On Monday 1st June 2015 Lochgilphead Medical Practice formally took over the management
of Inveraray and Furnace Medical Practice.

Practice Nurses

Practice nurses are qualified to deal with many ailments and you may be seen more quickly than if
you need to see a doctor. You can book appointments to see the nurse.

Last year, Dr. Sara Bradley of Highlands and Islands University undertook an in depth study into the provision of healthcare in our area and looked at the transfer of Furnace & Inveraray Surgeries from NHS Highland to Lochgilphead GP Practice. She has just published her findings, which are set down below.


This update is being sent out to all Being Here evaluation participants in mid-Argyll.  It outlines the findings following the first round of fieldwork in 2015 and concludes with a brief SWOT analysis covering all the pilot areas in the Being Here programme.

Evaluation fieldwork summary 
In September 2015 the UHI research team conducted interviews with health and social care professionals, third sector workers and community residents.  Three community groups were also visited.  A fieldwork summary was presented to the Being Here programme manager in October 2015
and a detailed report given in January 2016.

 Being Here project activities 
In mid-Argyll one GP practice runs the out-of-hours service, the community hospital in-patient service and A&E in Lochgilphead.  The GPs require additional skills to carry out these roles.  To date two separate week-long GP training courses have been delivered in Lochgilphead and have been designed specifically to maintain the skills of doctors working in non-bypass community hospitals.  In 2015 four new GPs were recruited for the Lochgilphead practice.  The Lochgilphead practice was awarded the contract to provide GP services for Furnace and Inveraray with the merger taking effect from 1 June 2015.  Emergency and out-of-hours are now provided from Lochgilphead with support from Emergency Nurse Practitioners based in the hospital and the community nursing team on duty until 20.30 daily.

Evaluation findings 

Practice merger
Dissatisfaction was expressed by patients with the take-over of the Inveraray and Furnace practices by Lochgilphead due to a perceived lack of communication and reduced continuity of care.  Generally, patients believed that two regular doctors would be assigned to the surgeries on a rotational basis, but this did not appear to have happened according to residents.  The quality of care was generally not an issue with the majority being satisfied with the safety and standard of the service.  Lack of communication, difficulty accessing appointments and lack of continuity were the most commonly
reported problems.  In Furnace several interviewees thought the quality of care had improved and reported being referred to secondary care more often than previously.  However, patients generally would have liked the new GPs to come to the community to introduce themselves.  Members of the
Furnace community had also understood from previous consultation meetings that the practice takeover would be a six month trial.

Practice model
Attitudes were mixed towards the team based practice structure in areas where it was new.  The importance of having a personal relationship with a GP was often stressed.  On the whole interviewees in other areas already registered with the Lochgilphead practice were happy with the quality of care and
the team-based model.  Generally, they thought if you were really ill, you would see any of the GPs who were all seen as highly qualified.  These patients tended to value choice and having access to a second opinion.  However, they thought if you had a long term condition, it was preferable to see the same GP to maintain continuity of care.  On the whole people were happy to see other staff if appropriate and thought being screened by a nurse could free up a doctor.  However, dissatisfaction and frustration were expressed with the appointment system in Lochgilphead.  Interviewees reported difficulties getting appointments and having to book an appointment on the day rather than being able to arrange one in advance.  Generally, people were satisfied with telephone consultations.

Although there was some awareness of the difficulty recruiting GPs, community members did not necessarily understand the reasons.  Recruitment issues were also reported by professionals in other fields including Occupational Therapy and mental health across Argyll & Bute.  Gaps in small teams were believed by professionals to have a more significant impact than in more centralised areas with greater flexibility and coverage.  Lochgilphead’s recent success in recruiting GPs was attributed to various factors by different professional interviewees as outlined below:

• Finding GPs who like the challenge of having the additional A&E work
• Having relatively new hospital facilities
• Team approach whereby the burden is shared and does not fall on one individual
• Relatively young team who may be able to stay together for some time.
• Rural Fellowship scheme
• Dedicated GP training available locally.

Most interviewees thought services were sustainable depending on future resource allocation and recruitment.

Standard and breadth of care 
On the whole people thought the service was safe and of an acceptable standard as long as it was fully staffed.  The range of care was generally satisfactory and the new chemotherapy service at the Lochgilphead hospital was welcomed.  Some interviewees believed that fewer services can be offered in a rural community and did not think people’s expectations were the same as if they had been living in an urban area.

Multi-disciplinary team (MDT)
Professionals interviewed were generally very happy about team working with the lack of compatible IT systems within the health and social work sectors being the only common issue reported.  Effective MDT working was seen as helping to relieve professional isolation.  A few professionals had to do training in their own time but on the whole there were few problems with access to training or work-life balance.

