Being Here BULLETIN AUTUMN 2015

PAGE 7: MEET ONE OF So what is Being Here? OUR RURAL FELLOWS NHS is involved in a major initiative to find differ- ent and innovative ways of sus- taining health and care services in remote and rural communi- ties. The three-year project was launched in 2013 with funding Feedback totalling £1.5 million from the Scottish Government as part of its 'Being Here' programme, and NHS Highland's brief was to devise and test innovative ways of recruiting and retaining healthcare professionals – and particularly GPs. Since its launch, NHS High- land has set up a specific web- site, http://nhshighland- on project rural.scot.nhs.uk/, detailing GP vacancies and featuring video testimonials by GPs from over- seas who have settled in re- mote and rural practices. A locum GP page has been added to the website and one for pharmacists will soon follow. NHS Highland is also work- ing with other organisations to enhance the image of North welcomed Highland and as a place to live and work, and is looking at issues such as ac- ITH funding totalling £1.5 very important. We need to get an understand- commodation, transport and IT million from the Scottish ing of people’s views of current services and of connectivity. Government, it’s impor- the changes being made or proposed under the It recognises that training W Being Here programme. and career development is im- tant that work takes place to assess “The feedback I receive is then collated and portant for healthcare profes- value and effectiveness of the Being analysed and then summarised for senior NHS sionals, and through Being Here project. Here NHS Highland is imple- Highland management.” menting a programme of ac- Enter research fellow Dr Sara Bradley. Dr Bradley added that she has so far had a credited training, workshops Since the initiative started she and col- “very good” response from residents in that and awareness-raising. NHS leagues at the University of the Highlands and they were keen to take the opportunity to pro- Highland is also working to Islands have been conducting what’s known as a vide feedback. However, as the work is ongoing develop some common princi- ‘qualitative survey’ of Being Here. and she has a great deal to collate and assess, ples about rural NHSScotland And for Dr Bradley in particular that’s in- Dr Bradley said it was still far too early to sum- requirements in the future. volved doing field work, visiting the Being Here marise that feedback. Being Here has been work- test sites and interviewing residents, community ing in four test areas: Kintyre She added: “I think it is important that peo- and Islay in Argyll and Bute, representatives, and health and social care pro- ple are made aware that this work is taking West and the Small fessionals, as well as attending community group place and that they can contribute to it. We Isles of Eigg, Muck, Rum and meetings. welcome their views – positive or negative.” Canna. She explained: “This data collection work is  Photo: page 5 We would welcome your views … positive or negative ‘ Produced by NHS Highland’s North and West Operational Unit, Larachan House, Dingwall ’

Page 2 Support team shows its worth

T’S been called a “virtual network” of health and social I care professionals. But Spreading the word at careers fair there’s nothing virtual about the difference NHS Highland’s new rural support team has been hav- ing in terms of delivering services in some of our more vulnerable communities. The multi-disciplinary team has been put together – and that work is ongoing – to provide cover wherever it’s needed. And although members may be based many miles apart from each other, they are very much a team, regularly linking up to pro- vide support for each other. The latest person to join the team is a GP who has both hospital and remote and rural experience in Dumfries and Galloway. Her appointment will complete the GP complement in Acharacle. “Dr Adrienne Swan will be a fantastic addition to the team,” said Tracy Ligema, recently-appointed deputy director of op- erations for NHS Highland’s north and west operational unit. “Acharacle has pre- sented us with challenges in the past and it’s great to get the practice fully staffed.” Tracy added that work was progressing on developing the out-of-hours element of the rural support model, and team mem- bers were continuing to receive training to widen their skills base. Meanwhile, a paramedic has joined the ‘THE only way is up!’ Dr Paul Davidson, director of medi- rural support team as an emergency practi- That was the message on the tee- cal education Dr Emma Watson, tioner and a practice nurse has been re- shirts worn by a group from High- consultant physician Duncan Scott cruited to widen the range of skills within land who attended the annual Scot- and remote and rural programme the team. tish Medical Training and Careers manager Martine Scott were at the “The team has been operating for less Fair. event representing the north of than a year and we are convinced that it’s a Held this year in Glasgow’s SECC . model that works,” said Tracy. “Earlier this on 12th September, the event is a They were joined at the event by year the Scottish Government launched a major showcase for medical training Kerry Russell of the North of Scot- review of out-of-hours primary care ser- in Scotland – and a team from NHS land Planning Group and rural fel- vices and a new approach to unscheduled Highland wasn’t going to miss the lowship co-ordinator Dr Gill Clarke. care led by Professor Sir Lewis Ritchie. chance to spread the word about “It was a good event and a tre- That review has been looking at multi- what’s happening in the north of the mendous opportunity to showcase disciplinary teams working to minimise country. some of the great work that we’re reliance on GPs – and that’s an important NHS Highland clinical director involved in,” said Martine. part of what our rural support team does.”

