Thursday, 7 August 2014

The Joy of Rural Practice

In a recent article in Pulse magazine Dr Naomi Reifenberg explains how the challenge of being a half-day’s travel from the nearest hospital is outweighed by the rewards of a varied workload.  Naomi is a single handed GP at Hillsgarth Surgery on Unst in Shetland.  She has a list size of 600 patients.

"Working on Unst provides great professional satisfaction. Our work is varied and challenging, and GPs get to use the whole gamut of their medical skills from good bedside manner to emergency medicine. We’re on call for all emergencies and look after patients all the way to the helicopter – or the mainland if necessary.

Distances between services are a problem. Agencies such as Women’s Aid and drugs and alcohol services are based in Lerwick, Shetland’s main town, which is two hours’ drive away, and patients have poor access to the range of services that the average practice would be able to provide. But we know all our patients well and we offer the advantage of great continuity of care.

Confidentiality is a major challenge. We have a system that ensures staff don’t have to handle any records or results that relate to their families or close friends. Having two part-time practice managers allows them the option to take over from each other when confidentiality becomes an issue, and we also offer patients the chance to specify that only a GP or nurse can read their records.  Staff consult with the doctor on the neighbouring island of Yell if they have a problem that they wish to keep confidential.  

We don’t have to compete for funding in the way practices might have to down south however, we need to budget for equipment like centrifuges and for near-patient testing because we are such a long way from hospitals and pathologists. We don’t get the economies of scale that big practices get, but we find ways to reduce costs.

Technology helps us deal with the problems of remote medicine.  We stay in touch with other GPs in Shetland by using videoconferencing equipment. We offer review appointments with consultants via video link, as well as with the A&E department if we need help treating an unusual injury. It takes a day to travel to hospital in Aberdeen and back, so if the appointment’s only supposed to be 10 minutes this saves patients time and saves the health board money.

Temporary patients are taking up more appointments at our practice.  Shetland and Unst are attracting more tourists and particularly in the summer months we face a rise in workload. Last week, we had three temporary patients during one morning session. Non-local patients usually attend for acute problems or minor injuries, but they often want to discuss chronic problems or general health ‘while they are here’. But we don’t get reimbursed for treating them, and this takes up time we should be spending with our own patients.  We haven’t found a way to deal with this rise in attendance yet, but at least we’re helping patients who struggle to see their GP at home – as well as taking casework off the shoulders of our southern colleagues.

GPs in this environment love what they do.  It used to be that the islands were a second choice for new GPs, who came only when they couldn’t find a position in towns and cities. But now GPs can see the attraction of rural practice – particularly those who are looking to get out of mainstream general practice and go back to more traditional family medicine.

We usually find prospective GPs through word of mouth or candidates get in touch directly. We recently had a GP spend a couple of weeks with us on sabbatical, which helped a lot.

There are advantages to having a small pool of candidates for vacancies.  Our practice staff are often overqualified (our receptionist has a PhD, for example) and we also have the advantage of knowing most candidates in a personal capacity before we recruit them. That said, we obviously have fewer candidates to choose from."

You can read her article here .  Article reproduced by kind permission of Pulse

So if you are interested in following in Dr Reifenberg's footsteps why not apply for our Rural Track GP Training Scheme when applications open in the November. We have rotations based in Shetland, Orkney, Western Isles, caithness, Fort William and Oban.

And for those wondering where Unst is!!

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