A spoonful of sugar helps the medicine go down!

ho-dgriSince starting work I have been more aware of the tendency of the media to focus on the negatives. It is almost daily that we hear stories of how the NHS has failed a patient, waiting times are simply unacceptable or that hospitals are not clean enough.

I appreciate that it is this negativity that sells newspapers. There is nothing overly dramatic about the tale of a wonderful NHS experience. The patient came in as planned, the procedure was carried out without complication, they felt better and they went home. Not exactly something which can be spun into a gripping yarn.

While press sensationalism is not something new, it has surprised me that at times we struggle to focus on the positives at a local level. We are trained to learn from our mistakes. For the sake of patient safety, adverse incident reporting and critical incident analysis are now key parts in quality improvement. This is important. There are always lessons to learn when a mistake is made.

However, is it possible that we also learn from the things that we do well?
When teaching children in their early years parents are encouraged to use positive reinforcement. Just because we become older and supposedly wiser does not mean that positive encouragement loses its’ impact. While we strive to improve on the areas where we can make errors, it is important to also remember the things that we get right. We are always asked to reflect on what we could do differently, not to address the things that you would approach in exactly the same manner. Something which in some situations would be an interesting topic to broach.

From my own limited experience I know at times you can feel totally out of your depth. However, if someone takes two minutes to reassure you that you are on the right track it can make a world of difference.

IMG_2447So here is my positive feedback. I was told prior to starting work that FY1 would be the most horrendous year of my life. However, I enjoyed starting work. I have was well supported and for that I must thank you all. Everyone working within DGRI has made me feel well supported and at the same time given me room to grow and develop. It is as a result of this that I have continued to enjoy my work and develop as my career has progressed. You have created a supported learning environment for trainees which I hope is something that is recognised, as we all strive to achieve more.

So in attempt to round off this entry: if you notice a colleague, family member or a friend doing something well let them know. It takes no time at all and you never know what you might inspire someone to do.


Galloway Community Hospital: the Truth by Angus Cameron

Angus 6

Dear Colleagues,

Recent Concerns regarding the Galloway Community Hospital.

There are two issues that have attracted public concern:

  1. The Emergency Department

The Emergency Department (ED) handles approximately 12,000 cases per year.  It is staffed by a suitably qualified doctor and experienced ED nurses.  In addition to that, the ED doctor can call on the services of an on-call anaesthetist if he is faced with a need to ventilate a severely ill or injured patient.  Alternatively, the ED doctor can seek help from the Emergency Medical Retrieval Service based in Paisley: This service is manned by consultant level staff 24 hours a day and has a helicopter on stand-by able to rapidly transfer medical staff to the Galloway and transport seriously ill patients to Glasgow Hospitals.

The Emergency Department has good working relationships with Scottish Ambulance Service paramedics based in Wigtownshire, who are often faced with critical decision making, deciding whether to transport patients to the Galloway Community Hospital for stabilisation, or to transport them direct to Dumfries & Galloway Royal Infirmary where definitive treatment is available.

Anaesthetic on-call cover used to be provided by two anaesthetists who lived in Stranraer.  One retired several years ago and the other last year, and it has not been possible to recruit replacement anaesthetists. As a result, the 12 hour shifts in the rota have been staffed by locum consultants and by consultant anaesthetists from Dumfries & Galloway Royal Infirmary.

We have had increased difficulty recruiting locum anaesthetists to the Galloway, which reflects a national shortage of locum consultants.  In addition, with 3 vacant posts in the anaesthetic department in Dumfries & Galloway Royal Infirmary we have had difficulty in rotating consultants out to the Galloway Community Hospital.  Obviously sending an anaesthetist out to the Galloway Community Hospital could result in theatre sessions in Dumfries & Galloway Royal Infirmary being cancelled – causing distress to a number of patients (some of whom could have come from Stranraer.)

In the last month there have been 3 occasions where an anaesthetic shift has not been covered as a result of failure to recruit locum doctors.  In these cases the impact has often been reduced by a doctor staying on longer after his shift ended, or a doctor agreeing to arrive earlier for the start of the next shift.  The dates when there was no anaesthetic cover were overnight were 4th July, 5th July, 6th July and 11th July 2017.

