in these cases would be a bed for palliatative care for those patients opting out of rescusitative intervention - a hospice bed for the time home care breaks down and 24 hour care is necessary and outside the scope of friends or relatives. The future of Craignure Hospital should be redefined not as a hub for out of hours care - we want that to be kept local for both doctor and patient convenience -statistics in the ObanTimes 2015 state that the call out rate on Mull averages 2 per week, that figure does not merit a central point of contact, it suggests LOCAL needs be met LOCALLY. Craignure Hospital could save traumatic visits to off island hospitals by providing the care specific to islanders, much like the old Cottage Hospitals There is no reason that this would conflict with general nhs considerations, which are matched to mainland and city needs rather than Mull specific and be more effective. Page 31 of 44

32 o e) The concept of Hub and Spike as applied specifically to the Island of Mull should be clarified and its shortcomings defined more clearly. This letter hardly touches upon the problems envisaged with the new proceedures in practice. [mi/14apr15 ] Cross in box for No. At present the two doctors of the tobemrory practice cover Tobermory and much of north Mull. The explanation of how linking the practices will change this is either woolly or non existent, other than sharing case notes how relevant is this given the distances involved? Chief concern is the distances to be covered and the implication that the 4 GPs could be based anywhere on the island. Distances in Mull are not to be measured in miles but hours. This will dilute the personal contact that has been so valuable a part of medical care and medical decision making hitherto. The sharing of case notes is no substitute for this particularly when demands from patients to see their own records may inhibit a GP from frankness in writing up notes. Hitherto there has been no necessity to make an appointment. I has been possible to go to the surgery during consulting hours and doctors on duty will see everyone in the waiting room. This may mean that patients have to wait, but it gives the system a flexibility and the assurance that patients can see a doctor when they need to no need to declare yourself and emergency and resort to A&E! Last two questions: 1. What is the advantage of providing Out of Hours service from the Community Hospital? 2. What is the continuing role of the Practice Nurse? Personal story no 1 I have had occasion myself to call out a doctor out of hours on three occasions: for a deep cut requiring nine stitches, for the extraction of a large fish hook and for severe abdominal pain (ovarian cyst). In the first two cases I was able to phone my doctor and (in the second case) the locum. In each case I was able to meet the doctor in the surgery, in the first to have nine stitches and in the second to have an antitetanus injection (I had found someone with a pair of pliers down at the pier who extracted the fish hook). This seems to me a very prompt and efficient response. Personal story no 2 The third time I needed out-of-hours treatment was a more serious emergency when I woke in the early hours of the morning severe abdominal pain. Again, the doctor was round in a few minutes and gave me a shot of (I think) morphine to ease the pain. She then sat with me for at least an hour, during which I chatted happily and she, presumably, assessed me. This assessment included the decision not to call out the Lifeboat but to transfer me to the Cottage Hospital for the night and consider the options. She visited me there in the morning and said that I would now be transferred to the West Highland Hospital in Oban for an emergency operation. A burst ovarian cyst was discovered and treated. This was the sort of situation that required a doctor not a paramedic, excellent though they are in many emergencies. Again, I consider that this was prompt, efficient and cost-effective treatment. Anecdotal evidence suggests that had I rang NHS 24 I might well have been told to take a couple of paracetemol and go back to bed. Personal story no 3 This perhaps should have been an emergency when I sustained full-thickness burns on my back on 21 st December this year. I managed to put the fire out by rolling on the hearthrug and (perhaps because I couldn t see it) didn t consider it necessary to call out emergency services. I did, however, call out a friend to cut me out of my clothes and she then applied cold wet towels to my back, meantime trying and failing to get through to NHS 24 (unprecedently high demand). I was not in any great pain (possibly because I had burned most of my nerve endings) and left it until the morning to see the doctor who promptly sent me down the Burns Unit in Glasgow, who checked Page 32 of 44

