As a GP in community practice, we have never been busier or experienced higher patient demand and I receive emails almost weekly advising of bed-number crises and asking for avoidance of hospital admission if at all possible.
I have been a GP partner at North Berwick Health Centre in East Lothian for the past 25 years. During that time, I have been part of the team of local doctors that ran the Edington Cottage Hospital, a productive local facility consisting of nine inpatient beds and a 24-hour minor injuries unit staffed by a team of dedicated and experienced nurses.
For over 100 years, this hospital has played a crucial role in local healthcare in North Berwick and its surrounding towns and villages, and until three months ago, it was a mainstay of local patient care and allowed us to manage patients close to home, without the need for central admission to an already stretched hospital sector.
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In September this year, the hospital was closed with only ten days’ notice and, one month earlier, St Michael’s Community Hospital in Linlithgow was dealt a similar blow.
The health board stated in both cases that the closures were temporary and occurred as a result of a nursing staff shortage across the whole region albeit, despite the many challenges of Covid, our unit had remained at full nursing staff capacity.
Our nurses have been redeployed to other hospitals in the area where there remain more pronounced staff shortages, a decision which has led at least one of our experienced nurses to leave the NHS.
The loss of this facility has had a severe impact on our practice and the wider community. With a small but well-run unit, we have always done our utmost to offer palliative and end-of-life care to our patients close to home with easy access for families.
Every inpatient had a designated GP and we ran a voluntary rota for weekend cover, so that patients and their families were reassured that there would be continuity of care especially in the final days of life.
We also offered step-down care for patients from the central hospitals not yet fit for discharge to home and general medical admissions for our elderly population. East Lothian is the second fastest-growing region in Scotland and our population also swells through tourism in peak season. The minor injuries unit ran 24/7 and treated approximately 2,000 patients a year from all over East Lothian, as well as visitors to the area.
All of this alleviated pressure on central A&E services and also freed up acute beds in Edinburgh for patients requiring more complex care, while supplying vital care to the local population when a journey to Edinburgh could have been stressful or unnecessary.
Clearly the very pressing nursing and medical staff shortage has to be addressed, but it feels entirely counterproductive to close community minor injury and palliative care services, with the resulting knock-on effect on central inpatient and emergency services, the loss of a more personalised local service and an associated high staff turnover.
The principles of integration laid out in the Public Bodies (Joint Working) (Scotland) Act 2014 promote the community-based delivery of care to better people’s lives. If this is to be believed, small local facilities must surely be seen as part of the solution to the current unprecedented pressures and not part of the problem.
I hope that NHS Lothian will be able to see the bigger picture, and prevent the Edington and St Michael’s from becoming further casualties of the pandemic.
Dr Claire Doldon is a GP partner and palliative care lead at North Berwick Health Centre