Stretched to the limit

Throughout virtually the whole of the United Kingdom the National Health Service is being stretched to the limit, and the NHS on the Isle of Wight is no different. A shortage of nursing and medical staff, including GPs; an ageing population and unhealthy lifestyles among residents is combining to heap enormous pressure on all parts of the Health Service. And with budget cuts being threatened it seems the situation can only get worse before it starts to improve!

I met Helen Shields, Chief Officer of the Isle of Wight Clinical Commissioning Group (CCG), and Caroline Morris, Head of Primary Care, to try to discover what is causing the intense pressures in the NHS, and what steps need to be taken to try to ease the situation.

They explained: “The Isle of Wight Clinical Commissioning Group (CCG) was founded in April 2013 and is a membership organisation made up of all the Island’s GP practices and is the system leader for the local NHS. The CCG is clinically led and is responsible for developing the health strategy for the Island NHS as well as the planning, buying and monitoring of services. The CCG has funding of £200m to purchase healthcare services for island residents.

“We buy a significant number of services from the Isle of Wight NHS Trust, however we also buy services from mainland providers such as Southampton, Portsmouth and London. We also have contracts in place that pay for care in nursing homes, the Earl Mountbatten Hospice, physiotherapists, as well as services provided by GPs and pharmacists. We hold over 200 contracts and are responsible for ensuring that we get good value for money and high quality care.”

Helen Shields continued: “We have to make the decision where the money goes. Yes, we do have to juggle, and this is getting more difficult as we are now facing a period of very low/no growth. The new formula which determines how much money the Island should get to pay for NHS services puts us in the very difficult position of being £35million over target. In other words, the Island is getting £35million more than the Department of Health thinks we need. That provides a huge challenge; if we were to lose £35million, even over a series of years, a lot of difficult decisions would have to be made.”

One of the major concerns on the Island today is the difficulty in attracting medical staff, particularly GPs. Helen said: “There is a recruitment issue on the Island in both primary and secondary Care. The hospital struggles to fill some medical posts, and therefore has to use expensive agency staff. They also have difficulty in recruiting nursing posts, and are soon to undertake an overseas campaign. Similarly in primary care there is a shortage of around 10 per cent of GPs and when you look at profiles of GPs on the Island, 20 per cent are over 55 years of age, nearing retirement.”

Caroline Morris said: “We have 17 GP practices (17 different businesses) on the Island and in the past GPs would routinely buy into a practice when they started. But practices are struggling to get GPs to buy into the partnerships these days. Many younger doctors don’t want to take out a big mortgage to buy into the premises, the business and everything that goes with it and are wanting careers with much more variety in them.

“We are also struggling to recruit GP trainees to come to the Island. When GPs retire, they can’t sell their share of the partnership onto the next generation, so they are instead employing salaried GPs and more specialist nurses to do the work. The Freshwater practice was a good example where recruitment difficulties brought the practice near to collapse as it struggled to meet the needs of their patients as they hadn’t the GPs required to deliver the services.”

It also appears the days when you went to see YOUR doctor for every health problem are going. Now you will see someone in YOUR practice, with Helen explaining: “You no longer register with a specific GP; you register with the practice, and a lot of GPs work part-time. In primary care we will see more team working, with the GP still in charge, but of a much bigger team doing work under his or her control.

Caroline added: “For the future we need to reassure patients that if you don’t happen to see a specific GP, then don’t worry, the GP is still in control of your care. When you go to your practice you will see someone highly qualified and capable of looking after you, but it may not be a particular doctor anymore.”

Helen pointed out: “The NHS on the Island is stretched, and so are lots of other areas in the country. A document recently produced by the NHS, called the ‘Five Year Forward View’, says there are some key things that need to be done.

Helen Shields

“Prevention is one, because the health of the public is leading to an increase in demand. We are seeing an increase in obesity that leads to all sorts of other conditions like diabetes, which puts significant pressures on the NHS. We need to make sure those preventative areas are addressed. In many places smoking has become socially unacceptable, but obesity and drinking hasn’t. Over a lifetime we can make sure people experience less illness by living a healthier life. People are also living longer, with a number of long term conditions and often need more care later in life.

“There is a lot we can and are doing to try to solve some of these problems. We are actively promoting with our partners that the Island is a great place to live and work, because it’s about getting people here in the first place. Once they are here, many of our staff love it and stay. We need to make a career on the Island more attractive to professionals.

Caroline Morris

“We are supporting GP practices to work more closely together in a collaborative –called One Wight Health – to help them support each other to remain viable and make their services as safe and effective as possible. We are working in collaboration with the Isle of Wight NHS Trust, the Isle of Wight Council and a wide range of voluntary and community organisations to deliver an integration programme – My Life a Full Life – which is supporting staff delivering health and social care to work more closely together and improve the experience of people who need services. There is also a focus on self-care and self-management to educate people to take ownership of their own care and reduce the pressure on NHS services.”

Caroline said: “If someone has a long term health condition this needs to be managed every single day. A doctor is there maybe 10 or 15 minutes every now and then, so the doctor cannot take responsibility for everybody’s care – the individual has to be supported to take responsibility for their own care. We also have to work with the public about different ways of accessing health care and giving them the information to choose the right service at the right time so that they are able to navigate the health service much better.

“The Isle of Wight NHS is lobbying nationally for recognition that delivering NHS services on the Island with a relatively small population is more costly than on the mainland and cannot be managed just through ever greater efficiency. We are asking that this is recognised in our financial allocation.”