GPs to cover out-of-hours at Western Isles Hospital

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GPs will be based in Western Isles Hospital as an additional medical resource for a period during May as the first stage of a pilot of new out-of-hours cover arrangements.

Over a number of months, a project team, comprising of key clinical staff, including consultants, GPs, and senior nursing staff, has been exploring how to strengthen medical cover out-of-hours at Western Isles Hospital.

As a result of ongoing difficulties in recruiting junior doctors in training, NHS Western Isles is facing significant challenges in maintaining the current model of service delivery out-of-hours, where a junior doctor covers Western Isles Hospital overnight, supported by clinical staff on site and consultant staff on call.

The issue has already had an impact locally, with a number of occasions over recent months, when GPs have had to step in to work in the hospital due to lack of availability of junior doctors to cover overnight shifts.

Key clinical stakeholders are therefore behind a proposal to pilot a new model to strengthen out-of-hours services within the hospital.

A pilot is due to take place from May 14, when GPs will cover the hospital as an additional medical resource, together with all current staff (including junior doctors in training). This arrangement will be monitored on an ongoing basis.

Following on from this, the plan would be to pilot a model without junior doctors in training on site out-of-hours from May 28. This model would be piloted for a further three months to ensure its safety, effectiveness and sustainability. The junior doctors will remain on call.

During this time, overnight unscheduled care provision in the Western Isles Hospital Emergency Department will be covered by GPs, who all have experience in covering out-of-hours shifts for NHS24, supported by highly trained and experienced Emergency Nurse Practitioners and Overnight Community Nurses. Inpatients will be covered by consultants, supported by specialist Clinical Support Nurses. For this three month period, Junior Doctors in Training will no longer cover from 8.30pm – 8.00am, but will continue to provide medical care from 8.00am until 8.30pm seven days per week.

Services to patients in the community will continue unchanged with GPs seeing patients at the hospital, and those patients requiring home visits being seen by either GPs or community nursing staff, depending on the needs of the patient.

The North of Scotland Deanery (which monitors and assesses the quality of training provided for Junior Doctors) has been informed of the pilot and is keen to see how the model evaluates as there are other hospitals in the Northern Deanery facing similar challenges. The Area Clinical Forum (ACF) is supportive of the move. The Area Partnership Forum (APF) has also agreed that a new model of care is necessary. The ACF and APF will receive regular updates on the pilot and the organisation’s Corporate Management Team will also receive regular formal reports.

NHS Western Isles Medical Director Dr Jim Ward confirmed that the purpose of the pilot is to strengthen services and to test a potential solution to an ongoing and increasingly challenging issue, at a time when there is still the option of going back to the status quo at a moment’s notice, at any time. No additional funding is required for the new model, and there are no anticipated savings.

He added: “The new model potentially offers a more sustainable way to provide out-of-hours services in the hospital, with care being provided by permanent senior trained staff rather than junior doctors in training who rotate through our service for short periods. The new pilot will also introduce an improved model of communication between clinicians, with much more robust and detailed handovers taking place between day and night staff.”