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Spotlight: Primary Care on Skye – Quintessential Healthcare

Over the next few months we will be featuring a number of spotlights on current rural GPs across Scotland.  Dr Steve McCabe works at the Portree Medical Practice on the Isle of Skye and has written the following to give his perspective on rural healthcare…

Portree Harbour

Who am I?

My name is Steve McCabe. I have been involved in rural health for nearly 30 years. But I grew up in Airdrie, a town in Scotland’s industrial heartland and as a child I had no real connections to rural Scotland. The house I lived in stood on a hill. My bedroom was on the southwest corner of the house and it had two windows – one looking south, the other looking west. From the south window at night I could see the sky being “set alight” when the giant steel works at Ravenscraig opened their furnace doors. But from the west window on a clear day I could see the mountains of Arran.

Where am I?

I work as part of a group practice in Portree, the largest settlement on Scotland’s second largest island, Skye. Skye is widely regarded as one of the most beautiful islands in the world. It is one of the few Scottish islands with a growing population and Portree is the hub of island life, a busy wee place.

We also look after the islands of Raasay (pop. 192) and Rona (pop. 2).

The Wednesday commute to Raasay

Why am I here?

I was brought up on the stories of James Herriot (and his idyllic life as a rural vet) and A. J. Cronin’s heroic rural doctor, Dr Finlay. During school holidays my parents took me to rural areas – the East neuk of Fife, the Galloway hills, the Yorkshire dales. I knew from when I was 14 years old that I wanted to be a rural doctor. It is for this reason I went to medical school and nothing there changed my mind. While all my colleagues were jetting off to California or Queensland or Fiji for their electives I was living in an old dairy in the Scottish Borders experiencing rural GP life first hand. As a result I did my GP training in the Borders and subsequently worked as an Associate GP on Islay and Jura during 1995/96 before taking up my current partnership in Portree in May 1996.

Who is our population?

The island has three other practices but ours is by far the largest with 5500 patients – about half the island’s population. On top of that we are currently also dealing with about 1000 visitors each year but these are only a tiny fraction of Skye’s total number of visitors each year which now exceeds three quarters of a million people.

Who do I work with locally?

We have a full complement of primary care staff on the island (and a separate out-of-hours service) and we work very closely with all of them. Of course, just as with rural doctors, there is a fairly constant pressure on the recruitment and retention of community nurses, midwives and allied health professionals.

The Cuillin of Skye

What impact has the new GP contract negotiations had on me?

In its 2004 iteration the GP contract, negotiated at a UK level, had a very negative impact on rural practice in Scotland. It withdrew at a stroke many of the had-fought concessions rural practice had achieved. So, no more distant island allowances, no more rural mileage payments, no more notional lists, etc. Literally overnight we saw our income fall by more than 20% and we have never recovered that deficit.

I worked hard for nearly 17 years on BMA Scotland’s Scottish Council trying to highlight rural concerns and to rural proof BMA Scotland policy. I had hoped that, as a result, a new Scottish GP contract, negotiated in Scotland, would have had rural issues at its forefront. But instead we are told by BMA Scotland that rural is “too difficult to sort” and we have been kicked into a patch of long grass called phase 2.

RGPAS have been excellent at highlighting this iniquitous situation and we must give strength to their arm by supporting them as much and as often as we can.

What challenges do I face engaging in the political process?

None really – it is something I have always done throughout my professional life, driven as I am by a core belief that as GPs we have a fundamental role in local and national social activism. I have even managed to go so far as to have a debate on rural health issues held in the Scottish Parliament. I have over the years widely discussed rural health issues and concerns in national newspapers and on national radio and television. I continue to write a monthly article for a current affairs magazine in which I refuse to pull any punches.

What are my thoughts regarding the future?

I try to live in the moment as much as I can. I absolutely love my job and look forward to going to work every day. I miss it when I am on holiday. For me it has always been a vocational thing and that remains so now more than ever.

