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Caithness.org News Bulletins -  November 2002

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A meeting on Saturday 16th November 2002 in Thurso heard that the Dunbar Accident and Emergency (A&E) Department would re-open on 1st February 2003, using the model described in this notice.

The event was hosted by the Caithness Local Healthcare Co-operative (CLHCC) as part of Highland Primary Care NHS Trust and was attended by approximately 40 people. The meeting was intended to bring people up to date on the work which has been done locally by the CLHCC and the Trust (of which it is a part) to re-instate the service.

Dr Johnston (Clinical Lead) and staff of the CLHCC outlined what services had been provided at the Dunbar A&E Department before its temporary transfer to Caithness General in Wick. They also explained the local proposal for a phased re-introduction of the service. This would mean that:

1st February 2003

Re-open the A&E Department - staffed by Nurses who would operate under agreed protocols and procedures. They would be able to dispense a limited number of drugs under Patient Group Directives. Medical advice will be available to the nurses, via the telephone or through video links to Caithness General, GP Practices, or Raigmore Hospital. This will enable a total of 60%, of the people that previously would have received treatment from GPs at the hospital, to be treated locally. They would also be able to undertake basic first aid.

1st April 2003

Minor Injuries Training for the nurses at the Dunbar Hospital will be completed. This will allow an increase to a total of 70%, of the people that previously would have received treatment from GPs at the hospital, of people to be treated locally.


Nurse Prescribing training will be completed for nurses at Dunbar Hospital. This will enable a total of 75%, of the people that previously would have received treatment from GPs at the hospital, to be treated locally.

We already have the resources (staff and money) to make sure the above happens. We are confident that this will be a safe and high quality service. The remaining 25% of patients will need the availability of a doctor. The CLHCC and the Trust are working with local GPs on ways of ensuring that this is available. This has so far been unsuccessful and we are looking at other options.

A workshop held on 1st and 2nd November at Dale House suggested that an additional three doctors would be required. This would require extra funding of around £300,000 per year which the Trust and CLHCC does not have. We therefore have the choice of reducing another service in the area to pay for it or requesting additional funding from NHS Highland. We will be exploring these options at the same time as putting in place the arrangements listed above, which will enable the A&E Department to open with a limited service.

At the meeting on 16th November, a number of concerns were raised. Some people felt that the doctor led unit could have been introduced using locums and it should have been done in May. There were two main reasons why this did not happen. First of all, the main priority was to persuade everyone to return to the previous arrangements. This is still hoped for, but now seems unlikely. The second reason was on the basis of affordability. Locum doctors are very expensive (approximately £10,000 per week) and it would not have been possible to find this additional funding. Even then, there was no guarantee that we would have been able to get the doctors, as there is a national shortage.

At the meeting, there was also concern that people did not understand why some GPs withdrew, leading to the service being transferred. The key factor was that, previously, a nurse could give certain kinds of drugs (paracetamol etc) to patients on the basis of a phone call from a doctor. The national rules changed and they were no longer allowed to do this. This meant that the GP had to physically attend the A&E Department to authorise the giving of the drugs. One practice felt that they could no longer continue on this basis and withdrew from the service, as is their right. Without sufficient medical support and advice, it was felt the A&E Department service as it operated at the time was no longer safe for patients and it was decided that it would transfer to Caithness General Hospital until alternative arrangements were in place.

There was also a general suspicion that the Trust wants the Unit to stay closed. This is not the case. The Trust and CLHCC have been working hard behind the scenes to re-instate the service. If agreement could have been reached over medical cover at any time over the past few months, the service would have been re-instated immediately.

We hope that this is helpful. The Trust Chief Executive, Paul Martin, as well as the Trustís Medical Director, Dr Ken Proctor, will be at the public meeting on Friday 22 November 2002. They will be happy to answer any questions about the situation. They will be accompanied by Dr Iain Johnston (Clinical Lead of the CLHCC) and Alison Phimister (Manager of CLHCC).



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 1st and 2nd 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 16th 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.


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