Practice Profile: Lochgilphead Medical Practice

Transcription

1 Practice Profile: Lochgilphead Medical Practice Overview Patient List Staff Structure (at time of writing): Inveraray and Furnace Practice merger mid 2015 Facilities Responsibility Geography More details General Medical Services Community Hospital Out of hours Accident & Emergency Teaching/Training Programmes Organisation Recruitment and Retention Local Area [Final Thoughts for GP recruitment purposes] 2Error! Bookmark not defined. 2Error! Bookmark not defined. 2Error! Bookmark not defined. 2Error! Bookmark not defined. 3Error! Bookmark not defined. 3Error! Bookmark not defined. 3Error! Bookmark not defined. 4Error! Bookmark not defined. 4Error! Bookmark not defined. 4Error! Bookmark not defined. 4Error! Bookmark not defined. 5Error! Bookmark not defined. 5Error! Bookmark not defined. 6Error! Bookmark not defined. 6Error! Bookmark not defined. 6Error! Bookmark not defined. 7Error! Bookmark not defined. 8Error! Bookmark not defined. Updated Sept

2 Overview Patient List We provide GMS and Community Hospital cover for our list of approximately 7,800 patients. This is divided into approximately 6,600 patients with Lochgilphead Medical Centre and 1,200 patients with Inveraray and Furnace Surgeries. Staff Structure (at time of writing): 7.5 WTE (whole time equivalent) GPs 1 WTE Practice Manager 1.75 WTE Senior Receptionists 7 WTE Reception staff 3.8 WTE Practice Nurses 2 WTE Health Care Assistant and 1 phlebotomist Attached community nursing establishment (based in our current surgery premises) comprising: Full community nursing team 2 WTE health visitors And working closely with: 1 WTE Macmillan nurse Part time Cardiac Liaison Nurse Integrated Midwifery team Part time Practice Pharmacist (no dispensing this is for clinical pharmacy input) Community Psychiatric Nursing team Updated Sept

3 Inveraray and Furnace Practice merger mid 2015 Part of NHS Highland s approach to building sustainability of health care services in remote and rural areas was to rationalise single handed GP practices with larger practices. As a result of this approach we incorporated Inveraray and Furnace Surgery (2 sites, 25 and 17 miles respectively from Lochgilphead) into our practice in Summer This increased added 1,200 patients, 1 practice nurse and 3 further administrative staff to our team. Facilities We work in a unique purpose built integrated care centre which opened in It is called the Mid Argyll Community Hospital and Integrated Care Centre (MACHICC). It provides us with great opportunities to provide seamless patient care with the help of our colleagues in social work, nursing and many of the allied health professions. This unusual environment has enabled us to work on providing care for our patients as locally as possible, both in primary care and for patients requiring hospital admission. We have superb facilities including meeting rooms, library and the capacity to videoconference. Inveraray and Furnace both have more basic and more compact facilities. Both have two consulting rooms and further nurse and admin facilities. Responsibility The GPs have total medical responsibility for day to day general practice work (conducting daily surgeries over 3 sites), for 15 acute Community Hospital beds and the A&E department which serves the whole population of Mid Argyll (approx. 10,000 this increases considerably in summer months). We have approximately 600 admissions to these beds each year. We work closely with the nursing team and 2 radiographers (who provide a 24-hour service) at Mid Argyll Hospital to manage this large workload of acute medicine and trauma. The enthusiastic team of midwives is developing local services and is largely independent although we assist them on unusual occasions. There is a small birthing unit within the Mid Argyll Hospital. We also provide the medical input to 4 psycho geriatric patients who live in a purpose built ward on the ground floor of the hospital. In addition to the core medical services offered we provide the medical input to the Updated Sept

