Wednesday, 17 December 2014

The Shetland "Hub and Spoke Model" - the Best of Both Worlds

Thanks to Dylan Murphy, a GP Educational Supervisor on Shetland, for this article on GP Training in Shetland, part of our Rural Track programme.

"Shetland has a thriving GP training environment, enabling the GPST to learn the art of General Practice in a remote location without losing the essential ability to complete training capable of independent practice anywhere in the UK.

The Remote and Rural track offers two places a year to GPSTs in Shetland. This is a four year scheme.

The first year is spent in the Gilbert Bain Hospital in Lerwick. The hospital has posts in General Medicine and General Surgery, with the emphasis on "General". The surgical GPSTs will see all manner of surgical pathology, including diverse areas like orthopaedics, for example. The medical GPSTs cover not just a typical general medical intake, but also paediatric inpatients and psychiatry cases. Both medical and surgical GPSTs cover A&E too. The Gilbert Bain Hospital consistently achieves high ratings for its training from registrars.

The second year is spent in various specialties in Aberdeen.

The training really comes into its own in the third and fourth years. The third year is split evenly between General Practice and a 6 month post out of scheme, which can be in any field of relevance to remote and rural GP training. My current registrar is just about to go to rural New Zealand for 6 months. The final year is then spent back in General Practice for the year.

So what is the hub and spoke? Well, Lerwick is the "hub" and there are a couple of remote small practice "spokes."

Lerwick is a thriving town with a population of 8,000. The Lerwick Health Centre has a practice list of 9,200 with 7 whole time equivalent GPs and an Advanced Nurse Practitioner, with further Advanced Nurse Practitioners recruited. The practice covers not just the town itself but the surrounding rural areas and the small island of Bressay which is reached by ferry. A large throughput of temporary residents, such as holidaymakers and oil industry workers, adds to the variety. Enhanced services are provided, e.g. Minor operations, sexual health services.

The Lerwick Practice has two experienced Educational Supervisors. The practice has an above average demand for appointments, leading to plenty of clinical exposure for the registrar. It also boasts possibly the best views from any consulting rooms in the country, but take care to pay attention to the patients rather than the panoramic sea view and the seals on the rocks!

Lerwick by itself, however, would not give the registrar enough exposure to some of the challenges of very remote practice. For this reason, the Lerwick practice has teamed up with some more remote practitioners with small list sizes in remote locations. Experienced GPs in both remote locations provide support for the registrar while they are at the remote practice. The exact amount of time spent at Lerwick and in the remote surgeries is flexible, and would be tailored to the needs of each individual registrar.

There is also the opportunity for the registrar to spend time in GP with Special Interest clinics, and even performing hospital inpatient work with a GP Obstetrician.

The remote surgeries are:
  • Hillswick Surgery - a single handed surgery with about 700 patients, on the northern tip of the Shetland Mainland, about 45 minutes' drive from Lerwick. The practice provides its own out of hours cover.
  • Unst Surgery - An island surgery, connected to the Shetland Mainland by two ferry journeys, with approximately 600 patients. The practice is single handed and provides its own out of hours cover.
Other services available for the registrar to participate in include:
  • Alcohol and substance misuse clinic
  • Dual diagnosis clinic (mental health problems plus alcohol or substance misuse)
  • Community paediatric clinic
  • GP Obstetrics (outpatient and intrapartum) 
Shetland provides the variety only available in remote areas, the bustle of a town training practice and the challenges of remote practice."

So why not consider applying for the rural track program and sampling the stimulating and rewarding career that rural general practice can provide?

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