33 that a skin graft would not be necessary and allowed me to carry on to Durham where I spent Christmas, my wounds being dressed by the Community Nurses there. The point of this particular story lies in the aftercare. Since my return home in January, I have been receiving treatment from the Practice nurse, Shona Reade, of whom I cannot speak to highly. There is much to be said for a continuity of care from a single person, dedicated to her job and very professional. Shona is a nurse who believes that the morale of a patient is an important factor in healing as well as being thoroughly versed in all relevant aspects of medical treatment. It seems to me that the new models for patient care tend to be more and more impersonal. It has been very reassuring to have been treated by someone for whom medical care is still as much a commitment as a job [mi/20apr15 ] Letter from the Ross of Mull and Iona Patient Participation Group mi/20apr15letter] ROSS OF MULL AND IONA PATIENT PARTICIPATION GROUP The Ross of Mull & Iona Patient Participation Group had a select meeting together with telephone and discussion, and have put together the following response, in addition to Jan Sutch Pickard s 3 page report dated , concerning the Proposed Model for Primary Care (GP) Service. The PPG understands the guidance about single handed Practices and for the most part welcomes the resolution of an Island wide single practice. Whereas we welcome the need for change, we have heard some resistance to change, of course, but also some very rational concerns, repeatedly. We now believe that these concerns need to be taken seriously, to the point of modifying a plan which will only work with local co-operation and the application of common sense. There are specific concerns relating to Brolass, the Ross of Mull and Iona: The consensus in the Ross is that the GP has to be resident in the Ross. This is too serious to be left to a Life Style choice. The doctor s house in Bunessan is there for the doctor. The particular geography of the Ross of Mull & Iona necessitate that a doctor, with Basics training and responsibilities, be resident. There are certain aspects of the Out Of Hours (OOH) that are not functioning efficiently. This has been highlighted by recent events where NHS24 and 999 calls have not always led to the GP being contacted either for the incident, or after the event. Both minor incidents and major crises are sometimes dealt with without the knowledge of the GP: there does not appear to be linked up communication, even if a GP is not required to respond. We believe information should be fed back at some stage to the local GP even if that GP is not involved, in order to facilitate appropriate follow up. Ambulance and Paramedic cover. When the changeover to the OOH being operated from the new hub at Craignure Hospital begins, it is considered vital that the Ross of Mull has an ambulance and paramedic stationed in the Ross or some form of Emergency Response that drastically reduces the current MINIMUM response time of 40 minutes. The local GP has always (of necessity) formed a first response Community First Responders will not be able to administer medication or oxygen where urgently needed. Page 33 of 44

34 The Health Board Proposal seems to lean heavily on the SAS together with local people coming forward, and those on the Ross & Iona who were considering volunteering for the training were concerned about the response time of the emergency services, which might leave them (possibly in isolation) carrying a major responsibility for a couple of hours. Is a MINIMUM emergency response time of 40 minutes considered acceptable by the Review Group? If not, what procedures will be in place by the commencement of the new Model of Care. Has a job share been considered where 2 GP`s with the support of a nurse practitioner could cover both daytime and OOH/emergency cover? In the event of an OOH emergency or even weekend daytime house call, would the GP based at Craignure be called away to the site of the incident or house? If this were the case at one end of the island, it could leave the rest of the island vulnerable, unless there is a contingency plan in place. A big concern is the lack of geographical, topographical and physiological knowledge of the islands (the Ross, Iona, Erraid) by call centres. We are concerned that this is also an issue for the designers of the Model of Care. The needs of the Ross of Mull and Iona are substantially different to those in Tobermory. How have these differences been catered for in the New Model? Have feedback and consultation responses been collated separately for the Ross/Iona and Tobermory? There is growing concern over the staffing of the local surgeries. We have been fortunate up until now in the Ross with the long term locums that have been in place and there has been continuity, but as this situation is changing it is leaving the surgery vulnerable until the new model together with the new GP s also in place but this could be quite a while away. Concern in the short term with compatibility of short stay locum doctors and computer programme systems. Need for a resident Nurse Practitioner in the Ross. With the cutbacks to Outreach services, there is concern that vulnerable members of the community will no longer receive active monitoring and care and that this model promotes passive Health Services, which will eventually lead to loss of life. Is it acceptable that Community Nurses should travel the length of this Island on a daily basis for only one visit? Surely the Ross of Mull/Iona have a strong case for a multidisciplinary nurse to be resident, thus saving many wasted travelling hours and reducing the obvious health and safety risk. It is also still not clear, how workable (or safe) it would be to ask patients, their families or Community Transport to make that journey to Craignure from the Ross at night, in any weather, through areas of poor or nil phone reception. Other issues more specific to Iona were getting as many procedures done on Iona as possible eg blood and smear tests. A regular nurse in attendance alongside the GP was considered part of the solution to this. Emphasis was placed on the economic costs for Iona residents of taking time off island to get kids, family members to appointments either on Mull or on the mainland eg childcare, lost work hours, transport etc. Islanders acknowledged that some of those costs were a given in their choice of living on Iona, but that there should be give and take and a sense that this issue was reflected in any revised model of health provision affecting Iona. Page 34 of 44

