New, innovative health care model for the Small Isles

The Nuka Health care model, Scottish Island style

A new health and well being centre for the Small Isles

Residents of the Small Isles of Eigg, Muck, Rum and Canna have a brand new health centre – and a new way of delivering healthcare to these remote communities.

A team from NHS Highland had been working on the conversion of the former doctor’s house on Eigg into a health and wellbeing centre.

Eigg’s newest resident, three-week old Bryn Lovatt, officially opened the facility on Friday 27 May during a special Community Health Fair on the island that brought residents of Eigg, Muck and Rum together.

The Health Fair was organised by the three Eigg Community Health and Social Care workers, appointed as part of the new health care system in place in the Small Isles, which is modelled on the Alaskan Nuka system.

NHS Scotland “Being Here” Nuka model

Director of operations for NHS Highland’s north and west operational unit, Gill McVicar, said: “Today is the celebration of work NHS Highland has been doing with residents of the Small Isles for a few years.

“The resident GP on Eigg passed away three years ago, and we needed to review the model of care for the people of Eigg, Muck, Rum and Canna. It provided us with an opportunity to do something different.”

The model which NHS Highland and the residents settled on is one that is inspired by another remote community – only several thousand miles away.

“We worked with the community to find exactly what they needed, and we’ve put in a model of care that is developed from Alaska,” Mrs McVicar explained. “The Nuka model of health and care services was created, managed and owned by Alaska Native people.

“The approach has been designed to bring about results by communities working together to achieve positive outcomes. We identified and trained four health and social care support workers based within the local communities to deliver health care to people in the Small Isles. There are three based on Eigg and one on Muck.

“We borrowed the Alaskan community health aid model from the South Central Foundation’s model of care and developed it here in Highland. There are five levels of training they can undertake, ranging from basic to advanced, and the beauty of it is that it is delivered by people living in these communities. They know the people they are treating, and they are more likely to remain within the community for longer.

The health and social care support workers are part of an extended integrated team that is supporting them from the mainland. “They report to the integrated team leader in Mallaig and medical care comes from Skye using our Rural Support Team model,” explained Mrs McVicar.

“We have three GPs that visit all of the islands on a regular basis. They travel to Eigg every week, and twice every second week, and visit the other islands every fortnight. Using this model, we have been getting to know the health needs of the populations and working with them to deliver sustainable high-quality healthcare.”

Community engagement through action research 

It was the potential of the Nuka model of care that finally convinced residents to get on board with this innovative and creative way of working.

“We couldn’t imagine any other way of working than having a resident GP,” explained chair of the Small Isles Community Council, Camille Dressler ( who is also chair of the Scottish Islands Federation).  “We had to go through the process of exploring every alternative available to us.

“In doing so, we began to realise that the way GPs work has changed in the last 30 years. They are now very much part of a team, and the turning point was when we started to look at the Nuka model in a deeper way.”

Mrs Dressler continued: “We liked the idea of having more community involvement and more say in how our care is delivered. The new model – Being Here- is the subject of an Action Research process, and we feel happy that we have been able to give our feedback throughout the process.

We may have lost a resident doctor, but we are gaining access to more services. Emergency care is still an issue that we want to work on as we feel that our First Responders are in  a unique position and should have access to some of the training that Emergency responders receive, but we are working on this.

I’m very happy that NHS Highland has committed so many resources and is committed to new ideas and innovation because we think this is where the future lies for rural medicine.”

A new way to look at health 

It was a busy day on Eigg, as the Small Isles Community Health Fair was also held on Friday to mark the opening of the new health centre. A series of NHS Highland healthcare professionals travelled to the island to deliver basic health checks, smoking cessation clinics and heart health sessions to the residents.

Islanders also provided head massage sessions, qi gong tasters, a wild life walk , a singing group session and a chance for everyone , and especially the school children to have a go a making green smoothies using the Smoothy bike.  “Well being is a wholistic concept” explained Berni McCoy who is one of the three community Health workers on Eigg. “we wanted the island children to be there and enjoy the day as well, and what better way to engage them than to get them to pedal hard to make a healthy treat! ”

Comments from the Alaskan guests.

The senior medical director for quality improvement and chief medical informatics officer for the South Central Foundation, Dr Steven Tierney, was a special guest on the day, with his wife Michelle who is the Foundation’s director.  He was delighted to see the impact the Nuka model of care is having thousands of miles from home.

“We have collaborated with NHS Highland for some time now, and we found that we have so many similarities in terms of recruitment and retention of medical professionals in remote and rural communities,” he explained.

“One of biggest challenges in Alaska was finding GPs to work in such isolated communities – in some cases they would require a six-hour flight to get to these communities.

“We decided to train people from within the communities to deliver basic healthcare, as they are adapted to the lifestyle of living in remote and rural Alaska, and they will remain in the community.

“It’s wonderful to have been invited to the opening of the Small Isles Health Centre and to see such community empowerment. The people of the Small Isles deserve a lot of credit for their resiliency and for embracing new ways of working.”

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