The number of minor injury and illness units in Angus could reduce from four to two next year because of staff shortages.
Minor injury and illness units (MIIU) currently operate in Arbroath, Forfar, Brechin and Montrose.
Angus Health and Social Care Partnership will bring options to the Integrated Joint Board in January over which centres will close.
An update report to the board highlighted ongoing recruitment issues and an ageing staff group. Training a nurse to work at a unit takes six years.
The report added there is “both professional and public confusion” over the purpose of MIIUs, with many people attending “inappropriately” with issues that should have been presented in a different environment or to a different healthcare professional.
It said in the short-term the clinical areas served by the MIIUs might have to be “consolidated”.
Jillian Galloway, head of primary care development, confirmed this would likely mean an option being brought forward to reduce from four to two centres next year.
However, these would be developed into community hubs, which would offer a wider range of services covering the out of hours period.
Under plans being developed, the Angus Out of Hours GP would be supported by a multi-professional team including nurses, drivers and social care officers to respond to urgent primary care needs.
She said: “What we have at the moment we know isn’t sustainable in the long term.
“There have been and continue to be recruitment challenges to get the nursing staff to the units.
“In the short term option is to look at having two community hubs and in the longer term having more locality-based ones in four areas.
“The hubs will offer some planned care services to support GP practices – for example wound reviews, dressings and blood tests.
“They could give a bit of flexibility to people who work full time to get a test done after work without having to go during GP practice hours.”
No decision has been made over which minor injury and illness units will be closed. Options will be brought to the integrated joint board to make a decision in January.
The future of the minor injury and illness units is being assessed along with several other reviews – including the number of hospital beds in the county, out of hours care and care home provision – as a new Angus model of care is developed.
North East MSP Liam Kerr said: “The public will rightly be concerned at the prospect of any closures but will be reassured to some extent that the Integrated Joint Board seems to have been active in planning for the future.
“In the context of an ageing workforce, the IJB is right to undertake rigorous and detailed planning.”
Reduction in Angus hospital beds defended
A stakeholder member of the Angus Health and Social Care Partnership has defended plans to reduce the number of hospital beds in Angus, stating the move is the “right thing for the future”.
Clinical director Dr Alison Clement said staffing challenges, low occupancy rates and financial pressures, as well as more support being delivered to people at home, means resources should be directed elsewhere.
The Courier revealed last month that the Partnership was reviewing wards that offer inpatient services at Arbroath Infirmary, Montrose Infirmary, Stracathro Hospital and Whitehills in Forfar as well as Brechin Infirmary, which has been non-operational for the past two years.
An audit of occupancy levels showed that a third of the 116 available beds were empty and that this was “typical”.
Dr Clement, who is also a Monifieth GP, said the success of the enhanced community support care model in Angus, meant that hospital admissions in the county were among the lowest in Scotland.
She said: “We are not admitting people to community hospitals so much and we are managing them at home.
“Community hospitals were built at a time where there wasn’t the infrastructure, the transport links, the telemedicine, community alarms – people weren’t safe at home.
“Now we do everything we can to support people being in their homes for as long as possible.”
A new Angus model of care is being developed, with minor injury and illness units, out of hours and care homes provision also being reviewed.
A series of options will be brought forward to the Integrated Joint Board to make a decision in January.
Dr Clement said that feedback from the public and members of staff at engagement events had been positive.
She added: “We have made a commitment that beds will reduce. We’ve done our initial engagement. We’ve got the opinions of people which are helpful.
“The options in January will reduce beds and it will be on the background of our concerns about workforce and the physical state of the buildings and financial challenges.
“We need to think about the right thing for the future.
“It will involve some people having to travel to get the specialist care they need when they are most unwell but that will be balanced with more being available in the community which is better tailored to meet the individual’s needs.”