35 One solution thought about was that we have a single practice covering Tobermory, the Ross & Iona with doctors being appointed to each area. The joint practice would enable doctors to confer about patients and if required they could be seen by a different doctor at the hospital. Neither Doctors nor surgery staff should have to commute from one end of Mull to the other, travelling time and state of the roads makes this unacceptable. This concern has already been expressed by a retired GP and by one who would be interested in applying for the post in Bunessan. Also, following the resignation of Dr. Picton, it is hoped that the Salen Practice will join in. Concern has also been expressed that when there have been resources of any sort available, eg roads, water, etc., Tobermory has usually been given priority and that the Ross and Iona have to fight harder to be recognised as needing attention. This is partly understandable because Tobermory has the greater part of the island s population. Nevertheless, it is important in this instance that Brolass, the Ross and Iona do not lose out. We must be working in cooperation with the rest of the island and must not be in a position where we feel we must compete. Bakehouse drop-in Notes on Conversations [mi/28mar15notes] o Need for integration of ambulance service on Mull with other services, at present and in future model. While the crews are competent and helpful, the ambulance response times make it the weakest link. Can SAS management please be present at public meetings, drop-in events etc., to hear concerns and state their strategies and constraints clearly? o Carers may be those who come upon a medical problem when they visit. They will seek medical help, of course. The painstaking approach of NHS 24, and time taken to bring a nurse or Dr on the line, will probably over-run the time allocated for a visit (this is a good example of the need for health-care and social services to work together). o Palliative care home visits on the Ross (by locums) much appreciated o People recognise that it is important for GPs, if possible, not to work in isolation. Comment: this situation that would suit experienced GPs, in second stage of their career, rather than young, ambitious and inexperienced Drs. o Some folk recognise and others question the constraints of dispensing under new legislation. It is a tremendous asset having a surgery that is also a dispensary. Being on an island means that both patients and staff need to plan ahead for drugs to be delivered in time. o There is a great advantage in having other staff beside the Dr who can take blood samples. In the winter this service will be limited when the ferries are not running (because samples need to go to Oban rather than the hub hospital at Craignure). Page 35 of 44

36 o Several people raised the question about how much of a hub it is just now, with so many services actually located on the mainland, and some problems of access, eg, when the dentist s van has been relocated there (necessitating a long journey for some), why isn t the waiting room with toilets open, as it is when clinics are happening in the building? o We need a Dr who knows us for many this has been a very positive experience in the past, and could be so again. o And it would be really good to have a practice nurse in each surgery likely? o It would be very helpful to have a (secure) letter-box at the surgery. o Recruiting for First Responders, the message is given that they would not have to deal with trauma cases. But they may well have to keep life-or-death cases going, with limited resources, for more than an hour, while an ambulance crew travels across the island. o People also cited the current problems of First Responders in Luing, with mobile phone networks. Are satellite phones being considered? o When people have long-term life-threatening conditions, will there be an agreed plan (between themselves/family/carers/ those on call) to deal with crises, or will response to each situation have to start from scratch? o A respondent was disturbed that there had been a situation one night when the operator at NHS 24 rang the Dr on duty locally but the phone was not answered. Is there a guarantee that this would not happen with out of hours cover based in Craignure? o The ambulance crew who were then called were excellent and arrived in record time. There was no other traffic at 2 am! o It is important, whatever system/model we adopt, to make sure we can deliver. Promises can take us so far, but it s important to build trust. o More than one person would like an explanation of what happens in hours (8am 6 pm on one of the diagrams) when a Dr may be engaged on surgery business but there is no receptionist on duty to answer the phone. Presumably the Dr can then only be contacted through NHS 24, if they judge that is necessary. Clarification needed. o More concern about out of hours emergency response time. At the moment NHS 24 can call out a Dr based locally, or an ambulance. In future, with no alternative to the ambulance, time taken to respond may be five times as long. Page 36 of 44

