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Extra psychiatrist could save money and improve service

NHS Shetland chairman Gary Robinson

NHS Shetland is to recruit another consultant psychiatrist to bolster the in-isles mental health team.

The NHS board decided on Tuesday to advertise for another consultant in a move that should cut locum costs by at least two-thirds and provide better patient care as well as easing staffing pressures.

But board members heard that recruitment was not a foregone conclusion as a recent drive to recruit GPs was met with limited success – no-one applied for the doctor job in Walls which will be re-advertised along with a part-time GP post in Brae.

The board heard that adding another consultant psychiatrist would bring the consultant roster up to three, plus a specialist mental health doctor who acts under the consultants’ supervision.

It should also greatly reduce the cost of providing locum cover, which was identified as £625,000 for a full year. The cost of a psychiatric consultant is put at £166,000.

Shetland health board non-executive member Marjorie Williamson described the recruitment decision as a “no-brainer”.

The board heard that advertising for the post could go ahead in November and that the extra psychiatrist could be in place by the new financial year.

Chairman Gary Robinson, who helmed his first meeting after he took over from Ian Kinniburgh, said that recruiting was a short-term cost to make a long-term saving.

He said: “Given the amount we spend every year on locums in total, a lot of the projected overspend is caused by this.

“There’s a question around how long we persevere with this.”

A shortage of doctors and specialists throughout the UK, particularly in the psychiatric field, was hampering recruitment in the isles.

He said that the NHS had to adopt new ways of doing things and the feedback he had received on the use of Skype to communicate with specialists on the mainland was very positive. Continued poor broadband coverage was the main obstacle to extending this service.

Robinson urged the board to press on with service redesign as urgently as possible. The former Shetland Islands Council leader said that his experience with the council was that changes effected now might take years to become evident in savings.

The board considered a report that says there is “continuing fragility” within the psychiatric team and the demand on psychiatrists “very high for a small population”. All out of hours work had been undertaken by the locum, and “this is not sustainable”.

Discussions with the other island groups are aimed at producing a standardised response to mental health treatment – at the moment Orkney does not admit any psychiatric patients and all are treated at Cornhill in Aberdeen.

The well-publicised “fragility” of this hospital was also contributing to the fragility of the service in Shetland, though it was not expected this would affect dementia patients.

Director of community health and social care Simon Bokor-Ingram said after that an extra consultant should reduce the need for patients to travel to Cornhill, easing distress for patients and families.

Financial implications of the move would be further considered by the executive management while the split in costing between the integration joint board and the wider NHS Shetland would have to be decided.

The board also revisited the difficulties of recruiting GPs to the isles. Lerwick Health Centre will be fully staffed by the end of August and Scalloway is short of one GP.

A full-time GP at Bixter should be in place by January. Yell faces a 35 week gap in having a GP while Unst faces a 25 week gap. Advertising will go ahead again for Walls and Brae, following an unsuccessful recruitment drive.