Page 3 Birthday bash for Belford!

HE in Fort Professor Derek Bell, president of the T William celebrates its 150th We have planned Royal College of Physicians of Edinburgh birthday this year – and a special and Dr Andrew Flapan, physician to the event is being held to mark the Queen in Scotland. this birthday party And among the speakers will be Dr occasion. Tyler Hughes from USA and Mr John Kyng- The Cabinet Secretary for Health, for quite some time don from New Zealand. Sport and Wellbeing, Shona Robison, is Dr Byrne said: “This is a broad-ranging to participate in the event, a conference ‘ conference with something to suit every- which will feature a host of internation- conference, which will take place in the one. We will cover a number of themes, ally renowned speakers, many of whom Nevis Centre in Fort William from 22nd- including acute medicine, education and have trained and worked at the Belford. 25th October, with the aim of attracting training, general practice, geriatric medicine Coincidentally, 2015 also marks the 50th staff from across all services, from porter’ and remote and rural. anniversary of the Belford on its current to physiotherapist, from doctor to domes- “Each of the four days will include a site, and event organisers Dr Patrick Byrne tic staff, both past and present – and cele- number of presentations and workshops on and Miss Sarah Prince hope the occasion brating the uniqueness of the hospital. topics such as future resilience for health- provides a fitting tribute to the hospital. “The conference will feature a ceilidh care in remote and rural areas and rural The event is being part-funded by NHS on the Saturday evening, with local musi- working around the world, and features a Highland’s ‘Being Here’ project, and Being cian Gary Innes providing the music.” one-day Train the Trainers course, which is Here will be running parallel break-out Guests at the event will include NHS aimed at medical students in their clinical sessions with a number of interactive Highland chair Garry Coutts, chief execu- years and foundation doctors. workshops. tive Elaine Mead and the director of opera- While the conference celebrates 150 Dr Byrne said: “We have planned this tions for the north and west operational years of the Belford, and half a century at birthday party for quite some time and we unit, Gill McVicar. its current location, a new-build replace- are delighted that we have had so many Also attending will be Professor David ment for the hospital is in NHS Highland’s positive responses from interested parties. Haslam CBE, chair of the National Institute capital plan, which could see the construc- Many of them previously trained or worked for Health and Care Excellence; Professor tion of a new building getting under way in at the hospital, and were only too happy to James Garden CBE, surgeon to the Queen 2019/2020 (see below). come ‘home’ and celebrate with all of us. in Scotland and Regius chair of Clinical For information about the conference “We decided to hold a general themed Surgery at the University of Edinburgh; visit www.belford-hospital-150.co.uk Council secures land for replacement hospital LAND has been secured for a replacement hospital in fordable housing. NHS Highland and West Highland College will Fort William. now work with the council to take forward proposals for the site. The Highland Council has bought a site on the Blar Mor, next The council’s chair of planning and development, Councillor to the health centre, to replace the 50-year-old Belford Hospital. Audrey Sinclair, said: “This is a tremendous and long awaited suc- The council was asked by its community planning partners last cess for the Lochaber area. It is a good example of partners work- year to take the lead to secure the land for a replacement hospital. ing together to achieve success. Tesco were selling the eight-acre plot as part of their portfolio of “I would like to add recognition for former council leader surplus sites and had set an imminent closing date. Michael Foxley who was a significant force behind this project and Working with NHS Highland, HIE, West Highland College UHI worked to get Scottish government support to make this happen.” and the Scottish Government, the council acted in an enabling role Michael Foxley, a non-executive member of NHS Highland’s in securing the land for £2 million for a new hospital and poten- board, said: “As instigator of the plan, I see this as a great result tially a new science academy for the West Highland College. for teamwork and genuine community planning across six public Once funding is in place for the new hospital, NHS Highland bodies. I am confident that a new hospital and a science learning will transfer the existing Belford site to the council to deliver af- centre will rise like a phoenix on the redundant Tesco site.”