37 o People are still trying to understand the different roles of family vehicles, community transport and ambulances in out-of-hours scenarios. o If, out of hours, patients need to be seen by the duty Dr at Craignure, the majority will be taken there by relatives or neighbours, a few by community transport. Will the patient travel scheme be re-instated to pay for this? o Another ambulance question. Does it make sense that if a helicopter is called an ambulance also needs to be called out to transport the patient for possibly a very short distance. One example given was a casualty in the Abbey in Iona, where evacuation had to wait for an ambulance to drive across Mull and come over on the ferry to transport the patient a few yards within the Abbey grounds. (This information however, was at second hand). o A recent first-hand experience was of a Sea-king helicopter having to wait at Bunessan School for at least 90 minutes while an ambulance came from Craignure, to transport a patient halfa-mile from the surgery to the school. On arrival in Oban the same patient, who had walked to and from the helicopter, was given a lift in a coast-guard vehicle across the hospital grounds to A&E. The Mull coast-guard had been in attendance in Bunessan. Why can their vehicle not be used on the island? o What will happen when Mr Price, the dentist retires? o How efficiently is information shared between practices on the island, clinics at the Community Hospital on Mull, the outpatients booking service in Oban, and consultants and hospital administration in Glasgow? We are part of a much bigger system. All the parts of it need to work together. o Have the two excellent Locums who have served the Ross for six months been asked for their comments on the proposals? They would have a very helpful perspective. Glen Iosal, Tobermory Notes of Conversation with local residents, 21 st April 2015 [mi/21apr15notes] o Out of Hours transport is this a only one way journey to hospital or will it include return home? o Visit by NHS 24 required to better understand the role of the service o If the proposed model was evaluated properly at say 6 months, that would give people the opportunity to see whether it really works or not, but if it isn t working there must be flexibility in the model to make changes to ensure it is fit in the eyes of those using the service o Role of Community First Responder Scheme seen as an excellent service, reassuring. Question if a first responder is called out, can a patient refuse to be treated by that person? Page 37 of 44

38 o Worried about ambulance response times - would like to see the options put forward by Scottish Ambulance Service Letter from South West Mull and Iona Development Trust Ltd (SWMID) [mi/22apr15letter] Dear Caroline, I am writing to you in my capacity as Chairperson of the South West Mull and Iona Development Company Ltd (SWMID ), a community based company with the objectives of improving the social economic and environmental health of our community, with particular regard to a larger more balanced population and improved community resilience. We have a range of projects underway to help us meet these objectives, including: a Harbours Master plan for the Sound of Iona (to improve accessibility and reliability of communication ); the purchase of a very substantial area of forest (to improve local employment and inject funds into local projects); and the investigation of the potential uses of a redundant Historic Scotland building in Fionnphort to create viable community facilities. We have been very fortunate in getting substantial financial backing from Highlands and Islands Enterprise to pump prime our initiatives and from other Public sources to fund the purchase of the forest and other consultancy work. We believe we are beginning to see a new spirit of optimism and endeavour in our local community and a willingness on the part of many individuals to work on behalf of the wider community. It is with some disappointment, therefore, that we have listened to local reaction to your proposals for the reorganisation of GP services in our area. To us what you are proposing looks like backward steps likely to make living and working in our area much less attractive to many and for some probably unacceptable. We are very conscious in our own dealings with Government agencies, local and public authorities of the time /distance dimension in getting together at the other ends of Mull, and we have heard about the apparent success of hub and spoke arrangements elsewhere, but Mull is a very inconvenient shape as OS Map or Satellite imagery will show you and the distances on single track roads between Craignure and Bunessan/Fionnphort, let alone Iona, are daunting. These difficulties are compounded by winter conditions and by the summer tourist peaks, conversations with the police/ ambulance drivers recount having to follow slow moving traffic for many frustrating miles despite blue flashing lights and sirens. Tourists don t seem to look behind them! I know that you already have had lots of feedback from the community consultations on the desirability of keeping a GP based in Bunessan, and I don t want to run over old ground but rather simply to emphasise that what you are proposing looks very damaging to our ambition to have a healthy and vibrant local economy. Our project is one that Highlands and Islands enterprise have dubbed growth at the edge and it seems that your proposals will make it more likely to be one teetering on the precipice. We urge you to listen most carefully to local concerns based on real experience of living here. We can accept we have been fortunate in the past with the GP service we have had, but we see no reason not to aim to achieve similar provision in future. What you propose seems defeatist and certainly not in tune with our hopes for the healthy development of our area. Page 38 of 44

