Archive | Community Hospitals

Highland innovations in eHealth

Thanks to RGPAS member Dr Richard Weekes for highlighting some fantastic work going on in NHS Highland to innovate eHealth applications aimed at improving access to healthcare in rural settings.

Here’s an introductory video showcasing some of the projects…

…an STV news item about the PILLCAM project in Ullapool to provide easy access to endoscopy facilities – using some very novel technology…

… and more about bringing endoscopy to rural communities…

… and the RAPID project to overcome connectivity challenges in rural Scotland…

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Next EMRS CG VC meeting on Friday

The next EMRS ScotSTAR Clinical Governance meeting is due to take place on Friday 12th May, at 1.30pm.

These meetings take place at the EMRS base next to Glasgow Aiport, and VC links are invited (via the NHS Scotland VC Network) from rural practitioners (GPs, nurses, paramedics) across Scotland.

The team values input and opinion at these meetings from rural practitioners. Combining the insight of both referring site clinicians and retrieval teams into the intricacies of missions audited creates a fantastic learning environment. Attendees come away from these meetings enthused and encouraged to provide the highest possible levels of care for our patients.

The meeting on Friday brings a few cases under the longitudinal audit microscope. The EMRS team have chosen two of the most challenging cases, one primary and one secondary retrieval and opinion will be welcomed in dissecting out the details so that we can learn from combined experience.

To join the meeting, contact Anne Cadman (details in agenda below) with your VC details.

Download the agenda for this meeting

The above text was modified from an email sent out recently by Dr Randal McRoberts, Consultant at EMRS and lead for the Clinical Governance meetings.

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#RuralGPframed – bringing rural healthcare into focus

Check the end of this article for tweets and images that have been posted online since the hashtag went live…

Image from W Eugene Smith’s “A Country Doctor”.  LIFE Magazine, 1948.

the best camera is the one you have with you

1948 saw the beginning of the National Health Service in the UK.  Many of its principles were based on the development of the Highlands & Islands (Scotland) Medical Service which was launched in 1913 following the publication of the Dewar Report into the challenges of rural healthcare in Scotland – and many consider the Dewar Report to be the blueprint of today’s NHS.

1948 was also a key moment in photojournalism, when LIFE Magazine featured the photography of W Eugene Smith. His photoessay of the work of Colorado country doctor Ernest Ceriani became a benchmark for photojournalism, and remains an iconic reference in the power of photography to provide perspective and insight. A YouTube presentation of the article is available too.

Since then, photography and photojournalism has evolved significantly.   Nearly everyone now has a quality camera-phone in their pocket.  The development of digital photography has resulted in the limits of photography being confined only to battery power, memory card space, and creativity.

Dr Greg Hamill (Arran GP) and Dr Stephen Hearns (Consultant, Emergency Medical Retrieval Service) work together using ultrasound-guided vascular access in an acutely unwell patient. (Patient consent obtained).  iPhone; 2017.

And yet, some would argue that this has had the effect of devaluing the art of good photography.  Paradoxically, because photography is within such easy reach, we sometimes fail to document episodes of experience – either as we assume someone else will be, or the immediacy of image capture devalues the art of composition, style and creative depiction.  And because so many images are produced (Facebook estimates that over 300 million photos are uploaded to its website every day), it is likely that great images fail to get the recognition and prominence that they deserve.

In just over a month’s time, I will be running a ‘Practical Tips’ session at the Rural WONCA conference in Cairns, Australia – on The Visible Rural GP: developing an image bank for modern rural practice.  The idea for this evolved through a personal interest in photography and its journalistic role, an interest in ‘how do we represent rural practice to potential rural GPs’ and awareness of projects such as  Document Scotland – just one inspirational project that aims to “photograph the important and diverse stories within Scotland at one of the most important times in our nation’s history”.

A tick that I removed from a patient who presented to our Arran War Memorial Hospital one summer weekend oncall. (Assumed consent from tick).  Canon 60D, with reversed 50mm; August 2016.

