Health Issues

Highland Primary Care NHS Trust has been criticised in the local media for lack of communication regarding the issues of the NHS Dental Services in Caithness and the Accident and Emergency services at the Dunbar Hospital.  We are sorry if you feel that is the case.  This article is to enable us to communicate with you direct about where we are with addressing these issues. We will provide further updates on a regular basis to make sure that you have up to date information as soon as possible.  We hope you find it informative.

DUNBAR HOSPITAL, THURSO

This notice outlines the work being undertaken by your Local Healthcare Co-operative  (LHCC) and the Highland Primary Care NHS Trust to reinstate Accident and Emergency (A&E) services at Dunbar Hospital in Thurso.

The A&E service has been temporarily closed since May of this year after local GPs, who provided the medical care, felt unable to continue to do so due to changes in clinical practice. This decision was taken by the GPs at short notice. As there were no other doctors at hand to fill the gap, the Trust felt there was no other option but to transfer the service provided at Dunbar Hospital to the A & E Department at Caithness General Hospital in Wick in order to ensure a safe service to patients. However, it should be noted that the  A & E work is not part of a GP’s normal duties.

The Trust fully appreciate the value of the Accident and Emergency unit at Dunbar Hospital and are working to re-open it. During this time we have been criticised for not informing and consulting local people about how and when this will happen. This notice is part of our efforts to make sure that the public are kept informed of progress.

The LHCC is looking at how A & E services can be re-opened at the Dunbar in a robust and sustainable way for the future. This work so far has involved a meeting held on 1^st and 2^nd November 2002 in Thurso where options for the A & E service were discussed. The meeting was attended by representatives from Highland Health Council, Community Councils in the Dunbar Hospital catchment area, the Dunbar League of Friends, plus local health care professionals. People at the meeting discussed and agreed what patients in West Caithness need from an A & E service and what staff require to provide it. These were:

1.      Primary Care Emergency Centre with an extended role for nurses with defined Medical cover

2.      Patient transport

3.      Prescribing and dispensing

4.      Reinstatement of an appropriately resourced service

5.      24 hour local service

6.      Future use of tele-link

7.      Education of patients

At the meeting, the people present discussed ways in which the 7 priorities above could be met and created three options for a “Vision of West Caithness Accident and Emergency Services”. The three possibilities were.

1.      Accident and Emergency  Services with dedicated doctor on call

2.      Minor Trauma Unit with telemedicine links

3.      The current service

Continuing with the current service was ruled out and the remaining two options meet (to varying degrees) some of the 8 priorities listed above.

Options 1 and 2 have been considered for their advantages and disadvantages but require more work on their value. The people at the meeting will be invited to take this work forward.  Once this work is complete, then there will be a firm basis for a wider public discussion on what these options would mean in practice.

The new service, however it shapes up, is likely to enhance the role of the nurses at the hospital.  The nurses have been supported to develop nurse prescribing. Four staff nurses at Dunbar Hospital will be in the first round of nurses undertaking the extended nurse prescribing course with further places secured in the second presentation. Robert Gordon’s University will be providing minor injuries training for nurses at the hospital. Patient Group Directives (whereby nurses can dispense drugs under protocols) have been developed for 22 drugs and training took place in October.

The  process of securing a safe and sustainable Accident and Emergency service at the Dunbar Hospital  is taking longer than we would ideally like.  However, because a return to managing the service as in the past is no longer possible, it is important that any changes proposed are robust, and will provide a sustainable service to meet the needs of the people of West Caithness.  They will also be subject to extensive public involvement.  This will involve a lot of people locally and will take time. 

The next stage is to provide more detailed information of the process to date, to redesign the service, for the general public.  There will be a meeting held to do this on Saturday 16th November 2002 from 10am at the All Star Factory,  Ormlie Road Thurso.  As places are limited, please contact Lyn Morrison at Caithness General Hospital in Wick, Telephone 01955 880212 to book your place.

After the meeting on 16^th  November 2002,  we should be in a position to identify the action required to establish the new service with clear timeframes.  These will be published in the next of what will become regular  public information notices.

This is a busy Community Hospital with 16 GP beds, including 2 respite beds, 2 palliative care beds, and a day hospital.  It also houses Consultant Outpatient Clinics, the GP Out of Hours Service, and a Accident and Emergency  Service.

THE CURRENT POSITION ON NHS DENTISTRY IN CAITHNESS

There are three types of dentists. The majority are General Dental Practitioners (GDPs) who are independent, self-employed, dentists who can opt to treat NHS patients if they wish.  The second type are Community Dental Services (CDS) who mainly provide dental care for children, and people with special needs. These are NHS employees.  The third type are Salaried Dentists, who are employed by the Highland Primary Care NHS Trust and provide NHS dental care for everyone.

In common with their colleagues in most of Scotland, the GDPs in Caithness are not accepting new patients under the NHS.  We are also about to lose two of these independent dentists in Thurso, who have been unable to sell their practice and are moving out of the area. 

The Trust has been trying to resolve this in two ways.  The first is that the Trust and a local dentist had submitted a proposal to the Scottish Executive Health Department.  This would enable him to provide NHS dentistry under a more flexible arrangement than the nationally agreed arrangements, in light of the urgent nature of the situation.  However, the Scottish Executive Health Department has advised us that they were unable to give us permission to proceed as we had hoped.

At the same time, we have been advertising two Salaried Dentists posts to replace the shortfall in dental provision, and to provide NHS dentistry in Thurso.  In fact we have been advertising since May 2002, before the resignation of the two GDPs in August.  So far we have had only one application. We are interviewing that person later this month.  Even if that person is appointed, we will still have a vacancy and a shortfall in provision.

We will continue to advertise our vacancies for the salaried dentist posts that we have been given permission to create in Thurso.  Similarly, we have been advertising our vacancies in Wick since September last year, with no applicants at all.  We are increasingly looking overseas to recruit and are also attending recruitment fairs to try to attract people to the Highlands.

Building works for a new dental surgery at the Dunbar Hospital have commenced this month and we hope this may help to make the vacancies more attractive.  Providing the new surgery is more cost effective than upgrading the vacant, leased, surgery.

We will continue to work closely with the Scottish Executive Health Department to explore any other options they feel would be acceptable.

Even if we are able to appoint quickly, with notice, it is now inevitable that no solution will be in place by 1 December when the Princes St Practice closes.  From that time, until we have a final solution, the Trust’s existing Community Dental Team in Caithness will provide access for children with dental emergencies and will provide routine care for these children during their visits to local schools.  Due to their existing workload, the existing Community Dental Team will not be in a position to offer treatment to adult patients.  These patients will be asked to contact the Dental Helpline 01463 704688 where arrangements will be made for them to be offered an appointment with an NHS Dentist as soon as possible. This is likely to be outwith the area.  If you need NHS dental care please call this Dental Helpline.

If you would like to comment on the issues covered by these articles, please feel free to contact Highland Health Council on 0800 834017 or Chris Meecham, Highland Primary Care NHS Trust, Highlander Way, Inverness Retail and Business Park, Inverness IV2 7GE, Telephone 01463 706893, Fax 01463 713844, Email chris.meecham@hpct.scot.nhs.uk