Argyll & Bute Health and Social Care Partnership Oban Lorn & Isle Locality Mull and Iona Locality Planning Group 10 August 2016 11.15am Meeting Room, Mull & Iona Community Hospital, Craignure, Isle of Mull Present: Apologies: Annie Macleod (AML), NHS Highland-Chair Fiona Brown (FB), Mull Community Council Billy McClymont (BMC), Mull Community Council Kate MacCallum (KMC), NHS Highland Jenni Hodgson (JH), Argyll & Bute HSCP Karen Thwaites-Jones (KTJ),NHS Highland Margaret Burnip (MB), Argyll & Bute HSCP Steven Malcolm (SM), Argyll & Bute HSCP Morag MacLean (MM) North Argyll Carers Centre Lorraine Paterson (LP) Argyll & Bute HSCP Roddy MacCuish Argyll & Bute Council(RMC), Shaun Davidson NHS Highland (SD) Elaine Garman (EG), NHS Highland, Lindsay Barr (LB), NHS Highland Toben Lewis (TL), Iona Community Council Tony Jeffree (TJ), Anne Baxter (ABa), Ross of Mull Action Group Jan Sutch-Pickard (JSP), Ross of Mull Action Group, Maggie Dougal (MD) TSI Video Conference Susan Spicer (SS), Scottish Care Andy Brady (ABr), Scottish Ambulance Service Item Detail 1. Welcome and Apologies Action AML welcomed everyone to the second Mull and Iona Locality Planning Group meeting. Apologies were given and listed as above. 2. Notes of Last Meeting The notes of the last meeting were agreed as accurate. 3. Primary Care Update Overview of Team Development AML advised the Action Plan had been updated and forwarded to all and she asked that it be viewed as a working document. KMC gave an overview of the current team development plan with efforts being concentrated in the following areas: - Examining what skills are available on Mull already - Working with Practice Education Facilitators to enable the 1
upskilling of nurses - 2 x nurses attending 6 month Prescribing Skills course in January 2017 - Examining equipment available to nurses and what they are actually carrying with them to appointments - ensuring they are adequately equipped - Avoidance of duplicating services and utilising all available resources - KMC advised the Marie Curie Nurses will help any end of life (EOL) patients as will the MacMillan Nurse from Oban providing a better EOL service. - Co-ordination with GPs and Homecare KMC advised they will also be looking at Power of Attorney (POA) and Guardianship but are currently concentrating on providing a smoother service by tying in all services thus becoming part of the bigger picture to tie in with the Action Plan and Anticipatory Care Planning. KMC is currently developing a chronic disease management programme for the island-wide practice. Recruitment utilisation will also be looked at with current funding for a vacant 1x grade 6 nurse post to be used to fund 3 x bank nurses instead. 4. 4.1 Primary Care Model GP Recruitment Update AML advised they have advertised for a single handed practice with the closing date soon and interviews to be held in October. Tobermory and Salen practices will be looked at as a combined business which is GP owned rather than NHS salaried, known as a 17c contract. AML went on to explain the NHS salaried contract offers have not worked so different options have to be looked at. Information from other localities such as an Arran GP practice partner involved in the rural fellowship programme who has been helpful in collating an attractive holistic package to sell Mull to potential GP candidates. BM queried if the 17c contract would have an effect on OOHs work for GPs. AML said she was looking at various options in regards to the OOHs and that we needed to be flexible. LP stated that a 17c contract can tie in GP s to OOHs cover. 4.2 Interim Arrangements AML advised the 2 resigning GPs will remain on the island until the end of October 2016.. FB asked for the real reasons why the 2 Tobermory GPs resigned. AML responded with saying there were a variety of reasons, one being a minority of the community did not make them feel welcome. There was 2
much discussion around this and it was concluded the community must come together to put ideas forward in making GPs feel more welcome. It was suggested that the Patient Participation Group (PPG) becomes involved in discussions and AML asked FB and BM to go back to the Community Council to discuss further how communities can welcome new GPs. LP suggested efforts could be combined with the Community Planning Group in welcoming newcomers. KMC asked if there was a role for her and JH within the PPG to which she was told yes, which would help move closer towards the neighbourhood model of person centred care. It was agreed that KMC and JH would contact PPGs. FB BM KMC/JH AML continued on advising they were also currently advertising for a Primary Care Development Manager who will be the lead for Salen and Tobermory GP practices on Mull to lead the joint team and develop practice infrastructure, eg IT. 5. Primary Care Development Plan AML explained the colour coding of the Action Plan document: Red = not on track Green = on track Amber = work commenced AML advised ABr will take section 5 Section 4: Salen Surgery: AML discussed Salen surgery. David Ross is currently undertaking the scoping work and costing of the building upgrade/extension. It was explained scoping calculates the possible square footage of the building using the number of patients in the practice. The dispensing would also be attached to the GP practice. LP advised a pragmatic approach is required to keep costing down and not to focus too much on the actual building. This is likely to lead to service change but not a major one. It would be best to try and utilise the existing building. MM enquired as to where the Carers Service was located within the plan. AML said they were just starting to amalgamate the action plan and could MM take the plan away and add to it any amendments she feels is needed. SM also enquired as to where the Children s Services were within the plan and AML asked SM to also add to it. BM enquired what was happening in regards to the Mental Health review. LP gave an update stating the review is ongoing: The size of the Mental Health unit - 23 beds and a small Intensive unit - located at the Argyll & Bute Hospital is not fit for purpose. The management structure is under review and an interim management team is in place now. Suicide prevention teams and psychological therapy teams will be reintroduced. MM SM 3
