Holistic primary care in the Hebrides
The islands of Benbecula, North Uist and South Uist are connected by causeway, home to around 5,000 people. The Atlantic stretches out to the west, with miles of white sandy beaches. On the east side, ancient mountains protect remote glens. Wildlife, archaeology, traditional lifestyles and arts, outdoor adventure and community life all make this a stimulating place to live.
There are three practices on the three main islands; Benbecula Medical Practice is a dispensing practice based on the central island. In addition to providing primary care services, we also provide medical cover to St. Kilda, the rocket range, and the airport.
We cover the 16 bedded community hospital as well as providing some of the out-of-hours. The hospital hosts visits from consultants, and has good support from larger hospitals elsewhere. Patients requiring specialist input are airlifted off the islands. This provides a wide range of educational opportunities, and has enabled previous students to reflect on their clinical strengths and enthusiasms away from pressure to conform with university careers pathways.
Each year, we aim to take one medical school applicant, one or two FY2 placements/GP trainee rural taster weeks. We are also a placement for the Rural fellowship, and can take students for part of their elective block, shared with a neighbouring practice. More detailed information is available about the GP Rural Fellowship from the NES rural fellowship page.
We will only consider applicants for placements who provide us with a letter setting out some clear learning objectives relating to our practice setting and workload. The letter can be attached to an email, and should include the name of at least one referee from their medical school.
The High Island
The Orcades Practice, formed in 2015, is a virtual group practice covering six of the outer islands of Orkney. The Hoy Branch covers the most southerly islands – Hoy & Walls. That’s a practice of 420 residents and thousands of summer visitors who come for the walking, the bird-watching, the WWI & WWII archaeology, the sunshine and the peace and quiet.
We have a purpose-built health centre and a small team providing 24/7 primary, community and emergency care. Our nearest hospital is 90+ minutes distant depending on the ferries and the weather. We are sometimes busy and sometimes quiet but always have time for discussion, reading and thinking. We share learning and experiences with our colleagues on the other islands via video-conferencing.
Web link: www.hoydoc.co.uk
The Remote Far North-West
A single-handed practice of 640 patients with GP doing 24 hour cover and attending all medical and trauma emergencies. 100 miles from the nearest A&E and 25-50 miles from neighbouring practices. Rural fellows come here for single-handing experience plus Hippokrates exchange doctors from Europe for 1-2 weeks observation.
We are a friendly rural training practice in the North East of Scotland providing the usual range of medical services plus covering a small cottage hospital. We train students and GP trainees . We provide care to isolated farms and the town of Forres and also cover the Findhorn foundation, an alternative eco community. One of the doctors is part of the Cairngorm mountain rescue team and the GPs in general are an active lot.
The Outdoor Capital of the UK
The Lochaber, Skye and Wester Ross area is part of the North and West Operational Unit in NHS Highland. Lochaber is the natural geographical area in the West Highlands which is centred on the town of Fort William, which acts as the administrative and medical hub for a diverse group of remote and rural communities encompassing the communities of Fort William, Spean Bridge, Roy Bridge, Fort Augustus, Ballachulish, Glen Coe, Ardgour, Lochaline, Ardnamurchan peninsula, Mallaig and Arisaig, Knoydart and the islands of the Inner Hebrides.
The local cultural identity is enhanced by the mountains, islands and musical tradition of the area. It is recognised as the ‘Outdoor Capital of the UK’ with access to the complete range of outdoor sports. Tourism, fish farming, forestry, crofting, fishing and aluminium smelting are the economic drivers in addition to good quality public services from the NHS, Education and local authority.
The Belford Hospital, Fort William is a Rural General Hospital with Consultant lead services in medicine, surgery and anaesthetics. The clinicians work within managed clinical networks with other specialists throughout Scotland. There are ten general practices in the Lochaber area which gives the Lochaber Rural Fellowship post unique access to the complete range of remote and rural general practices, from large health centre to rural dispensing practices and the remote practices of Lochaline, Ardnamurchan and Eigg.
There may be on occasion the need to support either the Torridon Medical Practice, which is a 1 WTE rural practice covered by two half time GPs covering a list size of 430 patients with no on call, and Applecross Medical Practice which is a single handed practice with a list size of 240 patients providing on call or potentially some of our salaried practices on Skye such as Carbost, Sleat and Broadford, and Glenelg Medical Practice which is just off the Island, who have the additional input and support from The Mackinnon Memorial Hospital based at Broadford.
The North and West Operational Unit are currently looking to build a Rural Support Team of Doctors and Emergency Nurse Practitioners, who can support some of these fragile rural communities by providing the most appropriate form of healthcare. It is anticipated that the Rural Fellow will form part of that Rural Support Team, hence flexibility is imperative.
Photo by Bernard Blanc, used under Creative Commons licence
One of Scotland's top tourist destinations
Skye is a fantastic place to combine work and an outdoor lifestyle, and we feel privileged to be paid to combine such diverse and stimulating work with living in such a beautiful environment.
Skye provides all manner of outdoor activities, from the infamous Cuillin mountaineering ridge, to coastal walks, sea kayaking, cycling and it is a photographer’s paradise.
Broadford provides the central services for the south of the island, with a supermarket, primary school, pharmacy, hotels and a couple of restaurants, and was even recently listed as one of the top 10 places to live in Scotland by The Sunday Times!! Portree is the island’s ‘capital’ – just 25 miles North of Broadford, it provides further shops, restaurants, and a cinema.