Perhaps we should be considering the need for presenting inspiring, accurate visual representations of rural practice today.

And so today, in the run-up to Rural WONCA 2017, I am committing to share (via Twitter, using the hashtag #RuralGPframed) at least one photo per day, from my own images, that depicts an aspect of rural practice.

I would be delighted for others to join me.  The more images that we can collect and share, to represent the stimulation, challenge and professional satisfaction of rural practice, the more insight that others – including potential rural GPs – will have into the opportunities that rural practice can offer.

Dr Kate Dawson (GP, Benbecula) and Dr Charlie Siderfin (GP, Orkney) during a valuable opportunity to get together and discuss research opportunities in rural practice.  Fujifilm XT1; January 2017.

What about video?

‘A picture is worth a thousand words’ but video often allows a narrative and mood to be more easily captured.  Video is important, and submissions of video are welcomed to this project.

Please remember, explicit consent is required for any footage featuring patients or anything related to them. Creativity  is welcomed!

#RuralGPframed

(search Twitter)

4/4/17 Update

Within 24 hours of this post going live, we’ve had an amazing amount of coverage across the world, particularly our Australian confreres.  Keep them coming!  Here’s just a few of the tweets that we’ve picked up on the hashtag…

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Scotland’s Mobile Simulation Unit – our experience on Arran

In January 2017 the team at Arran Medical Group and Arran War Memorial Hospital hosted a visit from the NHS Education for Scotland Mobile Skills Unit (MSU) – or ‘Skills Bus’ as some folk refer to it. In case you haven’t seen it: the MSU is a lorry, which expands into a workshop area where patient simulation scenarios can be run from a separate control room (also on the lorry). This setup enables a modern simulation facility to be delivered anywhere in Scotland – particularly rural areas – as it only requires a flat piece of land and an electricity hook-up similar to most caravans.

The skills unit just needs a flat area of ground, and an electricity hook-up. We were grateful to Scottish Fire & Rescue for hosting the unit at Lamlash Community Fire Station.

The folks at the Managed Educational Network (MEN) at NHS Education for Scotland (NES) [don’t worry, the acronyms will stop soon!] are keen for awareness to be raised about the unit, particularly its benefits to rural teams. We hope this description of our experience will encourage others to consider arranging a visit with the associated teaching that can often be organised to coincide.

Tell me more about the unit…

The MSU operates from its base in Tayside, and can be booked by contacting the MEN team. At the time of writing, Lynn Hardie is overseeing the unit’s bookings and couldn’t have been more helpful in organising for its delivery to Arran for a week.

Once the unit is set up and expanded by the driver, who usually returns the same day back to their base following delivery, there is a large teaching area which comfortably seats up to 12 people. The unit has heating and lighting, and offers a comfortable teaching space.

The unit can be set up – using the James-Bond style concealed TV – to deliver didactic teaching presentations. Whilst this is its most basic of functions, there are some areas in Scotland which will will find this to be a useful function as part of a more comprehensive course.

However, the main purpose of the Unit is by using its SimMan, SimJunior or SimBaby, along with various provided medical paraphernalia, to enable a wide range of patient assessment simulations to be carried out. The unit has been custom-built: its layout enables pragmatic connection points for the mannequins; there is a separate control room set up with appropriate control software; and an impressive ‘SMOTS’ video system records scenarios from three different angles. This is useful both for monitoring progress through a simulation, as well as for playback during scenario feedback.

This sounds a bit complex

The kit is certainly modern, technically impressive, and requires familiarisation. However the MEN runs excellent (and free) Faculty Development Courses (FDC) – usually at the Scottish Simulation Centre in Larbert – to introduce potential hosts to the simulation equipment and also the daily setup and operation of the unit.

We found the FDC to be fun, interesting and useful – not only for the operation of the unit but for generic skills in running simulations and delivering effective feedback.