Page 4 Pulling together ensures Islay faces healthy future

ORK is continuing to re- “The GPs on the island have always W verse uncertainty about It was clear that worked very well together but this new the future of healthcare provi- arrangement provides a co-ordinated, fully sion on Islay. integrated service that, crucially, is now something had to fully staffed,” said Alison. Along with many remote and rural Three salaried doctors now work be- parts of Scotland, Islay had a shortage of tween the three practices and another GP, general practitioners, and the remaining be done Dr Sarah Boulter (see page 7), joined the doctors indicated that they would no team in September. She will be practising longer be able to provide out-of-hours ‘from coming up with a plan for the future on Islay, as well as on neighbouring Jura, cover or staff the community hospital. which we are now implementing, a very for a year under the Rural Fellowship “We were facing a real crisis, there's positive outcome of the whole process has scheme. In Jura, she is providing support to no doubt about it,” said NHS Highland been that it's contributed to people on the the job-sharing husband-and-wife team of clinical services manager Alison Guest. ’ island working together. The public in- Drs Martin and Abby Beastall. “The staff and community were very, very volvement has been fantastic.” worried and it was clear something had to The new system on Islay has also seen be done.” Extensive public engagement, which changes at the island's community hospital. That 'something' was the commission- included a series of consultation events, Previously, each GP looked after their own ing in 2013 by Argyll and Bute Community has been hugely instrumental in the end patients when they were in hospital. Now, Health Partnership of an in-depth review of game that's now being played out on the the doctors operate a rota whereby health services on Islay – a review sup- island: the delivery of a sustainable new there's one GP in charge there each morn- ported by independent expert Professor health and social care model. ing with cover provided 24/7 by the inte- Gordon Peterkin and by the involvement And key to that model has been the grated GPs. by representatives of the island community. coming together of the island's three GP There's also been an acceptance that “Community representatives, social practices under a principal practice model greater resilience needed to be built into workers, local health managers and other with Drs Kate Pickering and Angus Mac- the system, and work has been ongoing to healthcare professionals came together to Taggart as the principal partners, maintain- improve the multi-disciplinary teams’ level form three groups to feed into the review ing GP services from the practice sites of of skills. process,” said Alison. “And quite apart Bowmore, Port Ellen and Port Charlotte. Alison explained: “It's very much a multi-disciplinary team approach. Nurses, midwives, Allied Health Professionals and GPs have all undertaken extra training – in some cases in their own time – to boost their skill sets. For example, there's a small midwifery unit in the hospital but there isn’t 24-7 midwifery cover. Midwives are not on call unless there was a woman 38 weeks into her pregnancy, so nursing staff and GPs have done obstetrics and neo- natal training.” HILE there have been signifi- ing facility on the island isn't big Another move has been designed to cant changes in the way ser- enough to contain all our services. W ensure that where possible a greater num- vices are delivered on Islay, plans “As well as a 10-bed acute ward, ber of people receive their care in their are also in hand to change where the hospital has a community casu- own home. There's a community nursing some of them are delivered. alty unit and a small maternity unit, team and a nursing team based in the hos- In its Asset Management Strat- and also has Allied Health Profes- pital, but Alison explained that they were egy for 2015, NHS Highland listed sionals, community nursing and ra- moving towards effectively forming a single among major developments being diography. nursing team, and community nurses have considered the replacement/ “Bowmore Medical Practice is been extending their skills so that they can refurbishment of based in the hospital, so it is all also work in the ward. (pictured), Bowmore Medical Prac- rather cramped, and there is also a Meanwhile, Alison said she was looking tice and Gortonvogie care home. 15-bed care home which needs at bringing the rural health and social care Clinical services manager Alison some attention. support worker role being pioneered on Guest explained: “We are now “The hope is to provide a fit-for- the Small Isles (see page 5) to Jura, where working in a much more holistic, purpose new facility to accommo- the retiral of one of two community nurses joined-up way than ever before and date the health and social care has prompted a close look at how best to it's increasingly clear that the exist- needs of the island. provide for islanders in the future.

