Orkney Network of Care

So how do you provide a modern primary and secondary care service to a population of 20,000 when it is spread over 17 islands?  Here is the NHS Orkney solution!

Orkney is an archipelago composed of a large central island (the Orkney mainland) and approximately 70 surrounding smaller islands, 17 of which are inhabited. The total population of Orkney is around 20,000 of which 3,300 live on islands without land access to Kirkwall. The Balfour Hospital is situated in Kirkwall, which is the main centre of population. Providing efficient and effective medical services to these island communities is a challenge faced by NHS Orkney.

In 2010 NHS Orkney had the opportunity to re-design the way primary care services are provided to the outer isles. The Isles Network of Care is the result of this work and has been created to achieve the following criteria:

• Be clinically safe with a strong clinical governance structure that avoids clinicians working in isolation.
• Provide continuity of care to the individual island communities.
• Be a model that can be recruited to and sustained.
• Provide the communities with the opportunity for input into the way their services are delivered.
• Provide efficient and effective use of clinical time.
• Be affordable within the budget of Orkney Health and Care.

The network of care includes General Practitioners on the isles of Westray, Stronsay, Sanday Rousay and Hoy and Nurse Practitioners on Papay Westray, Eday, North Ronaldsay and Flotta.

Individual practitioners are appointed to island practices to be the principle providers of care to each community. When on leave they are backfilled by another practitioner, including Rural Fellows, employed by NHS Orkney. In order to provide continuity of care the aspiration is that the same individual will provide cover to the same island for most of the time.

The provision of emergency care on the isles is an issue of great concern to both the islanders and their practitioners. NHS Orkney has an ongoing training programme for both isles practitioners and the staff of the Balfour Hospital to equip them with the knowledge and skills to manage cardiac arrest, trauma and the acutely unwell adult and child. A joint training programme, standardised equipment and effective communication helps allow the team at the Balfour Hospital to support isles practitioners during an emergency. In addition, isles practitioners are given the opportunity to periodically work in the Balfour Hospital to maintain their acute care skills. Placements within larger mainland practices are also available to help maintain primary care competencies and to develop strong working relationships with their colleagues in General Practice.

Videoconferencing is central to the network, 

providing clinical governance and peer support for practitioners. Weekly videoconference meetings take place between the isles practitioners and Kirkwall, alternating between clinical and administrative sessions. They provide a structure for case based discussion, significant event analysis and risk management. Dissemination of best practice throughout the network helps ensure that clinical practice, administration and the use of Vision (the primary care electronic patient record) develop synchronously to provide a unified way of working across the network. This facilitates easy access to data for joint clinical audit, QOF and research.