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What is the challenge your project is going to address and how does it connect to your chosen theme?

Access to outpatients services in our remote and rural island community is not as timely as we aspire for it to be and traditional models of referral do not support creativity in pathways to enable services to be provided in a more person centred and efficient way.  At the moment people are referred into secondary care electronically by their GP and the referral is vetted by a secondary care consultant.  Referrals for people who require access to a service not provided in our Rural General Hospital go to a mainland Health Board and patients are then required to fly back and forth to access care.  We are currently working on a project which will ensure there is greater access to virtual service delivery to ensure the provision of care closer to home whenever possible however discussions so far have started from the position of providers identifying opportunities for virtual provision from a clinical perspective however this does not allow the patient perspective to shape provision.

What does your project aim to achieve?

Our project aims to develop and test a referral management approach in  a remote and rural island setting which identifies place of care informed by the patient.

We believe the project will:

Improve patient experience

Reduce spend on off island travel

Improve access and reduce waiting times

Reduce inequity in access to care

As this project is at the initial stages a full measurement plan has not yet been developed.

How will the project be delivered?

The project will be led by an experienced QI Lead and will be supported at an executive level by our Director of Public Health.  Project management will follow the Prince 2 framework and dedicated project support will enable the project to be progressed at pace.  This is critical in a small NHS Board setting where it can be difficult to find the capacity to support change projects from within existing resources.

A communication and engagement plan will be developed and public participation will be a key factor.  Central to our approach will be the corporate objectives of NHS Orkney with a particular focus on:

Improving the delivery of safe, effective patient centred care and our

Optimising the health gain for the population through the best use of

Pioneering innovative ways of working to meet local health needs and
reduce inequalities.

What and how is your project going to share learning throughout?

NHS Orkney is connected into the North of Scotland region where there are 2 other remote and rural island groups, covered by other NHS Boards.  We will share our learning across the north through the North of Scotland Public Health Network and also through the North of Scotland Planning Group where there is scope for learning to inform service provision in the region.

We will also share the learning gained through the Scottish Modernising Outpatients programme and through the Q community.  We hope to be able to develop our approach to sharing learning as a result of the input from  other members to ensure there is maximum gain from this project and are keen to particularly share our learning with other island and remote and rural communities.

How you can contribute

  • Looking for members of the community to act as critical friends.
  • Would also appreciate members with expertise in this area to share their insight and experience.
  • Networking suggestions to similar projects/activities would also be appreciated.
  • Particularly interested in offerings from remote and rural context.


  1. Thanks for all the helpful comments.

  2. Guest

    Carolyn Chalmers 1 year, 9 months ago

    Great to see that the public/patient perspective is the starting point for this project.  It would be good if patients from the outer isles as well as Orkney mainland patients could take part?  Maybe the start of the project could be with one community eg in one of the north isles around one willing GP/GP practice, to test this out, with a view to spreading across other areas of Orkney and beyond?  I'm sure the patients will have some great ideas, and hopefully some will be willing partners to help test out some of the ideas.   Their initial stories and experiences about the current/traditional model of service delivery could provide a baseline qualitative measure, and can also be powerful in making the case for change; they may also have some ideas for quantitative measures in additon to carbon footprint from 'what matters to them'? eg time saving and economic cost of not needing to take days off work and have two overnight stays for a short 'how are you'  outpatient appointment, in addition to the not inconsiderable travel costs for ferries and flights, x 2 if an escort is required.

  3. Dear team,

    The RCP have a useful paper on thinking about the environmental impact of the NHS and how to reduce this. It strikes me that measuring the impact of your carbon footprint might be good. We did this for a telehealth clinic for kidney transplant patients in Bristol that were having to travel from other counties and we could show a difference.

    Best wishes and good luck


  4. Hi Christina and Louise,

    A winning project from last year focused on virtual consultations in rural areas. I wonder if Claire and others involved in the project may have shared learning from their work to help shape your plans?


    Good luck!


  5. Are you planning to involve patients in the project? It would be interesting to hear their experiences of flying off island for appointments and what benefits they perceive from the new service. Their experience of virtual provision of outpatients could be relevant in all localities, not just those that are remote - how are you thinking of sharing the learning?

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