I would like to stress, however, that at no stage has the Emergency Department been closed.  It has not been “downgraded to a Minor Injuries Unit” – the usual doctors and nursing staff were present and seeing patients normally.  Children with asthma or patients with fractures for example could still be treated normally.  While we regret that we were not able to provide the fall-back cover of an anaesthetist it should not be concluded that this was from lack of trying – we have spent a total of £1.5million on providing medical locum cover for the hospital in the year to April 2017 and will continue to maintain a rota for the foreseeable future.

Being truthful, I cannot give an absolute guarantee that we will never have this situation again. We will, however, continue all efforts to recruit anaesthetists both to Dumfries & Galloway Royal Infirmary and to the Galloway Community Hospital and it is likely the situation will ease as locum availability improves after the holiday season.  However, we do face a very difficult medical workforce market.  I can confirm that we have a working group led by the Deputy Medical Director working on efforts to improve our recruitment and retention in a highly competitive market.

  1. The In-Patient Wards

 You will be aware that there are two in-patient wards in the Galloway Community Hospital. One ward, the Garrick Ward, deals with more acute medical cases, whilst the other, the Dalrymple Ward, tends to deal with rehabilitation cases and care of the elderly.

Arranging a safe level of nurse staffing in the wards has been made difficult recently by 4 longer-term vacancies, and more recently by 3 nurses forced to take sick leave.  The nursing staff have worked exceptionally hard and flexibly providing extra shifts to help maintain the full service.  However, a decision was taken to move all patients into one ward (the Dalrymple Ward) for the period 5th – 12th July 2017, in order to allow for safe nursing levels to be maintained and for patients to be treated with dignity and compassion.  This was achieved by declining admissions to the Dalrymple ward for a week prior to this to allow the numbers of in-patients to decrease as patients were discharged.  During the period when the two wards were combined it was possible to admit acute patients to the ward from both ED and from GPs.

I am glad to say that following a very intensive weekend recruitment drive we have now managed to appoint to nursing posts and the new staff will start in September 2017, easing the pressure on ward staffing.

A statement from the General Manager was emailed to Councilors in Wigtownshire on Tuesday 4th July 2017 informing them of the situation.

A Senior Manager is carrying out a review into the Galloway Community Hospital at the request of the Chief Executive.  The remit is to look at how services can be made more resilient and sustainable and to consider what services could be increased in the hospital, particularly out-patient appointments, diagnostic investigations and day-case surgery.  Increased services in the Galloway Community Hospital may, however, be delayed if we remain unable to recruit consultants to the region.

The Health Board is committed to the Galloway Community Hospital.  This is evidenced by the fact that we have budgeted for routine renovation and equipment upgrade of the theatres and a renovation of the dialysis unit later this financial year. In addition, further money will be spent in the Galloway Community Hospital on equipment for endoscopic examinations.

On a personal level, I feel that ultimately, the stability of services within the hospital relates directly to medical recruitment in a very difficult recruitment environment where we are forced to compete with hospitals across the UK.  The Board will continue to work hard to recruit to what are unfortunately

perceived as professionally isolated and clinically challenging posts.  I believe that there is a role for community leaders of all persuasions in helping to promote very positive messages about the hospital, the community and the environment to help us attract the best possible staff to the area.

Again on a personal, and professional, level I feel it is extremely important that none of us unnecessarily promote avoidable anxiety or confusion in patients and the public.  I think it is, therefore, important that the language we use in public fora is accurate at all times.  The Emergency Department has not been closed and patients should attend there as normal.  They will be treated by suitably qualified doctors and trained nurses. They should not be led to believe that they are required to travel to the Emergency Department in Dumfries & Galloway Royal Infirmary.  Patients who are mistakenly led to believe that may make seriously inappropriate decisions to delay seeking help or travelling to Dumfries – decisions that could have significant adverse effects on their health.

Dr Angus Cameron is Board Medical Director for NHS Dumfries and Galloway

Angus 5

Angus 4Angus 2

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The Doctor can see you virtually now by Chris Fyles

While Googling recently (for Technology Enabled Care related reasons!) I happened to come across PawSquad.  They provide “instant, qualified online vet advice” through the provision of video or text chat consultations to keep your pet “as happy and healthy as they can be”.

Amazing! Whatever will they think of next?

How about similar services for you, me and everyone else? Wouldn’t it be nice to be able to use these options to support you and your family’s health or to deliver services differently?  We can do that… can’t we?


There are other health and social care partnerships in Scotland that support people to manage their health and wellbeing by video consultations and text message.  There is also demand from the public with the rise of commercial companies that offer GP appointment by video with the ability to deliver medication to your door the next day or email you a prescription.  Need a Physio? Initial and follow up consultations can be provided through video and exercise packages sent to your device for you to follow.

