Wednesday, December 03, 2014

Dr Adrian Baker of Nairn Healthcare Group appeals for community support in order to be able to continue to deliver services

Dr Adrian Baker of the Nairn Healthcare Group spoke to the combined meeting of Nairnshire Community Councils in the Community and Arts centre last night (Tuesday 02/12/14) and outlined the services that are provided to the community by the hospital and the practice at the moment, the fragility of those services and the dangers those services face. Adrian made an appeal for the community councils to support efforts to retain services. The threat to health care as we know it in Nairn comes from a perfect storm of staff recruitment and retention problems, increasing workload and a very dangerous funding crisis. We hear often in the media of cuts that are coming but it is very sobering to hear first hand from the head of the local practice just how serious things are and what is now appearing on the horizon. Below is what Dr Adrian Baker had to say, please find the time to read it if you can. 

“I’m just going to start off with an overview of what is happening around the UK and then look at Scotland, then Highland and then specifically Nairn itself as well. In the last 12 months we’ve been visited by people from Premier Health Care associated with the west coast of New Zealand. We’ve had visitors from Norway come to see us as well. We’re regularly visited by people from the Scottish Government in Edinburgh and other parts of the UK as well.

It’s worth reading if you get a chance, it’s relatively short and sweet: the Commonwealth Fund did a report earlier this year ranking Health Care in the world and globally, they looked at 11 developed nations including Austrailia, New Zealand, Candada and the USA and European nations and Scandinavian nations and the UK was ranked 1st on most areas including quality, access, efficiency and equity. And this is really, really important when we come back to some of the things that Alistair will be adding later. We get £2,173 per person to look after everything in Health Care. Only New Zealand spends less of the nations we were talking about and the USA is ranked last with the Commonwealth Fund and spends five and a half thousand pounds per person. So we’re spending £2,100 per person and America is delivering worse for more than double the cost. Why’s that? 

With taxation, it’s free at point of delivery, it’s the foundation of the NHS and also in my view general practice acting as the first point of contact acts as a pretty important clinical gate-keeper if you like. Whereas this is not as well developed in the United States and other countries I’ve already mentioned. General Practice in the UK is currently in crisis and that’s not me saying it, that’s the Chairwoman of the Royal College of GPs. There are 8,000 GP practices in England, 500 of which will close in the next few years mainly due to retention problems. GPs in their 50s and older are going to retire which will leave 500 practices without GPs in England. We’ve had a funding reduction from what was 11% of the Health Service budget down to about 7 and a half % over the last 7 years or so and there’s a campaign underway at the moment to bring Health Service spending on General Practice back up to 11%. It doesn’t sound much but it’s absolutely massive when you are looking at billions of pounds invested. 

Scotland: there’s about a 1,000 GP practices in Scotland and we are just one of them. 45 practices in Scotland stopped accepting new patients onto their lists last year. So they closed to new patients, so patients who want to register with the practice have to go to another practice. There’s significant workload pressures and 54% of Scots agree there’s a waiting time crisis in General Practice and I’m sure all of you who have waited more than a week or two to see the doctor of your choice at our practice as well. 

In Highland there are significant problems with recruitment and retention. There are over 20 GP vacancies around Highland at the moment. So practices do not have a GP or have locums around and that’s stretching from Thurso down to Campbeltown, includes Alness, Inverness and everywhere in between. There’s a massive advertising campaign. I don’t know if you have caught up with that [...] 

It’s complicated work, it’s complicated decision making, it’s balancing risk, deciding whether the sore throat is a sore throat or whether it is something a lot more serious like cancer or a serious infection. In 2000 when I came to Nairn we would have about 3 contacts per person per year. We measure the workload now, we now have 9 contacts per person per year. Our contact rate has trebled in 15 years. So the workload rate has increased dramatically and in the UK that’s also reflected 5 years ago with 340 million consultations last year in general practice. It’s 40 million more than 5 years ago. So there’s a very, very significant increase in demand there. 