The Royal College of Psychiatry were invited to do a review of services and issue a report. They stated a new building, a review of transfer services and a clinical leadership review were needed which were the anticipated findings. A morning safety brief which all community teams link into has been implemented so all staff are aware of what is happening in the whole community. Queries were made to LP regarding psychiatric OOHs services for Mull. If it is a medical emergency normal hospital measures will be in place. If it is not medical they will be taken to a place of safety; hospital or home. Carers safety was also queried to which LP replied if harm to self or others is involved, the police must also be involved. Staff on the islands, in rural areas and in A&E facilities need to be upskilled to handle mental health emergencies. LP further stated it needed to be acknowledged that transfer to the mental health unit is not the only option. BM asked for ABr to clarify the SAS policy. ABr stated if it was medical they would follow transfer to hospital protocol, treat and refer. If it was psychiatric then transfer to hospital unless a support network was in place. AML suggested this needed to be mapped and the August mapping day was a good opportunity to do so. LP advised ABr will be invited to join a group which will be looking at transport options, the date of which is yet to be set. LP wanted to clarify to the group drugs overdose and self-harm are classified as medical emergencies. The question was asked if people could self-present. LP advised anyone can self-present however the big drive is for looking after people in the community first. Anticipatory Care Planning becomes important and can be preventative. LP advised they are in the process of establishing a Safe Transfer group and Mental Health Planning Group which will use the same guidance and link into the LPG. 6. Role of Carer Support on Mull and Potential Future Developments MM gave an overview of what the Carers Service provides and carries out for Mull and the Islands:- - 1 x outreach support worker for Mull & Isles based in Oban. - 64 registered carers on Mull but is only a fraction of actual carers. - Balance of work is carried out by telephone and in group work - Variety of disabilities involved with 70% of carers over 65 - Variety of community events held to build rapport and networking - Training activities co-ordinator based in Oban travels to Mull - Social activities & well-being sessions for carers - Links to NHS incontinence nurses - Various information sessions Power of Attorney what to do 4
when someone dies - Coffee mornings utilising community facilities - Carers Voices group Quarterly meetings - Small pockets of funding for respite day trips - Mental Health carers support group held in Oban MM pointed out there were gaps in their service such as no real link with the hospital on Mull and they were not joined up with Social Work so duplicate reports can be issued in regards to assessments and care plans. MM stated the main issues of concern voiced by the carers themselves were respite, respite at home, transport, isolation, support services and being listened to. MM stated support workers need to be based on the islands and more resources put into the programme. The Carers Act has been passed in February 2016 and April 2018 it will become law. MM said they are currently looking into the skills gap they have in regards to this Act. The group discussed the doubling of reports by Social Work and the Carers Service and all agreed one point of contact was needed. JH advised this has already been discussed and agreed for the carers service to take the lead. MM concurred and said it was a matter of getting it done. The group went on to discuss respite and the situation on Mull. JH advised Mull is fully booked and only places in Oban were available, if at all. JH suggested respite should be offered in the home to allow carers to go away, all agreed. AML suggested the Self Directed Support Fund could be utilised giving the cared for a choice of how to use it. 7. 7.1 & 7.2 SAS Scenario Planning Dates and Process, Local Engagement A Table Top exercise is to be held for the local community including the Ross of Mull, tentative date Friday 30 September 2016. This will be held at either the hospital or Craignure Hall with representatives from the Health Board, GPs, Hospital and SAS to attend. The purpose of the day is to inform and instil confidence to the wider community regarding major incidents and emergency scenarios. ABr also advised on the same day the SAS will be holding a major incident awareness day for First Responders AML advised a small internal planning group will meet on 26 August 2016 to discuss the table top exercise and requested for more people to be involved. Representatives need to be clarified; date and venue also need to be firmed for the day. ABr advised the Ambulance staff located on Mull will attend. 8. Ambulance Performance Data ABr gave a brief overview of the Incident and Performance report. Overall 5
there is a pattern of 2 calls per day with the majority of calls happening within working hours. Within the Performance Figures chart the transfer figures for Mull to Oban are included in the Craignure figures. FB stated the figures still do not identify when Ross of Mull and Tobermory incidents happen at the same time. ABr ABr said personally he does not find the information useful in the way it is presented so has requested a new report to be compiled. 9. Update on Medical Redesign and Assessment Beds in L&IH AML advised the medical unit at the hospital has been reconfigured and is now piloting 4 Assessment beds. This will allow more time with professionals outside of the 4 hour target. The model is still undergoing testing and is being altered as the pilot progresses eg regarding where, female/male, timing etc. 10. Communication from Meeting The three key points agreed from this meeting are : 1. 30 September Tentative Planning Day SAS Major Incidents and Awareness Scenarios 2. Update GP Recruitment 3. Existing services on Mull: Primary Care Team training KMC Carers Summary - MM 11. AOCB KMC requested the date schedule for meetings of the PPG FB to forward MB requested a Community Representative from Mull who was a carer or service user to help with evaluating ICF monies. Meetings will be held in Oban and MB explained that she will be able to provide support to the candidate. MM said she will identify a carer/service user and advise MB. FB MB MM 12. Date of Next Meeting 14 September 2016 at 11.15 am in the Meeting Room, Mull & Iona Community Hospital, Craignure, Isle of Mull. 6