Realising Realistic Medicine: Chief Medical Officer for Scotland annual report 2015-2016 appendix

NHS Western Isles

Initial thoughts

NHS Western Isles has embraced Realistic Medicine in a variety of different healthcare areas and believes that the patient experience and journey should be at the heart of any new programmes.

What have we done so far?

A Patient Centred Care Pathways Programme has been established with the remit to explore individual pathways to improve efficiency and effectiveness of care. These include the Do It Referral Pathways, Patient Travel and Video Conferencing, Anticipatory Care Pathways, Self-Management and Pro-active Specialist Care.

A biologics reduction programme is already underway whereby patients on biologics are evaluated as to their suitability for dose reduction. Biosimilars have been adopted in full for new patients, once remaining stock is used up.

Anticipatory Care Planning ( ACP) has been identified as an important area. A sharper focus on ACPs is looking to maintain the patient at home where safe and appropriate, and ensure that healthcare is in line with a previously agreed, patient centred, plan.

In another priority area, Ophthalmology, NHS Western Isles has trained a specialist nurse for intra-vitreal injections, thereby releasing consultant time to perform cataracts. This is the latest in a series of moves to enhance the nursing role and reduce the pressure on medical consultants to enable them to address the more complex needs of patients.

What next?

Incremental changes to the Patient Centred Care Pathways Programme will be delivered on a pathway by pathway basis. The programme aims to change the way people receive care so that the benefits are long term and transferable to other pathways.

In the area of Varicose Vein treatment, we are currently working with NHS Highland in reviewing the number of patients referred for varicose vein treatment. All patients currently travel to Raigmore for treatment, often twice. Indications are that at least 50% of those patients could be more for cosmetic treatment than for the relief of symptoms. NHS Highland is reviewing the referral guidelines and it is expected to reduce the number treated by 50-70%. NHS Western Isles is likely to adopt the guidelines set out by NHS Highland.

The ACP work will in future focus on early supported discharge to minimise the time people need to spend out of familiar home circumstances. Length of stay has been identified as an area where NHS Western Isles is an outlier, particularly in relation to pre-operative stays. We are working to develop alternatives to pre-operative stay where there is no medical indication for early admission.

Final thoughts

NHS Western Isles has adopted the principles of Realistic Medicine and is actively working towards translating them into everyday clinical practice.