Future Health Care on the Islands

For the last few years, the topic of future health care provision for the islands of Rousay, Egilsay, Wyre and Gairsay has been high on the agenda of the Community Council.

Since the departure of our last permanent, full-time, resident doctor, in 2007, NHS Orkney has sought alternative options to 24/7 GP cover on our islands. The past provision of a resident GP resulted in an excellent level of medical care for our community, while in recent years a series of temporary/locum doctors have provided a similar type of cover, with the continued assistance of a resident, community nurse, although this hasn't provided the continuity of care that so many of us desire.

The senior management of NHS Orkney indicated that they are keen to remove 24/7 GP cover altogether. Their suggested alternative cover included the provision of a permanent, resident nurse practicioner, who they believe will be able to provide suitable medical care for our islands.

The Community Council is yet to be convinced that a nurse practicioner would provide a satisfactory level of care for our community.

Below are several articles relating to the issue of future health care on our islands.

'Developing a Network of Care for the North Isles' is a document which NHS Orkney produced in 2009, "to develop a robust system of care for the North Isles of Orkney".

Chairperson of Rousay, Egilsay, Wyre and Gairsay Community Council, Mr Richard Tipper, responded to the above document. You can see the correspondence between Richard and John Ross Scott, Chairperson of the NHS Orkney Health Board, as well as MSP Liam McArthur's response, here.

In December 2009, NHS Orkney produced a letter to the Community Council, with regards to the 'Proposed Programme of Engagement with Community Councils January - June 2010'.

In February 2010, a Special Meeting between Rousay, Egilsay, Wyre and Gairsay Community Council and NHS Orkney, was held on Rousay. Members of the public were invited to attend. The Minutes of this meeting can be viewed here.

In May 2010, the Community Council sent a letter to NHS Orkney Chief Executive, Cathy Cowan, with regards to the meeting held with NHS Orkney in February. You can view the letter, as well as Cowan's response, here.

In July 2010, NHS Orkney held a public meeting on Rousay, to which all members of the community were invited to attend. Prior to the meeting, residents were sent a booklet, outlining three options being proposed by NHS Orkney, for the future provision of healthcare on Rousay, Egilsay, Wyre and Gairsay.

• Option 1 - A Nurse Practitioner providing both in and out of hours services (24 hours a day, 7 days a week). Visiting GP service from the Heilendi Practice in Kirkwall, 3 days a week, provided during the normal working day. Members of the community would also be able to access services at the Heilendi Practice, should they wish to do so.



• Option 2 - A resident GP providing both in and out of hours services (24 hours a day, 7 days a week), except for 2 days per week, when he/she would travel to the Heilendi Practice in Kirkwall. A Community Nurse would be on duty for 3 days each week, including providing the daytime cover when the GP is working in Kirkwall. Members of the community would also be able to access services at the Heilendi Practice, should they wish to do so.



• Option 3 - A Nurse Practitioner providing both in and out of hours services (24 hours a day, 7 days a week). GP service by a resident GP, 9am - 5pm, 3 days a week. The GP would travel to the Heilendi Practice in Kirkwall, 2 days a week. Members of the community would also be able to access services at the Heilendi Practice, should they wish to do so.

Following the meeting, NHS Orkney developed another option - Option 4 - for future health care, and discarded two of the original options - Options 1 and 3 - due to a lack of support in the community.

The Community Council also suggested that the Community Nursing in Option 2 be upgraded to 4 days, as the financial cost difference between Option 2 and 4 clearly allowed for this increase.

In September 2010, NHS Orkney held yet another public meeting on Rousay. This time, the meeting focused on the one remaining option (Option 2), and the newly-developed option (Option 4) mentioned above.

Option 4 involved a GP providing 3 days of cover on the island, with a Nurse Practitioner on duty 4 days a week (resulting in 2 days a week when both would be on duty at the same time). Weekend and Nights Cover ('Out-of-Hours') would be shared by both Practitioners (each providing 50% of the cover). They would never provide Out-of-Hours cover together (i.e. at the same time).

In both Option 2 and Option 4, regardless of whether it be the GP, Nurse Practitioner, or Community Nurse on duty, they would each be supported by trained, 'Second-Responders'.

Comments received by NHS Orkney prior to the meeting, suggested that the community held a slight preference for Option 4, than for Option 2.

The meeting concluded that a 'Working Group' would be set up, to ensure that the two options would be presented fairly to the community, in a postal vote to be held in the near future.

The 'Working Group' consisted of 10 volunteers from within the community, who met with NHS Orkney in late October 2010, to suggest how to put the options together fairly. The resultant document was redrafted, following continued consultation with the Working Group. The options were rebranded as Option A (formally, 4) and Option B (2).

The results of the postal vote, held in December 2010, revealed that 70% of voters were in favour of Option B.

The post of permanent, resident GP was advertised in the British Medical Journal in April 2011.

Dr. Richard Brunt was appointed as permanent GP to Rousay, Egilsay, Wyre and Gairsay, and commenced employment in September 2011. He spents 1.5 days per week at the Heilendi Practice in Kirkwall, during which time cover is provided by the Community Nurse.