Health Intelligence and Knowledge Team NHS Highland

Community Hospitals in Skye & Lochalsh: patterns of local area use of GP led inpatient care

Ian Douglas

November 2013

The Health Intelligence and Knowledge Team are part of the Directorate of Public Health of NHS Highland and provide an expert resource of demographic and population health evidence.

Health Intelligence and Knowledge Team Directorate of Public Health NHS Highland Assynt House Beechwood Park Inverness IV2 3HG

Telephone: 01463 704939 Fax: 01463 235189

Email: ian. [email protected]

Community Hospitals in Skye & Lochalsh: patterns of local use of General Practice led inpatient care

Aim To illustrate local patterns of use of General Practice inpatient led care in Portree and Mackinnon Memorial Hospitals on Skye during a three year period.

Data sources and method 1. Hospital discharge data for patients admitted to the GP other than obstetrics speciality was extracted from the SMR01 (General and Acute Inpatient and Day case) recording scheme for the period of three financial years between 2010-2011 and 2012-2013 for Portree and MacKinnon Hospital. Additional patient demographic data, including postcode of residence, and basic patient management details were also extracted. Currently all inpatient beds are designated as GP other than obstetrics at Portree and this specialty accounts for 95% of the inpatient discharges recorded on SMR01 at MacKinnon Hospital.

2. We undertook a geographic analysis of local activity patterns using the Scottish Government data zone small area geography. Discharge rates were calculated using Small Area Population Estimates (pre Census 2011) published by National Records of Scotland. To adjust for differences in the age structure of local populations we also calculated directly age standardised rates using the standard European population.

3. Additionally activity patterns from each small area in Skye & Lochalsh and South West Ross to the two hospitals were mapped using a GIS. The software used for this was ArcGIS version 10 with the Network Analyst extension. This allowed the additional calculation of travel times for each discharge based upon the home postcode of residence of the patient. It was not possible to map activity belonging to non-Scottish residents or patients with no fixed abode. A complete road network (© Meridian 2: scale 100m grid) incorporating all Motorways, ‘A’, ‘B’ and minor roads was used for this purpose. Road speeds were applied to the network in two classes (urban and rural) and drive times to the hospital locations were calculated based upon the assumptions in table 1 applied along the fastest available route. In some maps straight lines are used to illustrate the catchment extent of each hospital. This is an illustrative convenience and all journeys were calculated using the complete road network.

Table 1: Road types and time travel speeds

Road type Rural Urban (Speed - (Speed – mph) mph) Motorway 52 34 Trunk 48 28 A Road 45 25 B Road 32 20 Unclassified 24 16 Landfill 6 4

Limitations It is recognised that actual journey times over the same roads may result in very different experience and will be influenced by factors that include the behaviour of the individual driver, the vehicle, and the volume of traffic and the incidence of road works. Driving conditions and journey times can obviously be affected by the weather. The travel times estimated by a GIS provide a representation of likely journey times and the distance that it may be possible to travel within a timescale. In attempting to model access to services this picture is more useful than the range of possible extremes that may be recalled from individual experience. Other studies have shown GIS estimates of travel time to be closely correlated with actual journey times1. It is also know that this association is less strong as journey distances increase and the opportunity to take alternative routes expands.

1 Haynes, R, Jones A, Sauerzapf V and Zhao H: Validation of travel times to hospital estimated by GIS. International Journal of Health Geographics 2006, 5(40): [http://www.ij- healthgeographics.com/content/5/1/40]

Key points

o 88 percent of discharges from GP beds at MacKinnon Hospital involve residents of the Skye & Lochalsh and South West Ross area

o 95 percent of discharges from GP beds at Portree Hospital are residents of Skye & Lochash and South West Ross

o The Portree Hospital catchment for inpatient care is extremely localised, primarily serving the north end of Skye

o MacKinnon Hospital has a wide catchment area on Skye for GP inpatient care and also serves the Kyle of Lochalsh area. In addition it also undertakes the care of most visitors who require inpatient treatment on the island

o After adjusting for the age of the population there are notable variations in the population use of these hospital services by area and also across the local General Practices of Skye & Lochalsh and South West Ross

o Areas that are close to one of the hospitals generally have higher rates of inpatient admission

Map 1: Data zone areas in Skye & Lochalsh and South West Ross

Mackinnon Hospital Table 2: Inpatient discharges from the GP other than obstetrics specialty at MacKinnon Hospital by data zone of residence, 2010-11 – 2012-13