Now, some of you will be thinking “that’s all well and good but the internet connection at where I live and work is terrible!”  While that may be the case right now in some of the areas across our region, it is getting better.

Don’t just take my word for it – there is an ongoing programme of work being led by the Scottish Government and Dumfries & Galloway Council to support the roll out of superfast internet access and improve the speed of regular broadband.  It began in early 2014 and is planned to continue to the end of March 2018 enabling access to superfast broadband for 95% of premises in the region.  The Scottish Government have also committed to deliver 100% superfast broadband by 2021.  At the moment, our region looks like this:

Chris 1 DGFibreMap20170629

Maybe you are thinking that the people that use your services don’t access the internet? It may surprise you to know that the internet was used daily or almost daily by 82% of adults (41.8 million) in Great Britain in 2016, compared with 78% (39.3 million) in 2015 and 35% (16.2 million) in 2006.

Or that during 2016, 70% of adults accessed the internet ‘on the go’ using a mobile phone or Smartphone, up from 66% in 2015 and nearly double the 2011 estimate of 36%.  It’s not only young people using the internet, recent internet use in the 65 to 74 age group has increased from 52% in 2011 to 78% in 2017, And finally, of those people using the internet, 51% of them were looking for health related information and 43% of people are using the internet to make telephone or video calls using applications such as Skype or Facetime.

If you wish to see some statistics on Internet users in the UK click here

If you wish to see some statistics on Internet access click here

So if we have connectivity, people are familiar with the internet, they are using it to access health information, and they are using it to make video calls why are we not offering our health and social care services via video?

In some places they already are. NHS Attend Anywhere was launched at the end of 2016 and has been developed by NHS24 in collaboration with Healthdirect Australia to enable video call access to Health services as part of normal day to day practices.  Instead of going to a health facility and physically sitting in a waiting room patients just use their device to access a virtual waiting area which the clinician comes and ‘collects’ them from to  begin the consultation. Services delivered elsewhere in Scotland include Pharmacy Reviews, Speech and Language Therapy, Dermatology, Endocrinology, GP appointments, Out of Hours care and more.

Chris 2WaitingAreaOverview

“What do I need to be able to do this?” I hear you ask.  For video consultations both the clinician and the person using the service need nothing more than a device (PC, laptop, Android or Apple tablet or Smartphone) that can access the internet with Google Chrome or an Attend Anywhere app installed and internet access of course.  NHS Attend Anywhere doesn’t need superfast internet access to work and generally speaking if you can watch a video on YouTube then you will be able to participate in a video consultation.

Curious to find out more and have a go?


If you already have Google Chrome installed on your device just copy and paste the link above into your Chrome browser address bar, press the return/enter key on your keyboard and follow any onscreen instructions to take a seat in our Demo Waiting Area.

Once you are placed into the waiting area a notification will be sent to me and if I’m free I’ll come in and join you for a quick video call.  If I can’t make it you will at least have seen how easy the system is to use and begin to see opportunities to use it within your service. Preliminary results from a national survey in Scotland completed by people that have used NHS Attend Anywhere already indicate that 95% of them would use it again.

Video consultations give us options for flexible services going forward. It can help to reduce travel for people using our services and it could be a tool to help us to recruit to specialist posts from elsewhere to link in to Dumfries & Galloway. If we were offering video sessions into the home, it is possible to think that the person providing the service could also be at home and not in Dumfries & Galloway?

We expect to be able to use technology to buy shopping, make travel arrangements, manage our banking, communicate with our friends and to keep up to date with what’s happening in the world. Hopefully this blog post has made you think about new ways to use technology to deliver your service or to access a service. So what are you waiting for?

For more information or help with any of this, please contact Chris Fyles, Technology Enabled Care Project Lead for Dumfries & Galloway by email: chris.fyles1@nhs.net
LYNC:  cfyles@citrix.dghealth.scot.nhs.uk  or by phone:      07979357010 / 01387220006

Video consultation is one of four areas of focus for the Dumfries & Galloway Technology Enabled Care Programme. The others include Telecare, Digital Apps & Services and Home and Mobile Health Monitoring (HMHM).

How to make a good death by Justine McCuaig

My Mum died on June 6th 2017 at 11 45pm at home asleep beside my Father while he held her tight.