Community involvement and communication
In Lochgilphead some community interviewees did not feel there was much public consultation.  Others thought there had been consultation but it had not necessarily made any difference.  They felt they were being informed about developments rather than being involved in decision-making.  People found it frustrating that a public event is labelled as ‘consultation’ when they feel the decisions have already been made by NHS management.  Some thought community members were reluctant to get involved unless there is a major change with a few criticising the lack of publicity for meetings and events.  The Lochgilphead Patient Participation Group was no longer meeting and it was reported there had been little interest in starting a Public Partnership Forum.  Lack of communication with the third sector over service provision was also seen as a problem in Lochgilphead.

Out-of-hours and emergency care
Generally, people were happy with the emergency response.  A second Emergency Nurse Practitioner had been employed in Lochgilphead to support A & E and out-of-hours services.  Some frustration was expressed with NHS24 because of long waiting times for calls to be returned, the repetition of questions and call handlers not knowing the local geography.  The designation of local hospitals had also caused confusion.  The local ‘A & E’ department does not have a consultant or registrar on call and therefore is often referred to as a minor injuries unit with the nearest A & E at Oban which is about one hours drive away.  Interviewees often reported phoning or visiting the local hospital if possible rather than using NHS24.  Transport arrangements for out-of-hours services caused confusion in Furnace and Inveraray which are now covered by the Lochgilphead practice.  Residents were not sure if the GP would do a home visit and concerns were expressed about the lack of public transport.  Some were aware that they could travel by taxi, but were unsure what to do and whether they had to call the taxi themselves.

Community resilience 
On the whole participants did not see an impact on community resilience.  At the time of interview Ardfearn had the only First Responder Scheme in the area.  Villages had been asked to produce emergency plans.  As part of their plan Furnace obtained a defibrillator and asked the Red Cross to run
some first aid training sessions for the community.

Community responsibility
Although in general interviewees felt individuals should take more responsibility for their health, they did not necessarily have a clear idea of what the community would be able to do.  A diabetes patient support group was started by a member of the public.

Generally, people were positive about the potential for extending telehealthcare and patient consultation via Video Conferencing (VC) facilities, particularly if it avoided the stress of travelling long distances for short hospital appointments.  However, interviewees also reported poor internet and
mobile coverage in certain areas.

Hospital services
Although services were viewed for the most part as of good quality, there were concerns about ward closures at the Mid- Argyll hospital.  The lack of local care home places and hospital beds for the increasing older population was highlighted.  Mental health services were a concern for many
interviewees with the replacement of the Argyll & Bute mental health hospital reportedly on hold and patients due to be transferred into the mid-Argyll.  A lack of Community Psychiatric Nurses (CPN) was also reported.

Home care
A significant capacity issue was identified across Argyll & Bute but particularly in mid-Argyll.  Care packages were reported as being delayed by the inability of A & B home carers to give medication due to a lack of training.  Staff recruitment was one of the biggest areas of concern.  Suggestions for
improvement included guaranteed hours, unified training across providers and increasing the flexibility of workforce with greater co-operation with community nursing.  Preventative work with home care users was viewed as desirable to build sustainability but the service was seen as lacking the capacity to make this possible.  The public perception of home care as a low status occupation was seen as a fundamental problem for recruitment.  It was suggested that because home care was becoming more specialised and skilled, it should be promoted as a rewarding and positive role requiring qualifications and with potential for career progression.

In summary mid-Argyll interviewees were generally very satisfied with the quality, safety and breadth of services.  However, there was dissatisfaction expressed in Furnace and Inveraray with the take-over of the practices, which was widely believed to have been handled poorly and criticised for a perceived lack of communication and lack of consistency of GPs.  Travelling to Lochgilphead out-of-hours from Furnace
and Inveraray was also a concern for patients.  Dissatisfaction was expressed generally with the appointment system and the difficulty getting appointments in the Lochgilphead practice.  Other areas of concern included the recruitment and retention of home care staff, lack of care places for frail older people, lack of CPNs and uncertainty over the future of the old mid-Argyll hospital.

Next steps
Evaluation findings have been reported back to NHS management.  The second round of fieldwork in Kintyre is due to take place in September/October 2016.

The Being Here project takes an action research approach.  This means that as project activities take place, they are monitored and assessed by researchers.  The researchers’ findings are fed back to the project’s operational team.  The findings are used to develop ongoing project activities and to respond to the needs of health and care staff and local communities.

If you would like further information about the research and evaluation work, please contact Dr SarahAnne Munoz, Senior Research Fellow at the
University of the Highlands and Islands, UHI Rural Health and Wellbeing, Centre  for Health Science, Old Perth Road, Inverness, IV2 3JH.

E-Mail: sarah-anne.munoz@uhi.ac.uk

Tel: +44 (0) 1463 279 000.

Being Here Programme SWOT Analysis 1  

A SWOT analysis is a study undertaken to identify a programme’s internal Strengths and Weaknesses, as well as its external Opportunities and Threats.