The unit also comes with relatively idiot-proof set up instructions, as well as an A-Z guide of equipment and a very helpful troubleshooting guide. This is all covered in the FDC and the MSU team also make themselves available by phone to help sort out any urgent problems during a visit.

OK, but who can we get to help us?

Dr Mark Davidson, Consultant with the ScotSTAR paediatric team, was one of several skilled colleagues who provided excellent teaching during the week.

The unit can be used by confident local teams to deliver training, however we would highly recommend requesting input from the ScotSTAR transfer teams who are often able to provide outreach support for rural training visits. In our case, over the duration of a week, we allocated Monday & Tuesday for paediatric acute care, Wednesday for obstetric emergencies, and Thursday & Friday for adult acute care. For this we were able to enlist the excellent help of the ScotSTAR Paediatric Retrieval Team, the Scottish Multiprofessional Maternity Development Programme (SMMDP) and EMRS (Emergency Medical Retrieval Service) who each came to Arran and delivered excellent teaching – including simulation sessions – during their stay.

In addition we invited a number of clinicians at Crosshouse Hospital – to whom we usually refer our cases – and their involvement was crucial both in clarifying local protocols and also understanding some of the challenges that we face in the rural and community hospital setting when referring to them and their teams.

How did it go?

Our local fire station provided excellent additional presentation space to run workshops, lectures and ample catering facilities.

We found that smaller groups worked best for simulation sessions. We also benefitted from the free use of our Lamlash Community Fire Station (who also kindly provided electricity and additional training space) as well as a daily donation of snacks and food for our Faculty from the Co-op.

Over the week the programme progressed through paediatric, obstetric and adult sessions. We allocated 10-14 clinicians into each morning or afternoon session, usually splitting them up into two groups to alternate between simulation and workshop training. We also held lunchtime ‘drop-in’ update sessions on topics such as sepsis, DKA (diabetic ketoacidosis), drug overdose and ECG interpretation; and we invited our First Responders to an evening of simulation too.

We delivered over 540 training hours during the week to Arran’s GPs, nurses, nursing assistants and paramedics/technicians, and collated feedback using SurveyMonkey – which was generally very positive and indicated an enthusiasm for doing more simulation training in the future.

What went particularly well?

Multidisciplinary colleagues worked together in simulations, and this reflected the nature of work on Arran in our community hospital.

Our teams enjoyed working in the same multi-disciplinary setup that we usually work in. For example, at our community hospital, it is common for a GP, two nurses, a nursing assistant and paramedics to continue working on an emergency case on arrival at the hospital, and we emulated this in teaching scenarios. The quality and experience of our Faculty – comprising experienced consultants, nurses and paramedics – was clearly appreciated by participants, along with the relevance of the teaching.

Prior to the training week, we surveyed our colleagues to identify what they felt were priority areas for development. As expected, sepsis and acute coronary syndrome were low down the priorities – there has already been a focus on these areas in our hospital (and nationally) over the last few years. Higher up were – obstetric emergencies, unresponsive/hypoxic children, severe asthma, drug overdose and major trauma; and so these were the areas that we focussed our training on this year.

During the week we kept a ‘Great Ideas’ board updated using post-it notes, to capture great suggestions and points for further consideration following the course. Collating this at the end of the week provided not only a snapshot of over 40 learning outcomes, but a great range of action points for implementation, as a result of discussion during the week.

What would we have done differently?

Based on feedback, we might have built in more time for skills stations – for example airway management, NG tube placement, chest drain insertion and femoral line access. There is equipment to provide this training on the Unit, however we opted to focus on more simulation training for our week.

Any further efforts to keep groups small and reflective of typical team configurations would have had benefits too, although the feedback indicated that most of the time this was achieved.

We also found – as do organisers of similar training – that running a week can be tiring!  Inevitably, there is a bit of running around before and during the week, to sort out equipment, printing documents and keeping a track on the programme.  Two of us kept an eye on this, and our advice to anyone considering running a training week would include the importance of running the week as a team, with adequate time to oversee the logistics!

What about funding?