My overwhelming and lasting memory is of going up to offer Dad yet another cup of tea, (my family home by this time had become like a scene from Eastenders with endless tea becoming a cure all for our woes) and finding them both asleep in front of the telly, holding hands, as if it were any other night in their lives together. By this point, knowing mum was soon to leave us, I chose a whisky over tea while my sister drank Mum’s Tia Maria and we laughed at our naughtiness downstairs.

We had been caring for Mum for 4 months at home. She had been diagnosed with idiopathic pulmonary fibrosis a few years before and her lungs progressively stiffened up despite her objections and indignation at the condition. Everything else was in perfect working order!

Mum was very pragmatic about her diagnosis and we often talked about its progression together with and without my Father. I asked her when her condition worsened if she thought my Dad had “got it” and understood that she had terminal disease and was not going to recover. The next day I visited and she said “yes he’s got it….I sat him down and told him that I wanted buried in the garden and listed who I didn’t bloody want coming to the funeral  so you don’t need to worry about that anymore!”

Although as a family we liked our privacy from the outside world, we were not particularly shy or private people at home and regularly discussed all manner of things and shared experiences. No topics were ever out of bounds for us and I had the privilege of being raised by tolerant humanitarians with a good sense of humour and a love of dialogue, music and life. We have always been able to talk about the big things with ease, disease, mental illness, romantic woes, religion and politics but struggled with the smaller things and general displays of affection. We loved truly and where truly loved but it was unspoken generally and wrapped up with rather woolly “oh you knows”

Cuddling was not a regular thing either (for no good reason other than we didn’t really do it much) This physical distance completely disappeared when I began to nurse my Mum and provide her with regular personal care. I was more unsure about how I would feel about this than how she would feel about it even though as a nurse I was simply using the tools of my trade.  To my delight caring for Mum (and Dad) was one of the most wonderful experiences I have ever had.  The physical closeness and honesty was liberating for us both. We had so many laughs (normally about things we really shouldn’t laugh about!) Gift giving changed and although a commode wasn’t everyone’s idea of a great birthday present, my Mum loved it, especially with the balloon attached.

To be able to wash my Mum, do her hair, paint her nails all the time chatting about this and that with up to 5 grandchildren lying alongside her at “Granddads side “ was a unique shared experience which we all enjoyed up to the last week of her life. Grandchildren came and went as it suited them without obligation and new routines developed for us all which were played out wholly to our tune. Nail painting changed to pressure care and symptom control but there were no restrictions on visiting, no alien environment or hospital smells, no distance to travel, no reduction in privacy or dignity.

Just home – where the heart is, and where sitting on the bed is actively encouraged!

Of course we couldn’t do this without support. It was great that I was able to use my nurse’s tool box to be my family’s advocate, to explain things lost in translation and to explore mums options. However it was the cohesiveness of our systems, the excellent communication between teams and professionals actively hearing what the patient aspired to and facilitating those aspirations that really worked for my family and resulted in such a good death for my Mother

NHS Dumfries and Galloway has the most outstanding staff members across all disciplines. With thier input we can successfully choose our own package of care and be fully supported in that choice. Anticipatory care planning and social care integration have the potential to really transform the patient journey and is not something to be afraid of but rather to embrace.

 However all of these services need to be heavily invested in to meet the expected demand from   an aging population. Without continued investment and service development, NHS Dumfries and Galloway will not be able to fulfil this ambition and enjoy the success that my family had.

Mum was admitted to DGRI 3 months before she died as an emergency admission and was discharged from ward 7 with a complete package of palliative care and specialist community respiratory support within 32 hours.  All of her drugs and letters were ready at our agreed   discharge time, the domiciliary oxygen was arranged and delivered and referrals completed for the McMillan, Marie Curie Nursing services and Community Respiratory Specialist Care.  Her DNR was signed and she waved it under the nose of anyone who was even vaguely interested in reading it. It remained pride of place on the bedside dresser as it was very important to her that her intentions were known. Everything my Mum did was delivered with humour and even this got a comedy slant!

The Kirkcudbright District Nurses introduced themselves and ensured that their door was kept fully open for when we needed their help and support. They responded promptly to any requests and where always available at the end of the phone to discuss Mums needs as they arose. Our Specialist Respiratory Nurse visited regularly.  When Mum developed a chest infection he promptly liaised with the consultant from our dining room relaying Mums reluctance to be admitted but advocating   the need for her to receive appropriate treatment which could prevent her condition worsening. Although her condition was terminal   there were still things that could be done to minimise her symptoms and prolong the length of her wellbeing. Mum agreed that if things got rapidly worse she would potentially consider IV therapy in hospital but would initially hedge her bets with tablets, lots of tea and nebulisers. She started her antibiotics orally that afternoon and recovered and remained well   long enough to see her beloved swallows   return   from Africa to nest in the garage, enjoy the spring flowers from the garden and support the children through their exams.