Directly age Number Crude discharge standardised of Percentage of rate per 1000 discharge rate per Up 95 lo 95 Data zone Data zone name discharges activity population 1000 population % CI % CI S01003752 Sleat 216 6.9 79.8 59.0 67.5 50.5 S01003757 Glenshiel & Glenelg 105 3.4 57.6 36.3 44.2 28.3 S01003761 Skye South East 245 7.9 89.3 72.1 82.1 62.2 S01003763 Broadford 349 11.2 123.1 92.8 103.4 82.2 S01003765 Kyle of Lochalsh 253 8.1 133.9 98.8 112.6 85.1 S01003768 Skye West 98 3.1 54.4 36.9 45.7 28.0 S01003773 Balmacara & Dornie 197 6.3 96.1 73.5 85.2 61.9 S01003774 Plockton & Achmore 157 5.0 78.9 60.4 71.8 49.0 S01003779 Skye East & Raasay 99 3.2 63.1 39.4 48.7 30.0 S01003800 Portree West 117 3.8 58.7 48.6 58.3 38.9 S01003808 Portree North 123 3.9 50.0 46.8 55.7 37.9 S01003826 Portree East & Rural 130 4.2 55.7 43.4 51.7 35.2 S01003841 Duirinish 113 3.6 58.5 38.4 47.4 29.3 S01003846 Lochcarron 42 1.3 20.5 9.1 13.0 5.2 S01003866 Skye Central North 135 4.3 46.1 36.6 43.0 30.2 S01003869 Applecross, Shieldaig & Torridon 14 0.4 6.3 4.4 7.3 1.5 S01003871 Dunvegan & Waternish 135 4.3 56.9 34.1 42.0 26.2 S01003911 Skye North East 77 2.5 44.0 31.8 40.4 23.2 S01003914 Uig 135 4.3 46.4 38.2 46.3 30.0 Skye & Lochalsh & South West 2740 87.8 64.7 Ross

English and overseas 198 6.3

Other Scottish patients 182 5.8

Total 3120 100

Data source: SMR01

Figure 1: Directly age standardised discharge rate per 1000 population from the GP other than obstetrics specialty at Mackinnon Hospital by data zone of patient residence, 2010-11 – 2012-13

Map 2: Location of inpatient admissions from the GP other than obstetrics specialty at MacKinnon Hospital, 2010-11 – 2012-13

Map 3: Discharges from the GP other than obstetrics specialty at MacKinnon Hospital; percentage of activity by data zone of patient residence, 2010-11 -2012-13

Portree Hospital Table 3: Inpatient discharges from the GP other than obstetrics specialty at Portree Hospital by data zone of residence, 2010-11 – 2012-13

Directly age Number standardised of Percentage of Crude discharge rate discharge rate per Up 95 % lo 95 % Data zone Data zone name discharges activity per 1000 population 1000 population CI CI S01003752 Sleat 4 0.4 1.5

S01003757 Glenshiel & Glenelg 3 0.3 1.6

S01003761 Skye South East 1 0.1 0.4

S01003763 Broadford 1 0.1 0.4

S01003765 Kyle of Lochalsh 3 0.3 1.6

S01003768 Skye West 33 3.1 18.3 8.3 11.3 5.2 S01003773 Balmacara & Dornie 0 0.0 0.0

S01003774 Plockton & Achmore 3 0.3 1.5

S01003779 Skye East & Raasay 60 5.7 38.3 16.3 21.2 11.4 S01003800 Portree West 138 13.1 69.3 48.1 56.9 39.4 S01003808 Portree North 117 11.1 47.5 35.0 42.1 27.9 S01003826 Portree East & Rural 143 13.5 61.3 33.1 39.5 26.7 S01003841 Duirinish 55 5.2 28.5 12.3 16.1 8.4 S01003846 Lochcarron 0 0.0 0.0

S01003866 Skye Central North 120 11.4 41.0 32.2 38.2 26.2 S01003869 Applecross, Shieldaig & Torridon 0 0.0 0.0

S01003871 Dunvegan & Waternish 69 6.5 29.1 17.1 22.2 12.0 S01003911 Skye North East 97 9.2 55.4 28.4 34.6 22.2 S01003914 Uig 155 14.7 53.3 31.4 37.5 25.3 Skye & Lochalsh & 1002 94.8 23.7 South West Ross

English and 36 3.4 overseas Other Scottish 19 1.8 patients Total 1057 100

Figure 2: Directly age standardised discharge rate per 1000 population from the GP other than obstetrics specialty at Portee Hospital by data zone of patient residence, 2010-11 – 2012-13

Map 4: Location of inpatient admissions from the GP other than obstetrics specialty at Portree Hospital, 2010-11 – 2012-13

Map 5: Discharges from the GP other than obstetrics specialty at Portee Hospital; percentage of activity by data zone of patient residence, 2010-11 -2012-13

