AMG’s Provision of Island Medical Care

Arran Medical Group has evolved quickly over the last few years to become a merged model of GP service, as well as provision of extended services to our rural/remote island community.

The Group currently consists of:

The Group serves a resident population of over 5000 residents, and up to 20,000 visitors during the holiday season. So whilst our medical staffing may seem slightly generous for its population, that’s because we provide a number of other services as well as core primary care, as well as catering for a geographically sparse population.

Our medical services include:

  • core primary care: from childhood vaccinations to chronic disease management, across 3 surgeries and 2 branch surgeries
    • minor surgery
    • travel clinics
    • well woman clinics, including coils, implanons and other family planning
    • sexual health service
    • homeopathy clinic
    • young person’s drop-in service
  • 24/7 medical cover to Arran War Memorial Hospital
    • inpatient care, such as daily ward rounds and acute admissions
    • Out-of-hours A&E and NHS24 cover
    • fracture and A&E review clinic

You can find out more about our range of primary care services here.

Geography

The Isle of Arran is located just 14 miles off the west coast of Scotland, close to Glasgow but further south than the central commuter belt and therefore the most accessible of the Scottish islands.

Its easy accessibility makes it very popular with UK tourists as well as international visitors who often use the island as a gateway to the Hebrides.

The island itself is made up of 200 square miles of granite, with dense woodland, sandy beaches, arable farming and, in the north, some substantial mountains and ridges. Most villages are dispersed around the coastline, with Shiskine being the only one in-land, just 3 miles from the coast, on the “String road” which cuts across the island.  You can view a map of our surgeries here.

Arran War Memorial Hospital

awmh

Arran War Memorial Hospital

AWMH provides 17 beds, including a High Dependency Unit. Admissions cover a full spectrum from emergency treatment to rehabilitative medicine, and most nursing staff have completed ALS training. There is also a maternity unit (run by 2 midwives) where there are around ten deliveries each year.  The hospital assesses a reasonable number of paediatric cases, and manages initial presentations such as pneumonia, cholecystitis, AF and psychiatric crises in adults. Patients are often transferred back to the hospital for ‘step-down care’, for example after hip surgery. The hospital can also provide some forms of chemotherapy, blood transfusion and all palliative care, unless this can be achieved at home.

AWMH is also the base for our community teams (midwifery, mental health, child health, community nursing), as well as physiotherapy. There is 24-7 X-ray cover, and this includes emergency care and clinics such as orthopaedics.

There are facilities to run clinics from a number of visiting consultants from various specialties.  We are keen to use these clinics as much as possible, not least as a mainland clinic involves a whole day trip including travel. Currently there are visiting consultants from orthopaedics, urology, paediatrics, ophthalmology and  psychiatry (adult and elderly).

Helmied 5

Helimed 5

We enjoy good links with the Emergency Medical Retrieval Service. Based in Glasgow, they provide a helicopter response to us when necessary, either to the scene of an accident or, more commonly, when transferring particularly unwell patients to mainland HDU, cardiac or ITU units. Whilst Arran GPs and nursing staff are able to stabilise most emergency presentations, ongoing care is often required in more specialist facilities, and getting patients safely to these centres is a tricky process. Our link consultant with EMRS is Drew Inglis, and having this level of liaison has been highly beneficial.

Where the skills of EMRS are not required, patients are transferred by the paramedic ambulance helicopter or by the ferry. One of the most challenging parts of the work on Arran is deciding when and how patients should be transferred, and we have some continuing work to audit and improve this particular aspect. Whether we need the assistance of the ambulance helicopter, Coastguard Search & Rescue helicopter, or even on occasion, the lifeboat, it’s a decision process that seems very daunting at first. However, we find that good support and discussion with more experienced colleagues (both on Arran and mainland centres) is extremely helpful at the time. We also enjoy good links with our Crosshouse colleagues – including A&E – for these types of discussion.

How does Arran Medical Group integrate with these services?

AMG provides 24/7 medical cover to the island.

AMG provides 24/7 medical cover to the island.

We enjoy close links with all the above, not least as we have regular face-to-face contact with all our local and visiting colleagues.

During normal working hours, one GP provides medical cover to the hospital. We refer to this as ‘Doctor of the Day’! They conduct a daily ward round, attend to emergencies and are normally the first port of call for any requests for prehospital care. They will often need to continue aspects of their primary care role too, so it can make for a busy, but stimulating day, and we encourage trainees and students to gain experience of this less common aspect of general practice.

Out of hours (evenings, overnight, and weekends) we have an on-call system whereby one GP is available at any one time. This role includes:

  • NHS 24 calls, including those requiring telephone advice, attention at the hospital or a home visit
  • Emergency presentations to the hospital A&E unit
  • Ongoing care of inpatients, including HDU facility
  • Our role as deputy police surgeon e.g. Fitness to detain assessment, venepuncture, confirmation of death
  • BASICS prehospital care, assisting our ambulance colleagues when necessary

As a result, workload can vary from very little to a great deal, and again support is available from more experienced colleagues.