The Occupational Therapist ensured Mum had all of the equipment she needed when she needed it. If a piece of kit was ordered it was generally   installed within 24 hours. The Equipment Delivery Staff ensured that we knew exactly how to use it after they had installed it and answered all questions fully and in a voice loud enough for my deaf Dad to hear! They ensured he knew who to contact in the event of any problems. Mum had everything she needed, a bath chair, a stair lift, a stand aid, a pressure bed.  Visiting relatives from the Deep South stood with mouths wide open in disbelief at the care and support my family were receiving and began to seriously consider relocation. After Mums death the equipment was collected promptly but respectfully and was almost symbolic of starting life without her.

We did need the District Nurse’s help more regularly in the days running up to her death and because they had developed a slow growing respectful relationship with my family they were welcomed in like old friends.  They encouraged me to be Justine the daughter rather than Justine the nurse which was invaluable advice. They looked after us all, and talked us through every stage or change in Mum’s condition. Most importantly Mum thought they were great and that is, of course because, they were.  She was so interested in people and life and living that she became just as invested in how they were doing as they were in her. This was especially true of the student who approached and completed her finals during mums care. She told Mum when she   successfully passed as she knew it was important to her to know despite Mums condition rendering her uncommunicative at that point.

However we all knew she was dead chuffed!

Mum received reflexology   and head and hand massage in her bedroom as part of her palliative care package which was a new experience for her and one she really appreciated. What she enjoyed as much as   the treatment was her was that she had another person to communicate with and to learn from. She loved engaging with people more than anything. It gave us all something to talk about too. Even then life remained interesting with new experiences to share.

When Mums condition deteriorated to the point of suffering the District Nurses and GP promptly began her syringe driver to minimise her symptoms. I had discussed this often and in detail when Mum asked about “what next” and she fully understood that when her symptoms were controlled this way, she would be less awake and aware. She made a very informed choice when the GP prescribed it and her consent made me feel content with that course of action. She had had enough. Any other GP may have been phased when she asked if he was “putting her down,” especially when after administering an injection she said “No, no I’ve changed my mind” with a wicked twinkle in her eye!” However Mums GP knew her well and knew that with her humour she was trying to make a difficult job easier for him.

The Marie Curie nurses would phone regularly to see if we needed help over night which was very comforting. In the end the nurses attended the family home twice. Once to administer breakthrough medication in the wee small hours on the day the syringe driver was started (all the way from Dumfries – a round trip of 60 miles) and the following night at 10pm for their inaugural sleep over. Mum died shortly before midnight that night and Dad then made the long walk to the spare bedroom to ask our guest to confirm that she had gone.  Having her there at that time was invaluable and over the next few hours we all chatted and laughed and cried while we waited for a registered nurse to certify Mums death.  The care and support we all received that night was beyond excellent . Mum stayed the night, there was no rush for her to go anywhere and we all spent time with her before she left us mid morning. Downstairs my sister and I repeatedly heard my Dad’s footsteps as he came and went into their bedroom to check that she was really gone.

And she had gone,  Mrs T had left the building. Although we were (and are) devastated we have all reflected our relief that she had suffered so little in the end and that she died where she wanted surrounded by the people she loved . Knowing this has filled our sad hearts with a warm feeling knowing we did right by her and in time this will be a great comfort to us.

Janice M 1

Justine’s Mum and Dad on Crosby Beach 

Justine McCuaig is a Health protection Nurse Specialist at NHS Dumfries and Galloway

How Advanced is your ANP knowledge? by Barbara Tamburrini

Advanced nursing practice is not a new concept. Indeed, specialist nursing roles, from which advanced nursing practice has evolved, have been around since as early as the 1920’s. The advent of World War 2 dramatically enhanced the specialist nurse role through the significant development of new skills which were required to meet the huge and urgent demand in hospitals and infirmaries throughout the world. The clinical nurse specialist (CNS) role was underpinned by academic qualifications as early as 1954 and over the following decades, these nurses were fully embraced as experts in their fields. This academic foundation represented a momentous shift in the educational vision for nurses towards university-based knowledge development with expertise achieving the application of this knowledge in practice.