We’ve got GPs retiring; we’ve got recruitment problems, an increase in demand and guess what there’s a funding crisis. OK, so three inter-linked important things that are going on UK-wide and that is also happening in Highland. Highland borrowed 2.5 million pounds from the Scottish Government last year and those of you who have been following the news, the audit report was unfavourable and was delivered to the Holyrood audit committee last month and there’s now a severe squeeze on to try and make sure that the legal requirement not to overspend again is achieved. So there’s at least eight million pounds of savings to be made before the 1st of April. So lack of money, difficult to retain and recruit staff and that’s not just GPs and also an increase in demand which brings us to Nairn. There was the End Child Poverty report which was reported quite widely showing that Nairn had 24% of children living in poverty. That’s ranked third in Highland. That may come as a bit of a surprise to some people but not to us delivering health care on the front line. The Highland average is 19% - 24% of children live in poverty. 22 and a half % of our population are over 65 and over 75 10% of population. So we’ve got about one and a half thousand people are over 75. It really means we are very successful in looking after people but by the time you get to 75 you start to collect the odd illness or two and by the time you are 85 you will collect more than 2 illnesses in most cases. 5% of our population here are over 85. So we’re got deprivation, we’ve also got quite an elderly workload as well. Put that in perspective with some practices in Inverness who’ve got 4% of their patients over 75. So there’s quite a disparity in workload.

As you know, we’ve got an A&E here, we provide 24hr cover. We’ve got a local inpatient facilities, we’ve got 20 beds. We work with the voluntary sector, with Arthritis Care, with the local sports club, Citizens Advice, for example. We’ve got X-rays. We deliver specialist services from our fantastic facilities that were open in 2010 and we’ve got a very comprehensive service. This allows people to have access to services locally which don’t exist further along the A96 for example, or in other similar sized towns. Just to illustrate that really we are able to look after our 70% of our population locally for end of life care. If you are coming towards the end of your life then there’s a very good chance you will be looked after and I think Nairn takes a tremendous amount of work from GPs, from primary care from community nursing, occupational therapy, home care, co-ordinating this and delivering this type of service is extremely rewarding but it is also a huge amount of work as well. To put that into perspective with the UK average, roughly 75% of people are dying in a large hospital. So we’ve reversed those numbers here thanks to the comprehensive care that we are able to deliver. We get a lot of positive feedback from many aspects of the care that we deliver here so we have a huge amount of personal and positive feedback from people. 

Given what I’ve already said with recruitment and retention problems, financial problems and also the sort of rising tide of demand we need your support. We need your support to be able to continue to provide these services locally in Nairn, Ardersier and the surrounding communities. Without your support some of the services that I’ve described will cease or be centralised in Inverness. So that’s where we are at at the moment. An example of that was the A&E closure for two nights last month at the end of October. We’ve got a very small A&E team. It doesn’t take much sickness to allow a gap to form. We’ve also got a very small team running the ward, community nurses, occupational therapy, physiotherapy - all of these teams are fragile, relatively small and it doesn’t take much for something to happen. So all I’m here to do this evening is really just to ask your support in an attempt to continue to deliver services to you locally and comprehensively. Thank you.”


Anonymous said...

Despite it being portrayed as negative by some people we used to have a patients group who were in many ways very supportive of our health care in Nairn, it's a shame it was disbanded

Anonymous said...

Let me start by thanking all the staff who are involved in providing medical care for us in Nairn, as a patient I’m very grateful. I’d like to make a few observations

To my mind our GP coverage is somewhat thin on the ground

Depending on who your GP is you may find that when you ring to make an appointment to see them they:

Only work part time

Or for any given week are:

At the Ardersier practice

On hospital duty

On A&E duty

And then there is sickness and holidays

I have yet to find an effective means of speaking with my GP other than making an appointment

A letter I wrote was passed onto another GP as mine was on hospital duty that week

An email I sent was likewise passed onto another GP as you have to send them to the reception mailbox rather than direct to your GP

And then there’s making the appointment themselves. On some days there is the telephone lottery that if you can be by a phone at 8:30am (I can’t, travelling to work) means that there’s just a chance you might get an appointment that day but can be anytime. On a day I was off work I eventually got through at 8:50 by which time all the appointments were gone

There is the potentially excellent service of a duty GP phoning you, but as I don’t have a mobile and you don’t know when they are going to ring it means taking a day off work just to talk with someone. I work in an open plan office so wouldn’t like to share my discussion with my GP with my work colleagues

I would say that when I get a regular appointment it usually takes me 3 weeks before I see the doctor

So yes potentially we have a great service and facilities in a modern building, a local hospital and an A&E unit but I would say it’s already on the edge in terms of staffing and has been predicted is sadly going to get worse

It’s a great shame that Scotland didn’t decide to be in charge of it’s own destiny then we really could have prioritised health care

Anonymous said...

I appreciate what we have isn't perfect but we must support Dr Baker so that we don't lose many of the facilities that we have in Nairn.