General practitioner Scotland

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Rural healthcare: the land of opportunity?

Fed up with urban English general practice, two doctors find sanctuary on the Scottish Isle of Jura — one of the regions where local residents are taking GP recruitment into their own hands

Martin Beastall quite happily confesses that until he saw a video on the BBC website last year he had never heard of the Scottish Isle of Jura — not even the whisky which bears the same name.beastall

Yet several months later he, his wife and infant daughter had moved from Doncaster, where he had been working in a 10-partner practice with 16,000 patients, to take over the local GP surgery (single-handed, 196 patients).

It was a huge boon for the island community — they had been two years without a permanent GP — and pretty good for the Beastalls (pictured right) too.

‘The idea of being a more old-fashioned GP appealed to me, of being part of people’s lives and seeing children grow up,’ he says.

‘I was also becoming dissatisfied with urban, English general practice. I didn’t like the changes being forced on the English contract by the Health and Social Care Act and I felt the Scottish government was more sympathetic to general practice.’

Resort to the web

That Dr Beastall found out about the post, and that Jura existed, was down to the determination of the local community.

Fed up that the health board’s traditional means of trying to fill the vacancy weren’t working, the islanders took matters into their own hands and turned to social media. The resulting campaign on Facebook and elsewhere attracted the media’s attention, and led to Dr Beastall’s appointment.

He, his wife Abby, who is also a GP, and baby Zoe moved to the island in February, taking up residence in the tied house next to the surgery.

When Abby Beastall finishes her maternity leave, the plan is that the two will share the job, potentially offering a wider range of services than would be possible for one GP alone.

The price of change

Inevitably it will mean a financial hit for the family, but Dr Beastall says the advantages of their new life make up for it — particularly being a stone’s throw from home and being able to spend time with Zoe.

Being on-call pretty much 24 hours a day, seven days a week, is often cited as a reason why remote and rural practice vacancies can be hard to fill.

Dr Beastall admits that it was something he had to think long and hard about, but says the actuality isn’t as daunting as the prospect had seemed. ‘You have to be the right sort of person,’ he says. ‘But most evenings you don’t get called at all.

‘At first I felt quite tense thinking the phone was going to ring, but actually, you know when someone isn’t feeling right if you’ve got your finger on the pulse, so you have a pretty good idea of who might be ringing you and what might be wrong. And people know they’ll be able to get an appointment the next day if they need to, which also helps.’

Reclaim life

A better work-life balance had been one of his priorities when he decided to shift to general practice — initially he’d been on a surgical training course.

It seems as though he has found it on Jura. ‘I walk to work for 8.30am, do some paperwork, then surgery runs from 9am to 1pm — there are nine appointment slots.

Doctor wanted signHe then spends the afternoon carrying out home visits and attending local events including a regular lunch for older people.

‘There are challenges: there’s no phlebotomist and no practice nurse, and blood tests have to be done in time to be picked up by the post lady. You have to watch the weather because if the ferry isn’t running then you can’t do blood tests.’

Being a dispensing GP is also a new challenge, he says, along with the realisation that if he didn’t clean the surgery windows, they wouldn’t get cleaned. ‘There’s no window cleaner on Jura,’ he laughs, adding that he does the vacuuming as well.

If Jura has finally found a permanent GP, other remote and rural communities aren’t as lucky.

Hire and retain

Applecross in Wester Ross — which is just about as remote as you can get on the mainland — has also turned to Facebook in an attempt to attract a resident doctor.

The community had a disappointment last year when they thought they had found one, only to have the candidate pull out at the last minute.

An NHS Highland spokesperson says the health board is discussing ways of ensuring future medical services and hopes to explore these ideas with a small number of applicants who have shown an interest in the post. She adds: ‘We are clear that for many reasons — including training, revalidation, governance and, importantly, personal — recruitment and retention is challenging and even where recruitment is possible, the continuation of traditional models of GP practice provision in remote and rural areas is no longer deemed to be desirable or safe.’

BMA Scottish GPs committee deputy chair Andrew Buist, who leads on rural general practice, says that filling vacancies is a challenge, particularly at a time when GP morale is being hit by years of pay freezes and attacks on pensions. ‘Practices in deprived areas and rural areas will always be hit first,’ he says. ‘That’s where you see the first signs of recruitment problems.’

Dr Buist has personal experience of remote practice. Last year he worked on the island of Colonsay when on sabbatical from his usual practice in the small town of Blairgowrie in Perthshire. ‘There are unexpected challenges,’ he says. ‘For example, mobile phone reception can be an issue. I remember being worried about just nipping out to the shop to get a pint of milk in case I missed a call.’

Network of buddies

He believes that there are advantages in ‘buddy’ relationships between rural and other general practices, whereby practices ‘adopt’ each other and the urban GPs take turns at providing locums for their remote colleagues. 

NHS Highland is working on a proposal to give ‘reassurance’ to rural communities that there are ‘robust and sustainable’ arrangements for health services. A report is expected to go to the Scottish government at the end of the summer. 

According to the government, the proposals are expected to have relevance to all remote areas of Scotland, but will not be a prescriptive blueprint as ‘successful solutions will be grown from local need’.

On Jura, Dr Beastabeastall 2ll is looking forward to summer by the sea. Any regrets for the old life?

‘Back in Doncaster I’d have been working from 7.30am to 6.30pm.

‘Here I can walk to work, get home for lunch, enjoy the wildlife and the scenery, and spend time with my daughter. It’s great.’