With CNS roles being conceptualised as fundamental to in-patient care quality, the nurse practitioner role was developed to replicate this degree of specialism in primary and community care. During the 1990’s, universities within the UK began to affiliate nurse practitioner courses with graduates predominantly practising in GP practises to address the targets around 24 hour access to healthcare professionals and 48 hour access to a GP. These nurse practitioners were trained to assess minor injuries & illnesses which freed GPs up to review and manage patients with more complex needs.

During the 1970’s, very specialised nursing roles emerged in areas such as pain management and colorectal surgery and less than 20 years later, academic institutions were making BSc Nurse Practitioner qualifications widely available with paediatric, primary care or hospital based routes all an option for graduation. This was further enhanced by the advent of the Hospital at Night (H@N) concept, piloted early in the 21st century and rolled out across the UK by 2006.

Here in NHSD&G, we have had nurse practitioners achieving significant levels of specialist nursing in GP surgeries for 2 decades and in the Acute and diagnostics Directorate, the H@N concept was introduced in 2006 with an initial team of 6 advanced nurse practitioners (ANPs). These nurses hit the ground running with assessing unwell & deteriorating adult in-patients overnight and gradual recruitment has enabled development into a weekend daytime role. The manifestations of this role evolution is evidenced by increased continuity and quality of in-patient care, decreased residual clinical tasks and reduced numbers of un-planned critical care admissions by promoting the early recognition and management of deteriorating patients. Furthermore, a presence has been fully established within the medical admission unit and an ambulatory care pathway has been formulated which is delivering on its commitment to reduce medical emergency admissions.

Within the Emergency Department, ANPs have been managing a case load of stream 1 (minors) presentations since 2005 when 2 existing members of staff commenced their ANP course & carved out this new role. This team gradually increased to 3 ANPs once the benefit on improved ED flow was realised. In recent years, the ANP presence in ED, has developed to include presentations in stream 2 (majors) and stream 3 (resuscitation) and this has contributed significantly to achievements in ED HEAT targets whilst also maximising ED patient care.

The Galloway Community Hospital also now has an ANP presence with a crucial role to play in the acute “Garrick” ward in addition to supporting the patients within the “Dalrymple” rehabilitation ward. In addition, advanced practitioners are now clinically active in the neonatal, obstetrics, gynaecology and paediatric specialities within NHSD&G and a number of GP practices around the region benefit from ANPs working alongside their GP, practice nurse, CNS, district nurse & health visiting colleagues. Indeed, a new and exciting venture comes to us in the form of advanced allied health practitioners which is currently in the recruitment process and this opens yet another door to the advanced practice house.

However, fundamental to all of these roles, is the definition of advanced practice and the demonstration of this achievement. For the first time, this area of healthcare is firmly on the Scottish political agenda with the Chief Nursing Officer’s Transforming Nursing Roles programme providing the following agreed definition for an ANP role:

  1. An Advanced Nurse Practitioner (ANP) is an experienced and highly educated Registered Nurse who manages the complete clinical care for their patient, not solely any specific condition. Advanced practice is a level of practice, rather than a type or speciality of practice.


  1. ANPs are educated at Masters Level in advanced practice and are assessed as competent in this level of practice. As a clinical leader they have the freedom and authority to act and accept the responsibility and accountability for those actions. This level of practice is characterized by high level autonomous decision making, including assessment, diagnosis, treatment including prescribing, of patients with complex multi-dimensional problems. Decisions are made using high-level expert knowledge and skills. This includes the authority to refer, admit and discharge within appropriate clinical areas.


  1. Working as part of the multidisciplinary team ANPs can work in or across all clinical settings, dependent on their area of expertise.


Advanced nursing has 4 pillars of practice which ANP’s must have as part of their core role and function and although the primary focus is on clinical practice, all 4 practice pillars must be demonstrated. These are:

  • Clinical practice
  • Leadership
  • Facilitation of learning
  • Evidence, research and development.

The demonstration of achievement of the pillars of practice and consequently the ANP role has also been clearly defined at national level and this involves the outlining of professional competencies, participation in effective clinical supervision and meeting robust continuous personal development. Within NHSD&G Acute & Diagnostics Directorate, the value placed upon this level of practice has been highlighted by the appointment of an ANP clinical manager to deliver this national agenda in a cohesive, collaborative and joined-up way across NHSDG to ensure we are meeting our strategic responsibilities within this national framework.