We used local training funding to free up time in order for two Arran clinicians to attend the Faculty Development Course, as well as some admin time required before, during and after the training week. Funding was also identified for GP locums – and this, combined with restricted leave during the week – meant that we were able to maintain normal service whilst maximising participation in the training scenarios.

The crucial advantage that we had by involving ScotSTAR teams is that they were able to fund their input via their own team outreach budgets – this is centrally funded with the aim of supporting rural clinicians, and so the conversion factor between local funding and the ‘worth’ of the week was 3-4 (i.e. we gained nearly four times as much value from the local funding required to organise the week).

Interested?

The SMMDP programme ran a fantastic, relevant- and fun – one day course on obstetric emergencies for us. Twenty staff from all disciplines attended.

David Hogg (GP) and Ailsa Weir (Senior Charge Nurse) oversaw the week of training. We can both be contacted via Arran War Memorial Hospital if you wish to find out more about our week. Lynn Hardie (Mobile Skills Unit Project Officer) was instrumental in organising the unit to be available, and our attendance at the Faculty Development Course. Lynn’s contact details are available on the MEN website.

In terms of team contacts, Sandra Stark (Nurse Consultant, ScotSTAR Paediatric Team) and Kate Silk (Programme Administrator at SMMDP) were our key links and very helpful in setting up the training. Every rural area in Scotland has an EMRS ‘link consultant’ and this should be the route that EMRS involvement is requested. In our case we were grateful to Dr Drew Inglis and Dr Doug Maxwell for their input.

If you are keen to consider a visit to your local area, contact the MSU team in the first instance, and they will be able to advise on availability, and advise on how to set up an appropriate programme of training.

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WONCA World Rural Health conference all set for April

This year will see the WONCA World Rural Health Conference take place in Cairns, Australia from 29th April.  It will be preceded by the National Rural Health Conference of Australia, which will promise to bring even more research, innovation and collaboration to the wider event.

Registration is now available from the conference website.  The organisers have also put together this film to whet the appetite of potential delegates.  It looks set to be a fantastic event.  RuralGP.com will be there, and we hope to run a similar range of interviews and podcasts like we did from Dubrovnik in 2015.  This reflective commentary from the 2015 conference demonstrates that the conference offers a unique chance to get together with like-minded confreres and share great practice from across the world.

We hope to see you there!

Early bird registration fees available until the end of January.

… and if that’s not enough (!), here’s Ian Couper of South Africa, being interviewed in Dubrovnik in 2015 giving some encouragement for others – particularly students and new doctors – to attend WONCA in Cairns…

ianIan Couper, South Africa

Ian is a rural family doctor, and a stalwart of Rural WONCA.  You can read more about his background here.


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Retrieval 2017 Conference programme now available

Details are now available for the annual Retrieval conference, hosted by the Emergency Medical Retrieval Service of Scotland.

Once again, there is a broad range of topics covered, and another impressive line-up of local and international speakers.  As well as clinical topics, there are also presentations about working with the media in the prehospital setting, and ‘Looking After the Team’ – being aware of the stressors and pressures placed on responders in the emergency prehospital setting.

Registration is now available and abstracts can also be submitted via the Retrieval 2017 website.

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#RGPAS16 a major success

Last week, over eighty students, trainees, new and more experienced GPs from across Scotland and beyond, met at the annual conference of RGPAS.  An action-packed programme provided a wide variety of clinical and non-clinical topics, and there were plenty of opportunities to meet and discuss rural practice.  Rural GP-ing in Scotland is a simulating place to be!

rgpas16_-1

Scroll to the bottom of the page for more conference photos…

ruralgpscot_2016-oct-24

But we had some GPs from further afield too!

screen-shot-2016-11-03-at-00-44-28

Rural GPs from across Scotland came for the conference…

Kicking off the programme, we heard from Dr Helen Brandstorp of the National Centre for Rural Medicine in Tromso, Norway.  Helen provided a good backdrop to the fact that “we’re all in this together” – the challenges and delights of rural practice are prevalent in Norway in similar levels to Scotland.  The ground is fertile for further collaboration with international confreres and we hope to see ongoing links with our Norwegian counterparts in rural medicine.