4 Casualty review clinic and chemotherapy services which are part of the day unit. We work closely in the community hospital with the AHP team, including physiotherapy, occupational therapy, speech and language therapy, dietetics, radiography and podiatry. Smoking cessation and alcohol clinics are held regularly by community teams, and we have open access to these. There is a wide range of outpatient clinics held by visiting consultants at the hospital. These include paediatrics, orthopaedics, ophthalmology, dermatology, ENT, general medicine, surgery, and obstetrics and gynaecology. Within the team we also provide clinical leadership in the CHP in the role of Clinical director and organise a GP training week twice annually for community hospital GPs in Argyll and Bute. Geography In terms of geography, Oban lies 40 miles north via a poor road (1 hour s drive), with general medicine and surgery only, with large secondary and tertiary acute units in Glasgow and Paisley 85 miles South East via better roads (2 hours drive). Helicopter air ambulance is based in Glasgow and military search and rescue helicopter in Prestwick. Both are about 25 minutes flying time from Lochgilphead, where we have our own helipad. There is a psychiatric hospital in Lochgilphead. The practice covers an area of approximately 500 square miles broadly in line with the area covered by the hospital. Our neighbouring practices are Tarbert (13 miles south) and Easdale/Oban (40 miles north). More details General Medical Services We provide all usual general medical services to our practice population of approximately 7,800 patients, increasing over the summer months. We have always focused on providing an efficient and effective care to the high standards expected of a teaching and training practice. We previously achieved very high QoF points each Updated Sept

5 year. With the health visitors we undertake child health surveillance and provide a full range of minor surgery and contraceptive services, including a sexual health clinic run by our partner who has an MSc in Community Gynaecology and is assisted by a Practice Nurse. Community Hospital We provide community hospital care for much of the acute medical workload in our practice population and our neighbouring practices. This means full care of most acute illness such as MI, pneumonia, CVA, DVT and VTE. About 75% of our admissions are cared for entirely locally as inpatients. Near patient testing in the form of Troponin I, D-dimer, full blood count and INR, blood gases and some biochemistry is all available now. We have x-rays available on a 2-hour basis, and the radiographer also operates a phototherapy unit for dermatological treatments prescribed by our visiting dermatologist. We have good links with large acute units to whom we refer if patients require care we cannot provide locally. Out of hours Out of hours cover is provided entirely by the practice. No-one GP covers the on call for more than 24 hours at a time. Weekends are split into Friday and Sunday, or Saturday, and a telephone handover is provided at 9 am at the start of an on call day. Most of us work from home at weekends, covering the morning ward round then being available as and when required. An informal second on call arrangement exists should extra help be required. Registrars and fellows (none at present) however always have a formal second on call doctor designated. Out of hours we also cover Tarbert Surgery area. Accident & Emergency All 999 and acute trauma is brought to Mid Argyll Hospital first, and we have a significant RTA workload. We work closely with the ambulance staff as a result, and transfer using land ambulance or helicopter as required, using the EMRS Retrieval Team (run by Consultants from Glasgow) for our more unstable patients during transfer. All partners have done ATLS and BASICS training and some have done advanced training in anaesthetics. In the A&E Department, highly skilled ENPs provide about 40 % of the immediate care, with our assistance if needed. Audit of our acute work has confirmed the value of this philosophy of carrying out as much acute care as reasonably possible locally, stabilising the critically ill before transfer, and transferring to large acute units with all the facilities necessary for that patient s care. Updated Sept

6 Teaching/Training The practice has a strong and proud history of teaching and training going back 25 years. We have hosted practice for Rural Fellows, Intermediate Care Fellows and Paediatric Higher Professional Training Fellows. Our present focus has been on providing a bi annual Non Bypass Community Hospital course for remote and rural GPs like ourselves. Most GP are involved as trainers, tutors, lecturers and instructors (ATLS/ALS/BASICS). We were invited to and completed a curriculum for Intermediate Care GPs, and have as a Practice been heavily involved in starting training programmes for a range of disciplines in Intermediate Care enabling new phlebotomists, health care assistant, nurses, radiographers and doctors to extend their roles. Even after years of experience Intermediate Care often extends new clinical dilemmas, we enjoy the opportunity to share ideas and experiences informally from day to day, and through a programme of fortnightly educational meetings at lunchtimes during term time. The whole Practice is involved in quarterly PLT afternoons - recently we have focussed on patient access, child protection, significant event analysis and alcohol. We firmly believe that rural practice has a positive future if the excitement and satisfaction it can give are transmitted to students and those in training in a consistent Updated Sept