Both nationally and locally, discussion and debate has taken place on the differences between advanced and specialist practice and as these nursing roles have progressed, differences and similarities have become evident. This is a wide-ranging area for debate encompassing all aspects of specialist practice but it is worthwhile to clarify that advanced and specialist practice should not be seen as directly hierarchical relationships; advanced nursing is not more senior than specialist and the reverse is equally applicable. Both levels of practitioners function at an extremely high level of practice, but with very different clinical focuses.

In summary therefore, it is obvious that advanced practice has evolved over a significant period of time and has ‘proved its worth’ in a number of healthcare areas with significant benefits for the delivery, safety and quality of patient care. Even though this concept has been fairly consistently on the agenda, the momentum around the role, its function and the measures of achievement and effectiveness has significantly gathered pace over the last 10 years with a further ‘injection’ since the implementation of Transforming Nursing Roles. This galloping horse (it is Ascot Week after all!) will only gather pace as more healthcare professionals such as physiotherapists, dieticians, pharmacists to name but a few, begin to realise the potential for their own advanced roles. This can only be a good thing with advanced practitioners now able to drive their own development whilst clearly evidencing their clinical confidence and competence for a discerning public who, quite rightly expect the best.

Exciting times ahead – are you ready to jump aboard?

Barbara Tamburrini is the ANP Clinical Manager

Being Carer Positive by Lesley Bryce

Lesley 3This week (12-18th June 2017) is Carers Week.

Carers week is a national awareness week that celebrates and recognises the vital contribution made by people across the UK who currently provide unpaid care.

A Carer is someone of any age who provides unpaid help and support to a relative, friend or neighbour who cannot manage to live independently without the Carer’s help due to frailty, illness, disability or addiction (Scottish Government 2016).

The focus this year is on building communities which support Carers to look after their loved ones well, while recognising that they are individuals with needs of their own.

3 in 4 carers don’t feel their caring role is understood or valued buy their community.    (http://www.carersweek.org/)

In Scotland, there are at least 759,000 Carers aged 16 or over and 29,000 young carers. The value of care provided by Carers in Scotland is £10,347,400,000 a year. Unpaid Carers are the largest group of carers in Scotland, providing more care than the NHS and council combined. Carers should be seen as a vital and valued part of our health and social care system. Three out of 5 of us will become Carers at some stage in our lives and I in 10 of us is already fulfilling some sort of caring role.


In Dumfries and Galloway, unpaid Carers provide over half of all care required, approximately 410,000 hours per week. There are 14,995 Carers in D&G (2011 census) although the figures are likely to be significantly higher as many people do not identify themselves as a Carer. Latest figures reveal that Carers in D&G make up 10% of the population and of this group, 29% provide more than 50 hours of support a week.

NHS Dumfries & Galloway recognise the important role that Carers play in our community and are determined to ensure that staff who have an unpaid caring role are supported to manage their own caring responsibilities with confidence and good health, whilst remaining in work.

One in five Carers give up work to care (https://carers.org/key-facts-about-carers-and-people-they-care). I gave up my employment when my son was 4. I returned to work after a long break. I personally know how much of a struggle it can be to juggle work and caring responsibilities and the effect this can have on your own health and well-being. I also understand the impact that giving up work can have on your personal finances and self- esteem.

lesley 2Most of you will know that NHS Dumfries & Galloway were successful in achieving the Carer Positive engaged award in 2016. Carer Positive provides a framework around which employers can develop and implement positive working environments which support staff who are unpaid Carers. NHS Dumfries is moving forward with our Carer Positive journey to improve and progress to established level. We are working in partnership with D&G Council and the Third Sector to embed a culture of support for Carers across the health and social care partnership.

During Carers Week, there has been lots of activities to support Carers including those in the workplace.

Arrangements have been made to promote the Special Leave Policy via workforce briefings and intranet flash ads so look out for these.

Carers Leave for NHS D&G is detailed in the Special Leave Policy which can be accessed from the BEACON intranet pages. If you do not have access speak with your manager in the first instance or contact a member of the Workforce Directorate team.

The new Carers information ‘z’ card is being promoted soon so look out for these 😊

Carer online training modules are available to all staff on learnProNHS (under the CPD tab) and through the Open University Open Learn platform. It includes NES EPiC levels 1-3. NES in partnership with the Open University in Scotland have developed Caring Counts in the Workplace. This is an online course for managers and policy makers. The course sits on the OU’s free Open learn platform, with a link from the EPiC e-learning site.