Mackinnon and Portree Hospital Table 4: Inpatient discharges from the GP other than obstetrics specialties at Portree and MacKinnon Hospitals by data zone of residence, 2010-11 – 2012-13

Percentage of Skye Directly age Number Community Crude discharge standardised of Hospital rate per 1000 discharge rate per Up 95 % lo 95 % Data zone Data zone name discharges discharges population 1000 population CI CI S01003752 Sleat 220 5.3 81.2 68.4694 59.8858 51.3023 S01003757 Glenshiel & Glenelg 108 2.6 59.2 45.4 37.4 29.3 S01003761 Skye South East 246 5.9 89.6 82.3 72.4 62.5 S01003763 Broadford 350 8.4 123.5 103.6 92.9 82.3 S01003765 Kyle of Lochalsh 256 6.1 135.5 113.3 99.5 85.7 S01003768 Skye West 131 3.1 72.7 54.5 45.1 35.7 S01003773 Balmacara & Dornie 197 4.7 96.1 85.2 73.5 61.9 S01003774 Plockton & Achmore 160 3.8 80.4 72.6 61.2 49.8 S01003779 Skye East & Raasay 159 3.8 101.4 66.2 55.7 45.1 S01003800 Portree West 255 6.1 128.0 109.8 96.7 83.6 S01003808 Portree North 240 5.7 97.5 93.1 81.8 70.4 S01003826 Portree East & Rural 273 6.5 117.0 86.9 76.5 66.1 S01003841 Duirinish 168 4.0 87.0 60.5 50.7 40.8 S01003846 Lochcarron 42 1.0 20.5 13.0 9.1 5.2 S01003866 Skye Central North 255 6.1 87.1 77.6 68.8 60.0 S01003869 Applecross, Shieldaig & Torridon 14 0.3 6.3 7.3 4.4 1.5 S01003871 Dunvegan & Waternish 204 4.9 86.0 60.6 51.2 41.8 S01003911 Skye North East 174 4.2 99.4 70.8 60.2 49.6 S01003914 Uig 290 6.9 99.8 79.7 69.6 59.4 Skye & Lochalsh & South West 3742 89.6 88.4 Ross

English and overseas 234 5.6

Other Scottish patients 201 4.8

4177 100

Figure 3: Directly age standardised discharge rate per 1000 population from the GP other than obstetrics specialties at Portee and MacKinnon Hospitals by data zone of patient residence, 2010-11 – 2012-13

Table 5: Directly age standardised discharge rate per 1000 population* from the GP other than obstetrics specialties at Portee and MacKinnon Hospitals by General Practice, 2010-11 – 2012-13

Practice Number of DSR per 1000 Up 95 % CI Lo 95% CI discharges population 55516 Broadford Medical Practice 593 78.9 85.9 72.0 55573 Medical Centre, Portree 1574 68.6 72.4 64.9 55569 The Surgery, Kyle of Lochalsh 703 67.8 73.2 62.3 55540 Sleat Medical Practice 182 55.2 63.8 46.6 55535 Dunvegan Medical Practice 444 52.9 58.7 47.1 55521 Carbost Medical Practice 127 46.1 55.5 36.7 55554 Glenelg Health Centre 40 29.8 39.9 19.6 55395 Ferguison Medical Centre, Lochcarron 100 14.2 17.6 10.8 55446 Torridon Medical Practice 25 8.5 12.0 5.1 Skye and Lochalsh 3663 64.9 67.2 62.6 Figure 4: Directly age standardised discharge rate per 1000 population* from the GP other than obstetrics specialties at Portee and MacKinnon Hospitals by General Practice, 2010-11 – 2012-13

*Rates calculated using the Community Health Index Practice list population

Patient drive times to the GP other than obstetrics specialties at Portree and Mackinnon Hosptials, 2010-11 – 2012-13 Figure 5: Box plot of the drive times of patients discharged from the GP other than obstetrics specialties at Portree and MacKinnon Hospitals, 2010-11 – 2012-13*

Table 6: Descriptive statistics of the drive times of patients discharged from the GP other than obstetrics specialties at Portree and MacKinnon Hospitals, 2010-11 - 2012-13

All discharges* Drive time in minutes

Mean Median 75th 90th percentile percentile

MacKinnon 43.4 33.1 47.9 68.9

Portree 20.7 12.6 29.1 36.3

Excluding patients with a drive time of over 90 minutes MacKinnon 30.8 30.7 43.0 59.8 Portree 16.3 12.6 27.7 34.5

*Excludes non-Scottish residents, patients with no fixed abode and discharges with missing postcodes