It’s only water, but it makes a difference

NHSaaaI work as an Associate Nurse Director for advanced practice within NHS Ayrshire and Arran. As far as I’m aware, it’s the only post of this type within NHS Scotland (if someone out there knows different, I’d be delighted to hear from you).

Advanced practice is “big business” in our healthboard.  Service change, reduction in medical staff, quality drives have all influenced the development of advanced practice posts across the whole continuum of care.  Advanced Nurse Practitioners now work in areas as diverse as Hospital at Night in Mental Health, Community Wards, Out of Hours primary care, Paediatrics, Neonates and acute hospital work.Cumbrae

One of the most exciting, and challenging projects my team and I have been tasked with has been the development of an advanced practice model that would be able to safely manage the care of the people of the Isle of Cumbrae, in the out of hours period.

For those of you who don’t know Cumbrae, it is a small island just off the coast of Largs. You may have cycled round it- hiring a bike and peddling around Millport (the town on Cumbrae) is a well recognised “thing to do”.


A short stretch of water

MV Isle of CumbraeThe ferry trip from Largs is a short, usually pleasant (though it is Scotland!) journey. A short stretch of water. But an incredibly significant one, when it comes to health care delivery.

Until relatively recently, health care on the island has been led by GP cover 24hours a day, seven days a week.  The Scottish Ambulance Service has a strong presence on the island, and the island has a small community hospital , with a functional A&E. GP cover changed.

SASA model was proposed that GP cover would continue 0800—2000, Monday to Friday, with Advanced Nurse Practitioners covering out of hours and weekends. Seems reasonable? The short stretch of water meant that the ability to transfer patients off the island would be extremely difficult out of hours, with the Emergency Medical Retrieval Service (EMRS) being required to helicopter acutely unwell patients off the island, if required.

Maintaining skills

The skills the Advanced Nurse Practitioners (ANP) would require would have to be extensive, from managing a patient with a sore throat, to dealing with a patient with a life threatening haemorrhage, or an acutely unwell child.  And if the ANPs were appropriately trained in these skills, how could we maintain their skills? On a small island, the frequency of acutely unwell patients are rare, yet the ability of the ANP to manage them should equal the abilities of an ANP in an acute hospital, without the medical support available within the acute setting.

Cumbrae discussionsAfter MUCH debate and review, we’ve developed a model with a small cohort of highly trained ANPs, who spend part of their time on the island, with part of their time in the acute. This allows enough exposure to the specific needs of the island and the maintenance of the core skills required to keep the environment safe.

This model, of a hybrid GP and ANP model has now been working effectively for over 6 months. The ANPs have risen to the challenge, and developed relationships with the people of Cumbrae, the GP on the island, Scottish Ambulance Service personnel and the nursing staff in the hospital. Its a model that works, and it’s a model we can replicate.

Any takers?

This week’s blog was by @docherty_e (Eddie Docherty), Associate Nurse Director, Advanced Practice, NHS Ayrshire & Arran and Lead Nurse (Interim), East Ayrshire Health & Social Care Partnership.