Page 5 Advanced nurse practitioner training A NEW, standardised approach to training The capability framework, which sets “This has been a significant piece of for remote and rural advanced nurse prac- out the level of skills and training required, work which puts these very important titioners and advanced paramedic practitio- was recently approved by the Nurses, Mid- posts on a more professional footing,” said ners has now been adopted in NHS High- wives and Allied Health Professionals lead- remote and rural programme manager land. ership committee. Martine Scott. Work progresses on Eigg centre

Y Christmas, what amounts to a new B health centre will be up and running for Being Here evaluation team residents of the Small Isles of Eigg, Muck, Rum and Canna. A team from NHS Highland has been working on the conversion of the former doctor’s house on Eigg into a health and wellbeing centre. NHS Highland architect Heather Cameron, who has managed the project, said: “We’re looking to transfer to the building this year and we’re confident that we’ll be using the new-look premises by Christmas.” NHS Highland is considering options for making the existing health centre available for community use. Still on the Small Isles, NHS Highland has agreed to a request by residents to postpone a health fair, which had been pencilled in for September, until next spring and it’s hoped that the event will also celebrate the opening of the new surgery. The health fair is intended to be community-led, and would offer advice on such as diet, smoking and alcohol. NHS Highland would be happy to consider any other ideas for the fair. Meanwhile, NHS Highland’s team of four rural health and social care support workers on the Small Isles are con- tinuing with their learning objectives to enable them to meet the needs of the island communities. Formed in April, the team – three Eigg residents and one from Muck – complements the work of doctors, nurses and therapists. They have already completed orientation and basic skills training, for which they have been provided lap- tops, and recently had a talk from the lead physiotherapist for Lochaber and Skye, who visited Eigg to assess some patients. They have also had infection control training by video- Meet NHS Highland R&D/University of the Highlands and Is- conferencing and will be receiving some training on basic lands team that is carrying out an in-depth evaluation of the nail-cutting. It is also planned that they receive smoking ‘Being Here’ project in NHS Highland. Pictured from left are cessation and alcohol advice, mental health first-aid training, Dr Jenny Hall, Dr Sara Bradley and Frances Hines, head of re- which will teach them to give initial help to someone ex- search, development and innovation for NHS Highland. periencing a mental health problem, and some IT training.

Page 6 Practices merge and more GPs recruited

HE remote and rural project for Both the service models are also sup- T Mid-Argyll and Kintyre is pro- The merger and re- ported by emergency nurse practitioners gressing well. based in the hospitals and by the commu- Its aim is to recruit to vacant general cruitment of GPs nity nursing team working until 9.30pm. practice posts, to provide a sustainable Stephen Whiston, head of strategic and high-quality primary care and commu- has been as a direct planning and performance in Argyll and nity hospitals (both in-patient and A&E Bute, said: “The Mid-Argyll GP practices services) and GP out-of-hours services in result of Being Here merger and the successful recruitment of the area. GPs to Kintyre have been as a direct result These services require GPs with an ‘whole of Kintyre and an additional 1.5 of Being Here. extended range of skills to undertake this GPs have been appointed to deliver this “The initiative has helped to establish a triple-duty role. service. local refresher training programme to pro- In Mid-Argyll, the medical practices Campbeltown Medical Practice has ’vide these triple-duty doctors to deliver at Lochgilphead and Inveraray have assumed responsibility for in-patient care the service required, and has also provided merged, providing a larger pool of general and out-of-hours services for the entire the funding to recruit additional GPs, cre- practitioners; four new GPs have been peninsula, while maintaining their own in- ating attractive, professionally fulfilling recruited in the past 12 months. hours general medical services work. posts with an improved work/life balance. The proposal for Kintyre is to establish Daytime GP services will continue to “We believe that this model of service a single GP out-of-hours service and a be provided across the area’s two other provision will ensure maintenance of a high single GP practice-led community hospital practice sites, Carradale and Kintyre Medi- quality and sustainable service to our re- in-patient and A&E service covering the cal Group. mote and rural communities.” Doctors are targeted at Glasgow conference

