Exploring Skye – what does the future hold for rural GP?

If you think the GP recruitment and retention crisis is the same challenge everywhere, spare a thought for your colleagues working rurally.  There’s a lot to suggest that this stereotypical, rural practitioner is dying away, and it’s a global problem.

Despite the lack of accurate data, the challenges of rural GP recruitment and retention are widely reported. There is a general workforce crisis in General Practice all over the UK, but this is felt even more acutely in rural areas. I’d read about the issues in Scotland and decided to take some annual leave to explore the rugged beauty of Skye and speak to GPs working there to learn what life as a rural GP is really like. I captured a series of short videos, mainly interviewing the incredible, inspiring clinicians practising in Skye. I wanted to dig deeper into what the barriers were for people to consider working rurally, but more than that what made people decide whether to stay or leave once there. And to also try and unpick what was being done to address the problem.

I stayed with rural GP Dr Richard Moss, who had left Yorkshire with his wife with the plan to stay in Skye for a year. Now four years into his adventure, I was keen to find out what made him stay and put roots down here. We also spoke about what a normal duty day looks like, as well as some of the challenges faced by rural GPs. See the video below to find out more.

I also spoke to Al Innes, a GP running the out of hours and emergency dept on the isle (as well as the fracture clinic and 20 ‘acute beds’ – and he showed me around the local Emergency department. We spoke of the ‘full on generalism’ practiced by GPs here.

On the final day I also visited a satellite surgery on the even more remote isle of Raasay (a ferry ride away from Skye) and reflected on what I’d discovered so far.

One of the key things being done to address the problem is the emergence of the Scottish Rural GP Fellowship, which allows GPs to gain the experience needed to be a rural GP – to get a feel for the increased breadth of scope and uncertainty within a supportive environment. I spoke to two GPs who had done the fellowship and had ended up staying working rurally. For them the big draws were community, support, continuity and also the feeling of thriving from a clinical skills/judgement point of view. They felt there was less of the ‘admin burden’, as well as 15 minute appointments. The big challenge was dealing with the remoteness – how would you deal with someone who was very sick, but due to the weather conditions, their evacuation was delayed for an unspecified period of time (maybe days!). Technology (such as remote video links to specialists) helped to bridge that, but the feeling that ‘you are the health service out there’ is palpable.

Organisations such as the SMRC (Scottish Rural Medicine Collaborative) exist to look at the whole picture to help solve the recruitment crisis for rural practice. In addition to the fellowship they are looking at ways to promote and support rural practice as a viable career option for rural students, as well as post-grad medics with the Longitudinal Integrated Clerkships to increase rural exposure in medical school. This will help in the medium term.

The current challenges will continue as the new Scottish GP contract negotiations continue. There is a concern that rural practices may ‘lose out’ as the uniqueness of rural practice is often difficult to measure and therefore recognise, but it is hoped that the next phases of negotiation evolve to appreciate this.

There is much more to living and practicing rurally than the breath-taking scenery. It isn’t for everyone, and the increased complexity and scope, and the ability to ‘do more of what you were trained for’ may be just the tonic for some urban GPs seeking a change.

If you are interested in practicing rurally, check out Rural GP Fellowship and have a more detailed look at the interviews with Sarah and Jess.

If you’d like to read more about my stay in Skye (including more videos), make sure to check out my blog.

Dr Shubs Upadhyay

GP, London

Co-creator, myGPevents
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