But the reality is I will be 53 later this year and I cannot go on for ever. I always said I would stop working as a doctor while I felt I was still at the top of my game rather than fizzle out and fade away. I can see already I don’t have the stamina I used to have and I am increasingly tired after busy days. My memory is also not as sharp as it was – the days of me never having a diary (which I didn’t until my mid-40s – I kept it all in my head and never missed anything) are now gone. So my plan is to retire at 58. One of the main driving forces behind that decision is that I will do my next revalidation at 54 and it will be my last. I regard revalidation as one of the worst things to happen to our profession and I am still sad to this day that we allowed it to be thrust upon us and that we let go of the wonderful model of appraisal we previously had.

And when I do retire I don’t know what I will do – but it will be something completely different…

Bluebell Wood, Portree

 

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Spotlight: Rural Practice on Jura

Over the next few months we hope to feature a number of spotlights on current rural GPs across Scotland.  Dr Martin Beastall works on Jura with his wife Dr Abby…

Life and Work on the Isles of Islay & Jura: Living the Remote and Rural Dream

Who are we?

Jura Medical Practice consists of a husband and wife GP team – myself (Dr Martin Beastall (42)) and Dr Abby Beastall (36). I am responsible for the running of the Surgery on Jura and Dr Abby works mainly at the Bowmore Surgery on Islay, and does one session per week on Jura. Between us, we are also responsible for out of hours care on Jura 24 hours per day, 7 days per week. We came to Jura just over 5 years ago having both worked in and around the Doncaster area in England for a similar length of time. We were both looking for a change, an adventure, and having both worked in large urban Practices, a chance to reconnect with our patients and make a real difference to their lives. We met on the Doncaster GP training scheme in 2005. I had changed from Surgical training, whereas Abby had always intended to train as a GP. Between us, we have a varied mix of skills, perfect for the challenges that Remote & Rural Medicine brings.

Where are we? 

Jura is a large island of approximately 400 square kilometres in the Southern Hebrides, situated to the north east of Islay. Jura has a tiny population (under 250), whereas Islay’s community numbers just over 3000. We are situated directly west of Glasgow as the crow flies. An ill patient can be transported by helicopter to Glasgow in under 30 minutes, whereas a journey by car requires two ferries and takes most of a day to complete.

Why are you there?

Rural General practice brings with it many challenges but also great rewards. We have the opportunity to genuinely provide ‘cradle to grave’ medical care and to be an integral part of our patients’ lives. We are a small but thriving community on Jura. We believe having medical services here is essential for the continued growth and stability of our community and that without continuity and stability, the future of the community overall would be threatened.

Who is our patient population?

The population of Jura matches the overall Scottish demographic, just in miniature. Every age group is represented and the care we provide ranges from baby vaccinations to very personal palliative care for those coming to the end of their lives.

Who do you work with locally?

Being the GP on Jura means being the Doctor, Practice Nurse, Phlebotomist, Health Care Assistant, Paramedic and Pre-Hospital Responder all in one. Flexibility and a willingness to attempt almost any task asked of you is key here. We are lucky to have a dedicated team of carers and District Nurses on the island, and are well supported by allied health professionals based on Islay also. Emergencies are dealt with locally when possible, but a comprehensive support structure exists regionally to provide help ranging from helicopter transport to full blown medical retrieval teams when required.

What is it like having 24 hour a day responsibility for your patients’ health and wellbeing?

Being ready and available 24/7 can be hard psychologically. Patients have direct access to their GP here (rather than using a service such as NHS24) which has its pros and cons. Being able to deal with things locally is very satisfying but it can be hard sometimes to demonstrate to the wider world the time and money saved by avoiding transferring patients elsewhere.

What impact have the new GP contract negotiations had on you?

We have both been very grateful for the efforts made by the RGPAS on our behalf. We feel that as rural GPs we are very much an afterthought. Issues such as the provision of out of hours cover after April 1st 2018 have been very unclear. This has had a destabilising effect on us, exactly the opposite of the stated intended effect of the new contract.

What challenges do you face engaging in the political process?

Being geographically remote and (due to childcare issues) essentially single handed means attending meetings is very difficult given the 24/7 responsibility for patient care. Video conferencing and webcasting still seems the exception rather than the norm. It is easy to feel out on a limb here.

What are your thoughts regarding your future? 

We both remain positive about our futures living on Islay and Jura. We cannot imagine a better community to live in and raise our daughter in, and are hopeful that the new GP contract will enable us to continue to provide the high level of medical care we have done for the last five years for the foreseeable future.

Photos by Martin and Abby.
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