7 and realistic way from an early stage, combined with a realistic workload and remuneration for those delivering a demanding level of service. Programmes We have an active programme of chronic disease management including all the usual areas (asthma, epilepsy, thyroid disease, warfarin, renal and lithium monitoring) and involving practice and specialist nurses as much as possible. We are pleased to have a specialised diabetic nurse as a part of our team. As such we have a one-stop shop clinic at least once per month for patients with diabetes, where they see the specialist diabetic nurse, dietician, podiatrist and GP in the same afternoon. We run a well established secondary prevention clinic, and hypertension clinics are also run by a practice nurse and pharmacist, with input from GP as required. Palliative care meetings are held fortnightly for all the palliative care team, allowing multidisciplinary discussion. We provide pre-op assessments for orthopaedic patients to prevent them from having to make the trip to RAH in Paisley for this. Organisation We have weekly lunchtime practice business meetings except during school holidays. Some of the partners meet regularly with other members of the primary care team, local management and hospital and locality heads of department. One of the partners is the locality clinical director and LHCC board member, another sits on the LMC. We operate a paper-lite practice, with very little requirement for the old paper notes. We run Vision (PCs in all rooms) with the appointment system, repeat prescribing and patient summaries computerised, networked to Docman for lab reports and letters etc. Laboratory records can be accessed online and teleradiology software allows us to view our local x-rays. Recruitment and Retention We believe that the answer to this significant problem in rural areas lies in developing more high quality, appropriate services to patients locally, generating the need for more staff to provide these services. The more staff there is, the less onerous the on Updated Sept

8 call rotas become, and the more satisfying and rewarding the jobs are. Developing training and teaching needs more staff too, as does the development of research in rural practice. Teaching and training attracts more young graduates to rural practice, and research will enhance the perception of rural practice in the country at large. Many groups of staff in Argyll and Bute, especially those with heavy on call rotas, are now developing this concept of service development, education and research as a way of addressing recruitment and retention difficulties. Local Area Our Practice covers over 500 square miles in a beautiful part of the west coast of Scotland. Lochgilphead itself has a good range of small local shops, a Co-operative supermarket, and community facilities including gym, community centre and swimming pool. There are plenty of beautiful walks, world class sailing, fishing, riding, field sports and cycling for all abilities from serious mountain bike routes to gentle family cycling along the Crinan canal. Further down the Kintyre peninsula there are some fantastic beaches with surfing, and ferries to Cowal, Arran, Islay, Jura and Gigha. Children are particularly well catered for with a good range of after school activities Updated Sept

9 including various dance classes, football, shinty, athletics, Scouts, Guides, sailing, family ceilidhs etc. A new joint Primary and Secondary building opened in Lochgilphead has an annual Music Festival in the spring with lots of local input, and a triathlon in the autumn. There is also an impressive lantern procession and firework display every November, with preceding craft workshops. Argyll College run regular evening classes and Kilmartin museum also run a programme of craft workshops. The Forestry Commission also host events locally, and we have occasional visiting dance companies, performances and regular visits from the mobile cinema the Screen machine! Further afield, Glasgow is easily accessible for day trip or weekend. [Final Thoughts for GP recruitment purposes] Every day here is a challenge. The variety is enormous, and the types of clinical challenge range from those which occur in any practice to those which go straight to secondary or tertiary care in most settings. As a result, our model of care is different to that in most of the country. Many people coming into this environment find it daunting (many of us still do) and with our interest in training we recognise that. New personnel need help and support and we are always ready to provide this. It isn t the kind of job where you can always go home at 5 o clock when you re not on call. There are many challenges other than the clinical ones. We may need to deal with an administrative, teaching or personnel problem, and have been very involved in driving the business case for redevelopment ahead. These problems and the need to be pro-active in developing the service may need after-hours meetings and work in our own time. It is a very fulfilling job, with the opportunity to develop rural practice in terms of service delivery including redevelopment, teaching and training, and, increasingly in the future we hope, research. Updated Sept

10 BBC Video: NHS Highland Official Website: NHS Highland Promotional video Rural GP: Updated Sept