Proposal for Shapinsay
Primary Care Services
Background / Purpose
NHS Orkney is responsible for providing a wide range of high quality healthcare
services designed to meet the needs of local communities across Orkney.
NHS Orkney recognises that over recent years there has been a lot of uncertainty
about the medical services provided to Shapinsay. We are aware that there have
been a number of false starts and a number of agreements that have not been
delivered on, whilst also recognising the level of mistrust and anxiety this may have
caused.
NHS Orkney wants to move forward from this unsatisfactory situation and to work
constructively with the community of Shapinsay to develop a sustainable and
effective system to provide your community with a first class medical service. This
leaflet is our first step in trying to achieve this.
In this leaflet we have set out a proposal as to how NHS Orkney would like to deliver
your medical services. We would like you to read this and tell us what you think
about the proposal. We will then come to Shapinsay to discuss the issues with the
Community in an open meeting. This meeting has been arranged for Monday 19th
April at 730pm in the Community Club Rooms.
The more feedback we get from you before this meeting the more time it will give us
to consider your comments.
Proposal for Shapinsay
NHS Orkney is proposing to appoint two Nurse Practitioners to Shapinsay, who will
provide 24 hour cover to your community. They will be supported by a visiting
General Practitioner (GP) service from Heilendi Family Medical Practice in Kirkwall.
The Nurse Practitioners will provide regular surgeries and a home visiting service for
those who are unable to attend the surgery. The GP will also provide regular
surgeries and home visits. The frequency of the GP surgeries will depend on the
level of need. The Nurse Practitioners will have daily access to GP advice and
support from Heilendi during the working day and from the NHS Orkney GP Out of
Hours Service and the Balfour Hospital GP Medical Team outside the normal
working day. Shapinsay residents will also be able to use the services of Heilendi
Practice when they are in Kirkwall.
In effect, Shapinsay Surgery would be a branch surgery of Heilendi with the resident
Nurse Practitioners being an extended part of the Heilendi Team. A new Heilendi
GP would be appointed to be the designated Shapinsay GP who would provide the
vast majority of the Shapinsay Surgeries. Another GP would undertake this role
when the Shapinsay GP is on leave. In addition the Heilendi Community Nursing
Team would be available to Shapinsay residents if the workload or specific
requirements of an individual meant that the Nurse Practitioner was unable to
provide all the care required.
NHS Orkney proposes to provide Shapinsay with high quality care delivered by
clearly identified individuals that will provide continuity to the community and is
effectively supported by a larger, dedicated team.
Page 2
What is a Nurse Practitioner and what can they do?
A Nurse Practitioner is a nurse that has undergone extensive further training to
enable them to diagnose and treat illnesses and injuries and prescribe medication.
Nurse Practitioners are trained to undertake different roles in different clinical
settings.
Nurse Practitioners appointed by NHS Orkney to island communities are trained to
manage the following clinical situations:

Emergency care: this includes the initial management of sick children and
adults as well as injuries caused by accidents

The diagnosis and management of common medical conditions

The long term management of chronic illnesses such as heart disease, high
blood pressure, diabetes and asthma

General nursing as well as some more specialised nursing roles
Page 3
If a nurse practitioner can do all these things why do we need
GPs?
Nurse Practitioners are very effective in delivering care in areas for which they have
been specifically trained. Nurse Practitioners are not usually trained to manage
patients with complex, multiple problems. The management of these patients is
appropriately undertaken by GPs. Similarly, GPs refer patients to Hospital
Consultant Specialists when the complexity of the problem is outside their generalist
knowledge.
For example, if a patient had a chest infection then a Nurse Practitioner would be
able to ask about how and when the symptoms developed, examine the patient,
make a diagnosis and treat appropriately. For another patient with a chest infection,
but who was also known to have chronic lung disease and heart failure, the Nurse
Practitioner would be able to listen to the story of how things developed, examine
and make a number of potential diagnoses. However, due to the complexity of the
case, the Nurse Practitioner would recognise that discussion and advice from a GP
would be important to ensure that the correct treatment was undertaken. This might
involve discussing the case by telephone or videoconferencing, but might also
require the GP to see the patient too.
Page 4
Why is NHS Orkney proposing to provide Shapinsay with Nurse
Practitioners and not a Resident GP?
NHS Orkney has a duty to provide appropriate and effective care to the communities
of Orkney. Previously we used to think about care being delivered by different
professional groups, such as doctors, nurses, physiotherapists etc. Over the last few
years things have changed dramatically throughout the NHS, we now tend to think
about what care a patient requires and who has the knowledge and skills to deliver
that care, rather than thinking that the care is for either a doctor or a nurse to deliver.
This change in approach has occurred throughout the NHS but in particular there
has been a lot of research undertaken into how the NHS can deliver more effective
care to Rural and Remote areas.
For doctors and nurses to maintain their knowledge and skills it is necessary for
them to see a sufficient number of cases. By understanding the medical needs of
Shapinsay more clearly and by looking at which professional group can most
effectively deliver these needs, we feel that the model of care described above will
deliver the most appropriate, effective and economical care. The population size,
level of need and closeness of Shapinsay to Kirkwall means that NHS Orkney
believes that the proposed model will deliver a better service to the community than
that provided by a single resident GP.
Page 5
Where else does NHS Orkney use Nurse Practitioners?

Papa Westray has had a resident Nurse Practitioner, with a visiting GP
service from Westray for 23 years.

Flotta had a Nurse Practitioner for 18 months and a visiting GP service from
Stromness for over 5 years. A permanent Nurse Practitioner has been
recently appointed to the island.

Eday completed a 6 month pilot of a Nurse Practitioner with a visiting GP
Service from Stronsay in 2009. The community elected to continue with the
arrangement and a permanent Nurse Practitioner has been recently
appointed to the island.

Heilendi Practice has a Nurse Practitioner working as part of the team. Nurse
Practitioners are also employed within the Acute Receiving Ward at the
Balfour Hospital.
Page 6
Isles Network of Care
NHS Orkney has created the Isles Network of Care to provide support to its isles
practitioners. The concept is to link the individual isles practitioners together to
provide a structure of mutual support as well as linking them directly with the
clinicians on the Orkney mainland. This will include regular videoconferencing and
the practitioners regularly being attached to larger General Practices and additional
training and experience in the Balfour Hospital. This will help ensure that they
remain up to date and are part of an extended team.
NHS Orkney has appointed Nurse Practitioners to Eday and Flotta as well as GPs to
Westray, Sanday and Stronsay as part of this Network. The first of these
practitioners will take up post in April. The proposed Shapinsay team would also be
part of this network. Members of the network are appointed to specific islands in
order to provide stability and ensure that patients are able to see the same
practitioner who will get to know the medical history of individual patients as well as
their own island community.
What Next?
We are sending this leaflet to all households on Shapinsay to get the Communities’
views on the proposal. A Community meeting will be held on Shapinsay on 19th
April at 730pm in the Community Club Rooms, as part of the consultation process.
Page 7
Tell us what you think
We value your feedback and there are a number of ways you can make your views
known:
 Complete and return the attached Freepost form
 Contact the consultation team in writing:
Shapinsay Consultation
c/o Georgie Clark
NHS Orkney
Garden House
New Scapa Road
Kirkwall KW15 1BQ
Email: georgie.clark@nhs.net
 Or you can leave your feedback on our website:
o http://www.ohb.scot.nhs.uk/
If you require this or any other NHS Orkney publication in an
alternative format (large print or computer disk for example)
or in another language, please contact the Clinical Safety and
Quality Department:
Telephone: (01856) 888204 or
email alternativeformats@nhs.net
31st March 2010
Page 8