UHI Evaluation
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BEING HERE PROJECT – UHI evaluation SMALL ISLES COMMUNITY UPDATE 3 04 September 2017 This update is being sent out to all Being Here evaluation participants in the Small Isles. It outlines the findings following the final round of fieldwork in 2017. Evaluation fieldwork summary In May 2017 the UHI research team conducted interviews with health and social care professionals and community residents in the Small Isles pilot area. A fieldwork summary has been given to the Being Here programme manager and the final report is due in January 2018. Being Here project activities Three GPs from the Broadford practice continue to provide the service with one GP visiting by charter boat twice a week. Outside these times telephone and Video Conferencing (VC) consultations can be arranged via the Practice Manager based in the Eigg surgery. A new boat contractor formally took over the service from September 2016. The First Responder team on Eigg has five core members with three additional trained volunteers. Following the departure of two members from the island, Muck now has a team of four First Responders. Health and social care support workers are still contracted for two hours per week and are being trained and managed by the Area Integrated Team Lead in Mallaig. Of the original four workers on Eigg and Muck, two have left the Small Isles. A new person has been appointed on Eigg and two new workers have started on Muck. Short films were made about the new primary care model on the Small Isles and they can be viewed via the following links: Isle of Eigg: https://www.youtube.com/watch?v=dK-fi30TWUk Isle of Muck: https://www.youtube.com/watch?v=iK8Zs3DRNf8 Small Isles (short version) https://www.youtube.com/watch?v=SSmbI-kuItg Evaluation findings GP practice model On the whole residents were very satisfied with the quality and range of the GP service. The GPs were well liked and interviewees felt continuity of care was being restored. Having a team of GPs offering a choice to patients as well as a wide range of experience was regarded as an advantage of the new system. Many residents across all the islands thought it was now a better service. Very few interviewees still called for a professional to be based on the island and generally interviewees felt more secure. However, although the model was generally accepted, there was still a feeling that having a GP resident on the island would always be preferable and would take away the burden of the new roles and responsibilities from residents. The management of the practice was widely praised together with the dispensary and prescription service. The Practice Manager had recently won an award for her work. The emergency medication stores were generally thought to work very well although on Rum uncertainty was still expressed over the most appropriate key holder. The service was generally believed to be sustainable with NHS budgets and GP recruitment remaining as the biggest threats. Many preferred the salaried practice in Broadford to the Mallaig take-over proposed initially. However, a small number of residents continued to think a link with Mallaig would be preferable as they could visit the surgery using the scheduled ferry. A few people again raised the issue of communication between the GP practice on Skye with other services like community nursing, midwifery and health visiting which are based in Mallaig or Fort William. GP boat Interviewees reported that the GP boat service had improved because of the change of contractor and they believed that the reliability had increased considerably. In particular, interviewees thought the availability of an ex-lifeboat able to go out in most weather conditions was a significant improvement. Community input into the tender process was also welcomed. The boat had picked up patients from Muck to see the GP and a visiting consultant on Eigg. This development of the service was very much welcomed. Surgery space Although the new Eigg surgery was appreciated and welcomed, some concerns were raised over the recent decision not to allow an alternative therapy practitioner to use the building. On Muck the situation had improved because a former storage space in the community centre was now being used as a private consultation room. However, there were still concerns that the area was not sound proof. On Rum no progress had been made on a dedicated consultation space. Some patients preferred home visits, but other interviewees thought a surgery space would be an improvement and enable the provision of publicly available information and advice leaflets. It was understood that the former teacher’s house, which had been suggested previously, was not suitable because of the current condition of the building. However, it might be possible to include a consultation space within a newly proposed development which could include new housing and a building associated with a possible fish farm business. On the last fieldwork visit Canna residents had had long term plans for a community building which could house a surgery space. However, issues with funding and land ownership which prevent the release of the proposed site for community use remain unresolved and plans were currently on hold. Visiting services Patients were very happy with the breadth of primary care, but the level of other visiting practitioners was generally believed to be disappointing. Although access to some services like health visiting seemed to have improved, mental health services were still difficult particularly if patients had to attend regular appointments or support groups in Fort William. A visit by a podiatrist was being arranged but was taking some time to organise. The community dental bus still goes to Eigg but not to the other islands where many residents would like similar access to dental services to avoid long and expensive journeys Being Here Evaluation Community Update 3 2 Small Isles UHI 04/09/2017 to the mainland. Although patients were largely very positive and open about using the VC link, very few had actually used it. Little change was evident since the last fieldwork visit. Attitudes were very positive towards a potential pilot of ‘Attend Anywhere’ for outpatient consultations accessed from a patient’s home. First Responders Persistent issues with the First Responder Scheme remained unresolved and continue to be raised by the community. First Responders were still unable to administer pain relief (Entonox). The possibility of training some members of the team to Emergency Responder level had been discussed but not progressed. First Responders were still unable to undertake certain patient monitoring tasks e.g. taking blood pressure which could be fed back to GPs or paramedics. Although quarterly training dates had been set on Eigg following SAS re-organisation, this had not been followed through and not all the training had been delivered. Concerns were again expressed amongst the community about the pressure and responsibility of volunteering on First Responders working within small teams. The potential high turnover of volunteers has implications for long-term sustainability. The issue of paying a First Responder on the same basis as a retained firefighter or member of the coastguard team was also raised again. Although community confidence had increased, having seen the scheme work successfully, it was generally felt that First Responders were not being valued appropriately by management as part of the new model. The First Responder vehicle was regarded as inadequate on Eigg given the poor state of roads and tracks. More oxygen cylinders were still required. It was suggested that a new role was required, possibly combined with the health and social care support worker post. Interviewees felt First Responders were overlooked as they came under SAS not NHS. New people were interested in being trained but this had not been taken up. Although the GP service was largely believed to be sustainable, these unresolved issues for the First Responders were thought to be a threat to the sustainability of the model. On the whole people were very confident about receiving a timely and efficient emergency response, but some felt that the number of emergency call-outs had increased because there was no resident GP to assess and treat cases like minor injuries. The increasing number of holiday-makers to the island was also highlighted because it creates extra demand on healthcare resources. Health & social care support workers On the whole interviewees remained open to the idea of the new role and felt it strengthened community resilience. However, most people had not needed to use the service and still knew very little about their remit. Understanding of the new role would be enhanced if patients were made aware of their training programme and obligations about confidentiality. Skills maintenance remained a concern as the new workers have not as yet been widely deployed. Consultation and community involvement The majority of interviewees across all the islands thought they had had the opportunity to take part in consultations and to give their views. However, opinions differed on whether these views had had any influence on the decision-making. The change to the boat contractor was cited as an example of community influence. Some interviewees thought NHSH had tried very hard to make the new service Being Here Evaluation Community Update 3 3 Small Isles UHI 04/09/2017 work but generally people did not feel they had been involved in proposing and developing the model along co-production lines. The proposed Small Isles Health Panel had not progressed since the last fieldwork visit. One of the potential Eigg representatives had withdrawn. Only a few interviewees on the other islands were aware of the proposal. In summary, there was a high level of satisfaction expressed with the quality and breadth of the GP service.