A great place for a holiday... but a career too? Despite their beauty, the most rural areas of Scotland have struggled to attract enough doctors. Jennifer Trueland finds out how this might be changing
If you go to Fort William, perhaps to take in the majesty of Ben Nevis, or the beauty of Loch Linnhe, you might spot a banner displayed on a building with a vantage point on the Scottish town.
This building is the much-loved Belford Hospital – and the banner urges doctors to come and work there. It’s an unusual recruitment strategy for the public sector but it’s one that the local health board hopes will pay off.
‘Audi or any other car dealership makes use of the opportunities for a visual display – so why shouldn’t we?’ says Katharine Jones, associate medical director for the NHS Highland’s north and west division, which covers some of the most remote and rural areas of the UK.
‘Thousands of people visit Fort William every year for all the great things it has to offer – it’s the outdoors capital of the UK. But unless they know there are jobs available, they might not think of applying to work here.’
Innovate to attract
The banner is part of a wider effort to ensure Belford Hospital remains sustainable for the future, as medical recruitment issues continue to bite.
And it’s also just one example of how rural areas are innovating to try to reverse a trend of rising medical vacancies.
Others include developing new roles, such as: the rural practitioner (essentially a GP with enhanced ‘front-door’ and emergency-care skills); a drive to provide student placements in rural health settings; and efforts to attract people while they are young and making career choices (see ‘The great outdoors’, below).
'I really loved medicine but also the culture and the way of life'
It’s certainly an issue and the situation at the Belford is far from unique. The latest figures from ISD (Information Services Division) Scotland show that the consultant vacancy rate in Scotland as a whole is running at 7.5 per cent, while in NHS Highland it is 10.3 per cent. This rises to 33.1 per cent in Shetland, 25 per cent in the Western Isles and 20.9 per cent in Dumfries and Galloway.
ISD points out that the highest vacancy rates are in boards with rural profiles – and that prospective medical students move to Scotland’s major cities to undertake training.
‘There is an ongoing challenge for boards with a more rural profile to attract them back home once they are qualified,’ ISD says.
Vacancies – particularly jobs that remain unfilled for six months or more – not only put health services at risk and pile pressure on those who are in post, they also have an effect on rural towns and villages, says Dr Jones.
‘The NHS is a significant contributor to the local community. Consultants are relatively highly paid individuals and they contribute to the local economy,’ she says. Short-term locums, on the other hand, usually live – and spend the bulk of their money – elsewhere.
Other health boards covering rural Scotland are also stressing the attractions of the local environment on their recruitment sites. For example, anyone thinking of applying for a job in NHS Orkney will be told that it is ‘truly a wonderful place to live and voted one of the happiest places to live in the UK’.
‘With spectacular natural surroundings, unique wildlife and a rich culture it is not hard to understand why,’ it adds.
Similarly NHS Shetland sells itself on its ‘low pollution, low crime, excellent schools, great leisure facilities, unique wildlife and amazing scenery’, while NHS Dumfries and Galloway talks of ‘an exceptional quality of life’, citing mountain biking, hill walking and great star-gazing opportunities.
At just a couple of weeks into the campaign, there is no indication yet of whether it will pay off in terms of applications from suitable candidates. But Dr Jones points to one case where spreading the word led one family to up sticks from urban practices in Doncaster and move to beautiful Jura.
Dr Martin Beastall took on the role of Jura’s GP in 2013 following a social media campaign run by the local community, telling BMA News at the time that ‘the idea of being a more old-fashioned GP’ appealed to him.
Five years on and he and his wife Abby, who is working as a salaried GP on neighbouring island Islay, have settled into the local community – but are taking action to improve the sustainability of the practice.
‘We are currently in the process of renegotiating our out-of-hours service,’ he says.
‘This was partly prompted by the formal separation of core and out-of-hours work in the new GP contract, but we would have had to change something even if the contract hadn’t changed, as more than five years of 24/7 responsibility has been quite tough on our family and personal lives.
‘Our new system will come into place in January, and we’ve been working hard to engage with our community during the redesign process.’
'Give people a flavour of working in a rural environment early in their careers'
Dr Jones is herself a case in point. Formerly a GP partner in Liverpool, she and her family moved to Scotland 18 months ago after she spent some time working as a locum on Scottish islands.
‘I loved it,’ she says simply. ‘I really loved the medicine, but also the culture and the way of life.’
Although she now holds a managerial job with the health board, she still does ‘some GP work on the side’, as she puts it. ‘Working here has really reignited my interest in clinical medicine,’ she says.
She cites a Japanese concept called ikigai, which essentially means finding a life where you are in the right place, doing what you love and what the world needs – and, ideally, being paid for doing it because it is your job.
‘There are people out there for whom this will be the job they want to do because they love it. We look forward to welcoming them to Highland.’
The great outdoors: rural life can enhance doctors’ careers
In her years at medical school in Edinburgh, Eilidh Urquhart worked in numerous clinics, wards and operating theatres.
But it was the work experience as a schoolgirl in her local hospital, Raigmore in Inverness, that has really stuck in her mind.
She was in the first cohort of an organised Doctors at Work programme, a five-day placement for secondary-school pupils in Highland who are considering a medical career.
'Give people a flavour of working in a rural environment early in their careers'
The idea is to encourage local teenagers to apply to study medicine, give them some practical experience, which will help with the application process and, ideally, will be minded to come back and work in the area when they graduate.
‘I remember going to theatre and watching a hip replacement. Now orthopaedics aren’t really my thing, but it was amazing to see it happening.
‘The work experience confirmed for me that I wanted to be a doctor – that I wanted to do it for the long term.’
That week back in 2012 was one of the deciding factors when Eilidh, or, as of this year, Dr Urquhart, was applying for her foundation training.
‘I had studied in Edinburgh and the hospitals were much bigger. That suits some people, but I found that Raigmore, being smaller, was friendly and supportive and better for me.
'The Doctors at Work programme helped me understand what it means to be a doctor, and it also helped me with my application as I was able to discuss what I had seen and learnt when I was writing my personal statement and taking part in interviews.’
For Dr Urquhart, who hopes to pursue a career in paediatrics, the rural setting has another advantage. ‘It’s great being so close to the outdoors. I grew up in the mountains and on boats, and it’s good to be back.’
She also thoroughly enjoyed a placement at Fort William’s Belford Hospital. ‘I got far more clinical experience there than anywhere else and saw much more than I did in Edinburgh,’ she adds.
BMA Scottish consultants committee deputy chair Quentin Cox, a consultant orthopaedic surgeon at Raigmore, is strongly supportive of the work-experience scheme and other initiatives to encourage people to work in Highland.
‘If you can give people a flavour of working in a rural environment early in their careers, then they are more likely to consider it as a place to work,’ he says.
He points out that around a quarter of the clinical training of Aberdeen University medical students takes place in Inverness, and that a specific rural strand is oversubscribed.
The Doctors at Work programme has been a success, says Mr Cox.
‘It allows students to demonstrate that they have had contact with the NHS, and it really does give them a view of what happens in hospitals.’
Find out more about the Doctors at Work programme
The story so far
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