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40 APPENDIX 4 EVENT TABLECLOTHS Dervaig Conversation Café, Tuesday 7 th April 2015 (2pm 4pm) Husband & wife GP team doesn t work Geographical location of patients NHS 24, SAS Practicality of roads on Mull Continuity of care? Travel commitment. Important GP knows the patient Ethos of salaried GP vs. Independent Practice recruitment challenge Practice management challenge if only one GG&C / SAS stent story Dr/patient relationship so important how will this be maintained with merged practice job satisfaction! OOH s Hub ok. Merger of practices; unethical, unsafe? Will loose continuity of care. GPs know their patients/communities. 2 communities very different Landward (Dougie Vipond) e.g. of footage to promote rural life. Nat Geo Channel life on Mull, Ewan MacGregor. BBC Alba Gaelic Transport who pays for taxi or community transport service if used? Education sessions based on Mull sponsored by companies. Good for clinical isolation issue Cost of getting all medical records onto one system Key issue mobile phone reception Rural practices in past encouraged to take on trainees to see how attractive rural practice is. GP recruitment. Previous patient w/b advantage. National issue. Key exposure to rural life. Potential problems with accommodation. Not practical on Mull. Tobermory practice still advertising for trainee post or under graduate students. Good to see this on Mull to promote rural practice retention Ulva Ferry Conversation Café, Wednesday 8 th April (6pm 9pm) Anna raised question of ambulance cover for Bunessan & Iona. Caroline explained the 4 options Piers is the emergency nurse practitioner at the hospital Q Where does the helicopter/fixed wing fit in? A Responsibility of SAS. Looking for sites in Bun/Tob with lights for night time service Anna Mull roads are a challenge. Especially for young people from urban areas People get used to the status quo and change is difficult. Expectations are different SAS ENP PTS 20 mile limit HITS review? No financial cover for respite care Page 40 of 44

41 example 200 for respite not covered Patient transport services. Taxi in Tob. Comm transport in Bun. Nothing in the Ulva Ferry area how will that work? Discussed sessions / full time / part time Wouldn t take the patient to hospital because of the road. I can t fault NHS 24 Admin is slow. Respite in Nov/Dec but bill not received until 1 st week in April SAS Rapid response vehicle + ambulance some concern expressed Nick happy with Salen (independent business) Q Problem for elderly who has to go through NHS 24 when there is a doctor in the surgery. A Depends on how the doctors want to operate the practice Communication (hosp carer) not happening. Ambulance transfer failed due to a 999 call but no-one let the patient s wife know Q Do we only have 1 doctor OOH now? A Yes that is the current situation Q Lack of communication / information from clinical team to patient s carer Q Do we have an emergency nurse practitioner? A Yes, based at hospital Q Patient transport costs. Depends on distance from hospital so under 20 miles not covered. C Cecil find out how the costs work. Will not pay for cost of transport for respite care Iona Drop In Event, Thursday 16 th April 2015 (1pm 3pm) Podiatry Service couple of days missed due to weather. Impression that visits (at Iona surgery) have now ceased for Iona, patients now asked to go to Craignure unless on home visit list. If missed 3 monthly, patients have to wait until next visit which would be 3 months, some patients may have to receive treatment privately Model good option Iona Practice issues with computer system not working urgent for resolution. Are paper records still being used? Appointment system brilliant. Operation hours extended to 12 noon? (or bit longer) (9am for 9.30am appts to 11am then random) Consideration re cancellation of clinic due to weather. Re-arrange to another date rather than following Thursday. Practice nurse visiting island for blood tests, blood pressure and other tests (so nurse over 1 day with GP on Thu?) Practicalities re travel and single track roads Practice nurse over on Iona to carry out routine tests, injections etc rather than hold up the GP Bloods going to Oban are going out of date Page 41 of 44

42 Tobermory Drop In Event, Tuesday 21 st April 2015 (5pm 8pm) 2 nd paramedic won t be practising for another year, at least (min) Doctors should visit patients at home Idea of OOHs at Craignure is good Concern about how long it will take for a properly trained professional to get to a patient in an emergency Patients should not have to pay for a taxi to get to see a doctor in Craignure the cost will stop patients getting the care they need Landing sites for air ambulance at night What other options were considered? Geographically challenging NHS Health Boards should employ all GPs, independent practices should become a thing of the past Role of practice nurse valuable GP appointment system very good Not impressed with NHS 24 couldn t get through too busy Page 42 of 44

43 APPENDIX 5 Below is the scanned copy of the illustration from feedback reference [mi40/07apr15] Page 43 of 44