NHSWI are accused of causing needless alarm

The Health Board in the Western Isles has been accused of causing “needless alarm and concern throughout Barra and far beyond” by the island’s GP practice.

By Peter Urpeth
Wednesday, 25th November 2020, 9:35 am
Barra Medical Practice currently provide cover to the hospital.
Barra Medical Practice currently provide cover to the hospital.

This comes as a result of the board’s announcement last week of changes to GP out-of-hours services for the island and medical cover at St Brendan’s hospital, which will take effect next April.

In its announcement last Friday, NHS Western Isles (NHSWI) said that it had received notice from Barra Medical Practice (BMP) of its intention to withdraw from the services, which had been provided “for a number of years” by the medical practice’s two principal GPs. 

NHSWI confirmed in its announcement that there would be no change to daytime GP services, which would continue to be provided by Barra Medical Practice, and that the practice’s decision means that NHS Western Isles would “have to consider potential options for the provision of hospital cover and out-of-hours services for the population of Barra and Vatersay, both in the short and longer term.”

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NHSWI concluded that the change presents: “an opportunity to redesign and maintain the high quality, patient centred and modern needs-led service for the local population,” and said that it would be engaging with partners and the local community “as this work progresses”, and that the delivery of “safe and effective healthcare will be maintained during any transition period”.

“Longer term options,” NHSWI added, “will be developed over the coming weeks in close collaboration with partners and the local community.”

But in a statement issued on Tuesday, Barra Medical Practice (BMP) said that the announcement had come without warning to them, and that it was “difficult to understand the health board’s intention considering the timing and incomplete content of this communication.”

BMP said in its statement that it had informed NHSWI of its intention to withdraw from the service to St Brendan’s Hospital last July, and said that it had been in negotiations with the health board for the last three years with regards to a new contract.

The practice statement went on to say they have been attempting to address other  issues it had identified for health care provision on the island.

BMP said: “As the people of Barra will be more than aware, provision of healthcare workers to Barra has been steadily eroded (freezing of nursing posts, reduction in midwife hours, loss of the community psychiatric nurse post, reduction in health visitor services, loss of a social worker etc.). 

“At the same time the demand for care on Barra, including that traditionally done by mainland hospitals, has increased. Continuing the status quo is not an option given the above, particularly in light of the upcoming retirement of one of the GPs and the need to attract a replacement doctor.”

BMP added that the talks it had held with the board had been “wide-ranging and aspirational consultations” at which they had put forward a number of suggestions including raising the banding of nurses “to reflect their actual duties and responsibilities”, and an increase in the doctor provision “in light of a forthcoming retirement and increasing demand on the medical services on Barra”.  

BMP claimed that at a meeting in February 2020 they had been  “promised a new contract for ‘St Brendan’s/Out of Hours’ “in two weeks” but in June 2020, they stated, the new medical director for NHSWI “informed us that he did not intend to proceed with this commitment.” 

“Instead,” BMP stated, “his vision is that St Brendan’s will be run like Broadford Hospital [on Skye] with visiting employed Emergency and Rural GP doctors, as is also the case on Uist.”

BMP concluded that they were “disappointed” not to be involved with “shaping the St Brendan’s services”, but the health board’s plans “would be a positive step for the island.”

Earlier this week, local councillor Donald Manford also responded to NHSWI’s announcement claiming that NHSWI had caused “significant concern and anxiety throughout the community”, and had raised “a number of disturbing questions.”

In a letter to the chair of the health board,  Mr Manford said: “It is common knowledge that the medical practice is, or would be engaged in the necessary recruitment for a vacancy brought about by planned retirement.

“It is also expected that the long-awaited Accident and Emergency designation for Barra and Vatersay’s hospital would have been concluded, with its necessary medical cover already agreed, if only in principal. 

“Given the critical timelines for both situations, it is scarcely credible that discussions on these core requirements is only now beginning!”

“How can a medical practice with an existing compliment of two GPs be expected to engage in credible recruitment without knowing what its future service expectations might be?” Mr Manford asked, adding: “Has no discussion or negotiation been embarked upon by NHS Western Isles until now, or has negotiation broken down? Either way, it is time the board levelled with the islands’ community councillors and the public.”

Brian Currie, chair of Castlebay and Vatersay Community Council, said in response to NHSWI’s announcement – and prior to the release of the statement by BMP: “The most concerning element of this announcement is timing. We are fully aware we have a GP retiring in the short term. We are fully aware that the costing of the new hospital is at a critical stage with business cases already having been sent to government.

“It seems extraordinary that at this late stage the practice has supposedly announced its withdrawal. We need to know what has occurred to have brought the announcement on.  What negotiations have taken place, and over what period of time.”

In response to initial questions over its announcement, a spokesperson for NHSWI said: “As [our] press release states, Barra Medical Practice is entitled to withdraw from providing these services. This does not require consultation. 

“The board will engage with the local community, however. on potential future models to deliver these services.

“The provision of general medical services (GMS) contract (that is the standard GP and related services delivered during office hours) is a direct responsibility of the medical practice.

“The provision of out of hours GP cover is the health board’s responsibility, as is the medical cover for a hospital facility.  

“To date, Barra Medical Practice has covered both GMS and St Brendan’s/Out of Hours GP cover with two GPs, via a contract for services. The health board has supported this service with locum cover as required.”

When asked if the changes to the GP service would affect the proposals for a new medical hub and hospital in Castlebay, as part of a wider public services campus, NHSWI said: “The Castlebay campus will provide the population of Barra and the healthcare specialists a state of the art facility to support the delivery of 21st century, patient focused care. There is no associated impact on that development.”

NHSWI concluded in its statement: “NHSWI is committed to ensuring safe, resilient and sustainable healthcare for the residents and visitors to Barra and Vatersay; working in collaboration with the Barra Medical Practice and embracing the many positive changes to healthcare delivery seen nation (and indeed world) wide.”

NHSWI were asked for an interview with the Chair of the Health Board on the matters raised by BMP. The request was declined.