The rest of the conference featured a rich variety of clinical and non-clinical topics of relevance to rural practice.  We were lucky to have an excellent range of engaging and entertaining speakers.  From updates in emergency medicine, to humanitarian and MSF work, to developing rural LGBT-friendly health services, to IT Reprovisioning, to research tips, to rural surgery, to featured student presentations… there was plenty going on, and the conference dinner provided plenty of opportunity to make further connections and allow the conversations to flow, along with a bit of traditional music too.

We were delighted to host a good number of students, trainees and new doctors… in particular there were nineteen heavily-subsidised student places – and they didn’t disappoint in their contributions of innovative ideas throughout the conference.

Instead of listing all the speakers here, the programme remains available – and we were delighted that over 200 #rgpas16 tweets were exchanged in the course of the conference.  We’ve collated these with Storify, and you can view the Storify timeline here.

Here’s a few of the twitter highlights:

The conference rounded off on the Saturday with a visit to the Bristow Coastguard helicopter base at Inverness Airport, where Winchman Paramedic Duncan Tripp and his colleagues treated student and experienced GPs to a tour round the facilities, including one of their £26 million Sikorsky search and rescue helicopters.

Thanks to all those who presented, and to all others who contributed to the conference planning.  The event proved to be fun, engaging and relevant to rural practice.  We hope to do the same next year – provisionally booked at the Craigmonie Hotel again on 2nd-4th November 2017.  Meantime, at RGPAS we are keen to stimulate and encourage further work in Scottish rural practice.  A new committee was formed, and I am delighted to take the helm of an able and enthusiastic team.  It’s going to be an exciting year!

Here’s some photos of the event…

 

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Rural GPs Scotland (RGPAS) Conference 2016 – registration open

newlogosquaretextTwitter hashtag: #RGPAS16

The annual RGPAS (Rural GP’s Association of Scotland) conference will be held on Thursday 3rd and Friday 4th November 2016, at the Craigmonie Hotel in Inverness.

Once again, we hope to welcome both new and experienced rural health professionals, and we have a stimulating programme lined up to cover a wide spectrum of topics which are relevant to rural general practice in Scotland.


Programme

The latest programme will be kept updated here: http://scotland.ruralgp.com/conferences/

Thursday 3rd November 2016

(Lunch can be organised with the Craigmonie Hotel by prior arrangement – please contact them directly).

1330 Registration & Tea/Coffee

1400 Introduction :: Dr David Hogg (Rural GP, Isle of Arran)

1415 Rural Medicine – a Norwegian Perspective :: Dr Helen Brandstorp (National Centre of Rural Medicine, Tromso, Norway)

1445 Transfers Workshop :: Dr Iain Cromarty (Rural GP, Isle of Hoy) 

1450 Initial response and getting people away to hospital :: Dr Iain Cromarty

1505 Stabilisation & Treatment in the Rural Hospital :: Dr Kate Dawson (Rural GP, Benbecula)

1520 Transfer & the role of ScotSTAR Retrieval Teams :: Dr Sarah Maclean (Senior Clinical Fellow in Aeromedical Retrieval, EMRS/ScotSTAR)

1535 Discussion & Comments

1600 Refreshments

1620 Legal Highs  – should we be worried? … and other A&E Hot Topics :: Dr Luke Regan (Emergency Physician, Raigmore Hospital)

1700 Rural GP & Humanitarian Work: A Journey to Congo, Pakistan and beyond :: Dr Catherine Sutherland (Rural GP Fellow, Isle of Arran & MSF Volunteer)

