Planning and developing a new PD service for Moray

Moray is a county in the North of Scotland. It is a remote and rural region nestled between Inverness and Aberdeen and borders the Cairngorm mountain range. It has one small District General Hospital (Dr Gray’s Hospital in Elgin) and five small community hospitals serving the population of around 95,000 people.

Until 2016, Moray Parkinson’s disease (PD) patients were looked after by a 0.6 WTE (whole time equivalent) geriatrician with input from the neurology team in Aberdeen (approximately 70 miles away) for younger patients (<65 years old) and a part time PD nurse specialist. In 2016, the geriatrician went on sabbatical for a year, the PD nurse specialist resigned and the neurologist team in Aberdeen were under significant pressure with long waiting times and were unable to accept new patients >65 years old.

The entire PD service was in ‘crisis’ and the patients themselves went to the media and the MP to raise their concerns. It was expected that recruiting a full time geriatrician would be able to support and develop a more robust service.

I was appointed as the first full time geriatrician for Moray in August 2017. This post was created to develop an inpatient service for older people with frailty, develop community services and links with primary care and also deliver a service for patients with Parkinson’s disease.

Data collection

There was no single up-to-date database of PD patients within Moray. What was available had not been maintained in recent years and was inaccurate, contained details of patients who were deceased or moved out of area and did not incorporate patients who had been diagnosed in the past two years.

The databases were reconciled, cleaned up and a single accurate spreadsheet was created. It is now possible to determine at a glance when patients were diagnosed, which GP practice they belong to and when a consultant or PD nurse specialist had last seen them.

The database showed there were exactly 200 patients with Parkinson’s disease within Moray. 124 male (62%) and 76 (38%) female. The majority (115 patients) are over the age of 75 as would be expected. Only 28 patients are younger than 65 years, which is the cut off the neurology team wanted to enforce as their patient group.

The patients are widely disseminated within Moray, 80 patients within the surrounding area of the District General Hospital but 120 patients with more than a 15-mile journey to travel to be seen in clinic. This information was useful to determine where to hold clinics and the frequency with which these clinics are required.

Service development

This information and more in depth data was presented at a service meeting in October 2017 to describe the current workload and develop a more person-centered service. The hospital management team and members of the Integration Joint Board (IJB) as well as the neurologists, geriatrician and PD nurse attended the meeting.

It was agreed to set up more local clinics specific to the more remote and rural areas. It was also agreed that a combined multi-disciplinary clinic with geriatrician and neurologist input supported by the PD nurse, physiotherapy, occupational therapy, dietician and speech and language therapy would be the gold standard service to develop. This model is already established within Aberdeen and we would be keen to replicate this service within Moray.

A primary care facility within Elgin that already houses the community therapy team has been identified as a suitable environment. It has adequate clinic rooms, good parking and is on a bus route. Negotiations are ongoing to develop this service in 2018.