( http://www.open.edu/openlearncreate/course/view.php?id=1841)

I am one of the Carer stories in this web based learning and it really shows how far I have come when I look back on the last 4 years. From that pilot with the Open University, I went back to UWS then I got a role on the board as a Non- Executive Director where I am also proud to be the Carers champion.

I know that it is exhausting sometimes having caring responsibilities and working and it has certainly helped me to have support to continue in my role.

Lesley 1The Hospital Carers project offers support and advice. It is based in the centre opposite the lifts in the main entrance lobby at DGRI where you can also find their Carer’s Week information display.  You can contact Lindsay sim or Jennifer Cranmer on 01387 241384.

Dumfries and Galloway Carers centre provides information, advice and support to anyone who cares for a relative or friend. They can be contacted on 01387 248600 or email info@dgalcarers.org . The centre has been an invaluable lifeline to me for the last 15 years.

The current Dumfries and Galloway Carers Strategy expires in 2017.Following consultation with Carers, Carers organisations and partners, a draft strategy has been developed for 2017-2021.The consultation closes on 30th June 2017. Here is the link:


For more information or assistance to complete the survey, please email Carers@dumgal.gov.uk or phone 01387-246941. Hard copies are available on request.

If you are a staff member who is a Carer and would like to be involved in Carer Positive, please feel free to get in touch. Please contact Philip Myers, Health and Wellbeing Specialist (philip.myers@nhs.net) or Larel Currie, Commissioning Officer, Joint Strategic Planning and commissioning (larel.currie@dumgal.gov.uk).

Lesley Bryce is a Non Executive member of NHS Dumfries and Galloway Health Board



Eat Fact, not Fiction….by Laura King

Laura K 1Barely a week passes without headlines (or Twitter trends) about diets and how to lose weight, improve your energy levels / skin/ hair / libido / life expectancy. Often these are contradictory and can lead to confusion. Whenever the headline suggests that a fad diet or miracle food is the holy grail that will solve all our health problems alarm bells should ring!

Dietitians are trained to examine the evidence behind such claims and sift out the facts from the fanciful. Unlike many medical trials where a drug is tested for effectiveness (usually against a placebo), nutrition trials are usually more complex and difficult to interpret. Mainly because nearly everybody eats, and people’s baseline diets and habits are so varied it makes it difficult to isolate the effect of altering one aspect of the diet.

We also consider the person as a whole and aim to prioritise dietary aims. An example of this is a referral that came through recently for a lady in her 80’s who wanted advice for diverticular disease and type 2 diabetes. When we saw her, it became evident that she had lost a considerable amount of weight since losing her husband. We were able to explain to the patient and her family that this was the greatest nutritional risk to her so we would encourage her to prioritise eating a little of what she fancied to try and boost her weight rather than follow a restrictive diet for her other conditions, particularly while she was an inpatient when we know that people are vulnerable to malnutrition.

As part of the fourth annual Dietitians Week being held June 12-16, the BDA and dietitians in Dumfries & Galloway are encouraging the public to get their advice on diet from the properly qualified experts. The public should also ensure any diet plan they follow is based on scientific evidence. Some of the advice given in relation to fad diets is not just ineffective, it can actually be harmful to people’s health.

Evidence-based nutrition advice is important because often the trials that are reported may be based on small, specific experiments and the results may not translate easily to real life or real people. Dietitians can interpret the evidence and help people make adjustments that fit into their lifestyle and are sustainable.

Eg. There is evidence that eating large quantities of soya can reduce cholesterol, but for the majority of people, having large quantities of soya-based products for breakfast, lunch, dinner and snacks is not going to be an achievable goal.

Laura K 2Dietitians Week

Annually, the BDA run a weeklong event called Dietitians Week, aiming to promote the importance of dietitians and the great impact they can have on the nation’s health and wellbeing. This year the week runs from 12-16 June and is taking the theme of Evidence and Expertise and you will spot our myth-busting displays around DGRI. This is to promote the importance of ensuring that dietary and nutrition advice comes from evidence-based sources, whilst highlighting the risk of following guidance that is not scientifically credible.

Please take time to look at our displays next week and when you see us out and about in the hospital, grab us for a chat about nutrition, fad diets and separating the fact from fiction.

Laura King is Lead Acute Dietitian at NHS Dumfries and Galloway