1930 Conference Dinner :: Venue TBC

2200 Music Session at The Craigmonie Bar :: Open to all musicians, hummers, spoon-players…


Friday 4th November

0815 Breakfast Mentoring Session 

0900 LGBT Youth in Rural Communities :: Dr Thom O’Neill (Paediatric Clinical Research Fellow, NHS Lothian)

0945 BASICS Scotland Update :: Dr Ben Price (Assistant Clinical Director, BASICS Scotland & GP, Auchterarder)

1000 Sandpiper Trust: We Want to Support You :: Aly Dickson (Founding Trustee, The Sandpiper Trust)

1015 Rural Prehospital Care: Discussion

1025 Remote Island Medicine in Tanzania :: Dr Isla Hislop (Sessional Rural GP)

1045 Refreshments

Parallel Session A:

1100 Finding your Inner Teaching Mojo (Undergraduate Teaching Workshop) :: Dr Jim Finlayson

1145 GP IT Reprovisioning for Rural Practice in Scotland :: Speaker TBC

Parallel Session B: For Students & New Doctors :: Led by Dr Gemma Munro and GP Rural Fellows 2016-17

1100 Workshop: So You Want to Be a Rural GP?  Tips & experiences on what makes it fab

1215 Lunch

1300 The Challenges of Rural Medicine: New Models of Delivery :: Dr Charlie Siderfin (Rural GP, Orkney)

1330 Getting into rural research :: Prof Phil Wilson (Centre for Rural Health, Inverness)

1400 Pecha Kucha Presentations (back by popular demand) – presentations where a maximum of 20 slides auto-advance every 20 seconds, thus being able to keep lots of presentations to time!

Consortium of Longitudinal Integrated Clerkships, Toronto :: Dr Chris Williams (University of Dundee)

Invitational Symposium on Rural Health, Tromso (Norway) :: Dr David Hogg (Rural GP, Isle of Arran)

A Medical Elective on the Isle of Arran :: James McHugh (Glasgow University)

A Medical Elective on South Uist :: Michael Durbar (FY1, Complex Care Medicine, Royal Bolton Hospital, Lancashire)

Selected Medical Student Innovations (TBC)

1445 Refreshments

1500 AGM – all welcome

Including reports and standing items

Update from the Scottish Rural Medicine Collaborative Update (Dr Chris Williams)

University GP Societies – what can we do to support them?

Hot topics & representations

1700 Conference Closing Comments


For details about our student scholarships, please see this page.  Please also note our heavily discounted fees for students and trainees.

To register, please email hello@ruralgp.scot .

Registration Form
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New number for Scotland’s Retrieval Services

News just out which will be relevant to all Scottish rural GPs and healthcare practitioners…

scotstar

Download a poster for your unit (2.2MB)

From 11 July 2016 the telephone number to access a transport team for advice or retrieval will be 0333 990 222.

This number will connect you to the new Specialist Service Desk in the Glasgow Ambulance Control Centre.

The Scottish Ambulance Service are making this change to deliver the following improvements to service users;

  • Provide a single point of contact for advice or retrieval for all age groups
  • Provide real time updates on transport availability at the time of call
  • Utilise multi-party voice conferencing when required/requested for pre-transfer advice or planning
  • Call recording for audit and governance
  • Provide a single point of contact for mission progress updates

To report any issues with this new activation process, please contact the Specialist Service Desk Supervisor on scotamb.ssdsupervisor@nhs.net

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EMRS Clinical Governance: next VC meeting 9th September

emrs minilogoDate for the diary… the next clinical governance meeting of EMRS (Emergency Medical Retrieval Service for Scotland) – available to any rural health practitioners in Scotland – will take place on Friday 9th September from 1.30 – 3.00pm.

The usual format will be presented: a general review of activity since their last meeting, along with two cases of interest, representing elements of both primary (from scene) and secondary (from rural hospital) retrieval.

To attend, you will need access to either a VC site connected to the NHS Scotland network, or your own NHS Scotland VC Jabber account.

To register, you can contact Anne Cadman at: Anne.Cadman@ggc.scot.nhs.uk with your ISDN number or Jabber account ID.

 

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