Rachael Crawford is a Rural Fellow working with NHS Highland as a GP in Sutherland. In this article for NHS Highland she describes her day as a rural GP
I usually wake before 7am and leave the house just after 8am depending on where I am working that day. I work for NHS Highland as a Rural Fellow through a scheme promoted by NHS Education Scotland designed to give newly-qualified GPs a taste of life and work in a rural setting. I am attached to Brora and Helmsdale surgery in Sutherland for most of the time, but for several weeks during the year I get to travel further afield and work in more remote practices, which includes Durness and Kinlochbervie/Scourie.
Morning surgery starts at 8.30am, initially with a number of urgent or ‘on-the-day’ appointments and then with routine appointments until around 11am. Following morning surgery, I try to grab a coffee from the staff room and sift through the triage, which involves dealing with medication requests, prescription authorising, doing sick notes, telephone consultations and seeing any extra patients who have been unable to get an appointment if all the slots are filled for the day. Depending on numbers, this can take up to a couple of hours as there’s only one doctor on site (except Mondays, when there are two). It is different in North West Sutherland, where due to lower patient numbers we have less demand for appointments and more time is spent being on call for emergencies.
Most days there are home visits to do: one or two a day in an average week. The length of time spent visiting patients can vary depending on the nature of the visit and the patient’s location. I’ve realised that a unique aspect to rural general practice is the disordered arrangement of crofts. I’ve not yet discovered the navigation formula for this! The challenge is usually overcome by phoning the patient for directions, unless there is no mobile reception of course.
Lunch is usually had at some point between 12 noon and 3pm. As a GP in a rural practice, I am required to attend any ambulance call-outs, which can occur at any time of day and take priority over other clinical activities. When I’m working in Durness or Kinlochbervie, the ambulance may be a couple of hours away, as is the hospital itself (Raigmore Hospital is up to three hours away or more by road ambulance), and so the responsibility is solely on the doctor to treat the acute medical/surgical problem, at times employing air ambulances if needed.
Compared to working in inner-city practices where the receiving hospital is only a short distance away, spending time working in these areas of Scotland has been a very rewarding and an enjoyable challenge for me. I’ve felt equipped to deal with this added responsibility, having had the chance to attend pre-hospital emergency care courses run by BASICS Scotland, the study leave and budget for which was provided by NHS Education for Scotland through the Rural Fellowship scheme. Additionally, the Sandpiper Trust enables me and other doctors in rural areas of Scotland to have a kit bag of emergency medical equipment to carry with me in the car.
Afternoon surgery starts at around 3pm and usually the last patient is seen just after 5pm. During the afternoon, in addition to routine face-to-face appointments, any further urgent cases are added to a triage list for the GP, and if necessary these patients can be seen before the surgery closes at 6pm.
After surgery ends and all the patients are seen for the day, time is then spent doing admin-type tasks, such as patient referrals. We have 15 minutes allocated per routine consultation, which can allow time to do any referrals immediately after the patient leaves. Otherwise I tend to type and send mine at the end of the day.
Admin also involves looking through all of the mail that was received by the practice that day. This includes test results from the laboratory (the majority of which are blood tests), if necessary acting on the results, for example if the patient needs any follow-up treatment, etc. All correspondence received from hospital consultants and other healthcare professions relating to patients is sent to the GP and must also be dealt with, be it simply filed in the patient’s medical notes or new treatments initiate. This workload varies and can take anywhere one or two hours.
I usually leave work anytime between 6.30 and 7pm. Some days it can be later and so I find it hard to commit to anything in the early evenings. I used to enjoy going out for runs and exercise classes. However, by the time I have dinner it can be after 8pm but when it is dark and cold out I sadly lack the motivation to do anything except watch DVD box sets!
I love living and working in the Highlands and am very much looking forward to the longer and lighter evenings to be able to get out and enjoy it more.