DOCTORS at the annual conference of the Royal College of General Practitioners, held in Glasgow’s SECC from 1st-3rd Oc- tober, were given an insight into practising in remote and rural parts of Highland and Argyll and Bute. NHS Highland, along with NHS Shetland and NHS Dumfries and Galloway, mounted a stall at the event promoting remote and rural working. At the royal college’s conference in Liverpool last year, NHS Highland not only had a stand promoting remote and rural practice but arranged for a van, carrying adverts plugging the Highlands as a great place for doctors to work, to drive around the city. That exercise was repeated at this year’s event. Remote and rural programme manager Martine Scott said: “Our presence in Liverpool last year attracted a great deal of attention and we hope that joining up with colleagues from Shetland and Dumfries and Galloway will further enhance the profile of remote and rural practices.” GPs get refresher training The theme of this year’s conference was ‘Expanding Hori- AN important part of the Being Here initiative has been zons of Care’. ensuring that GPs keep their skills honed. Ross-shire GP Miles Mack (right) is pictured at the exhibi- And Being Here funding is being used to deliver a roll- tion stand along with, from left, NHS Highland primary care ing programme of GP training, accredited by NHS Educa- manager Melanie Meecham, Lydia Burnett of Dumfries and Gal- tion for Scotland. loway, Anne Ribet of Shetland and Dumfries and Galloway GP A refresher training session was held earlier this year Dr Neil Kelly. and a second one took place in Lochgilphead recently, led by Dr Adrian Ward, who practises there.  See photo on back page

Page 7

HE may have been a rural fel- low for only a short time, but S Dr Sarah Boulter’s pretty sure that her future career will involve ‘I expect I’ll always working as a GP in a remote and ru- ral area. And they don’t get much more remote and rural than Dr Boulter’s current patch: be working as a GP Islay and Jura. As we report elsewhere in this news- letter, Dr Boulter joined the GP team covering Islay’s newly federated three practices in September. She’s based in Port in a rural area’ Ellen but during her fellowship she’ll be working one week a month on neighbour- particularly in a place like this where peo- said. “You treat the whole person and not ing Jura. ple tend to be less transient and where just the condition, and you get to spend a “I love it here,” said Dr Boulter, who there’s a great community spirit. You get lot of time with your patients, which I has set up home in Bridgend, in the heart to know entire families, and that can only liked. of Islay. “The people here have been very help when you are speaking to and treating “I knew when I was working there that welcoming, and I’m looking forward to patients.” I would learn a lot that would be useful to getting involved in some community activi- Dr Boulter is from Croydon in South me as a GP, and so it’s proving. ties, such as a nearby community garden. London but as her father did overseas “But my job here is very different, and I’m no gardener but I’m sure I can learn!” development work for the government, I’m benefiting from using a wider range of But while Dr Boulter’s taken a shine to she moved around. She lived for a spell on practical skills and seeing a wider range of island living, she’s also been enjoying island Vanuatu in the South Pacific and later spent patients. It’s going well.” work. two years in Zimbabwe. And, being on an island, Dr Boulter’s She had previously worked in Pem- She did her medical training in Cardiff, looking forward to doing some swimming brokeshire in rural Wales, where she en- and had placements throughout Wales (open water when the weather’s better), countered similar healthcare challenges, before doing her GP training in Pembroke- and canoeing. not least those associated with being some shire. Her other big interest is tall-ship sailing distance from a tertiary care centre. However, she developed a keen inter- with the Jubilee Sailing Trust, an organisa- “I enjoyed working there and I suppose est in palliative medicine and in the year tion which works with disabled and able- I expect that I will always be working as a prior to her moving to Islay she worked as bodied people. Earlier this year she spent GP in a rural area. There’s a degree of a doctor in a 19-bedded hospice in Water- 10 days sailing off Norway and next year independence in this kind of work that I looville in Hampshire. she plans to join the trust on a voyage enjoy. You get to know your patients, “Palliative work is very holistic,” she from Fiji to Sydney, Australia.

Page 6 Recruitment drive...

HITTING THE ROAD: NHS Highland has been continuing to use innovative methods to advertise GP careers in its re- mote and rural areas. This eye-catching advertising van promoting rural practice in the Highlands did the rounds in Glasgow during the Royal College of General Practitioners’ annual conference in the city’s SECC from 1st-3rd October. A similar campaign was mounted at last year’s annual conference, held in Liverpool. Also last year, NHS Highland mounted a high-profile advertising campaign on buses and billboards in Leeds.