The Skye acute rural fellow post is to be based in the Mackinnon Memorial Hospital, Broadford, Isle of Skye. Mackinnon Memorial Hospital is the referral centre for acute medical services for the Isle of Skye, Raasay & adjacent mainland Lochalsh. It is a unique Community Hospital providing 20 intermediate care beds, surgical theatre, midwife suite, radiology unit, outpatient clinic facilities, chemotherapy facilities & a fully equipped emergency resuscitation room.
The rural practitioners accept everything across the spectrum for initial assessment. Admissions to MMH are those appropriate for a unit covered by up skilled generalists rather than specialist consultants, with more complex cases being transferred to Raigmore Hospital, Inverness, some 100 miles away. Resuscitation, stabilisation and emergency transfer of acutely unwell & trauma patients also falls within our scope and remit and all RPs have undertaken training in airway management and transfer of critically ill patients, usually liaising closely with the EMRS (emergency medical retrieval service).
Mackinnon Memorial Hospital is also the primary focus for out of hours care for the Skye and Lochalsh primary care general practices and so, out of hours, the RPs are involved in consultations and visits to primary care patients as required, in conjunction with their hospital commitment.
As an acute rural fellow, you will work alongside the rural practitioners (GPs with additional training in acute care) – their role involves dealing with the full range of varied A&E work, primarily medical and surgical inpatient care with the occasional paediatric and obstetric care; they also support the visiting surgical service, and provide out of hours care for the Skye & Lochalsh primary care general practices.
Photo courtesy of Pelle Sten, under Creative Commons licence
Spanning all aspects of emergency care
Amongst the greatest concerns of the prospective rural general practitioner is the potential for encountering acute emergencies or covering medical services without specialist support on-site.
As a fully trained general practitioner, each Fellowship applicant has the skills necessary to deliver generic rural general practice, but confidence with the challenges of acute pre-hospital medicine/trauma/surgery may be daunting and the ability to gain further experience in these extended roles may be quite limited in the current provision of medical training.
As a hospital based acute care fellow, you will experience frequent exposure to patients with acute conditions and manage the first few hours of acute illness and injury in a supportive environment with hands-on involvement and responsibility to allow skills and confidence in managing such cases to evolve at a rapid rate. The acute competencies have been scoped against the specific needs of the Remote & Rural General Practitioner recognising that in real life there may be the requirement to perform some relatively uncommon interventions of a time-dependent nature. For example, this might be thrombolysis for myocardial infarction or stroke, or the insertion of a chest drain amongst many others.
This is an exciting development in training developed by NES and the Remote and Rural Fellowship programme, now extended to include rural general practices in Moray and a rural District General Hospital – Dr Gray’s Hospital in Elgin.
Photo courtesy of Robert Linsdell under Creative Commons licence
Near to both the Highlands and the Central Belt
The Fellow will spend the year working within two practices in rural Tayside. The base practice will be the merged practice of Aberfeldy and Kinloch Rannoch and the fellow will work with The Comrie Medical Practice. Both Comrie and Aberfeldy and Kinloch Rannoch are training practices. Comrie, an ex inducement practice with 2.5wte partners has admitting rights to Crieff community hospital. Aberfeldy and. Kinloch Rannoch is a merged practice based over two sites with 4.25wte partners. Kinloch Rannoch is a remote dispensing practice in the North West Perthshire where normally a GP works single handed. The Fellow will also be encouraged to engage in an ‘intermediate care’ role in both Aberfeldy and Crieff community hospitals, In addition to developing an interest, of mutual benefit to personal development and the service.
Comrie has a practice population of 2400 and Aberfeldy and Kinloch Rannoch have a practice population of 4550. Both areas are popular tourist destinations, and have a much increased population in summer months.
Photo courtesy of Stu Smith, under Creative Commons licence.
Scotland's best kept secret
West Galloway is a wonderful rural environment, from unspoilt beaches up to 10 miles long, water sports of all kinds and a marina. It is close to the Galloway Hills where there are fabulous cycle tracks and many walks through forest trails or to the wilderness of the Galloway Mountains, the highest of which is Merrick at 843m, which is the knuckle of a wilderness mountain range called “the awful hand”.
Galloway Community Hospital is GP not consultant led. The hospital practitioners are GP trained, and are supported by on-call anaesthetists, highly trained nurses, nurse practitioners and visiting specialists.
The hospital provides accident and emergency, chemotherapy and dialysis services, maternity care, general medical beds (20 beds), and Day surgery beds for low risk surgical procedures(12) (performed by the visiting surgeons). 24 hours X-ray and laboratory services are available, and there is a CATS on site.
Hospital practitioners provide accident and emergency cover, and lead care in medical and surgical wards.
The hospital averages 16,000 emergency attendances annually, and 1400 admissions.
Photo courtesy of David Shephard, under Creative Commons licence
Work and live in an exceptional environment
The Cowal peninsula is situated in the west of Scotland, around and hour and a half drive from Glasgow.
Cowal is part of NHS Highland Argyll and Bute Community Health Partnership, covering a population of around 22,000. The main referral centres are Inverclyde Royal in Greenock for general secondary care, Argyll and Bute Hospital in Lochgilphead for psychiatry and Royal Alexandra Hospital in Paisley for maternity and paediatrics.
Cowal’s exceptional natural environment is a paradise for outdoor enthusiasts, inspiration for artists, a joy for food lovers and a haven for wildlife. Bordered on three sides by spectacular sea lochs and in the north by mountain, forest and glen, Cowal is a peninsula of outstanding scenic beauty and cultural heritage.
For such a small part of Scotland, there is an amazing contrast in the landscape throughout the Peninsula. North
Cowal is distinctively rugged and remote, with Loch Eck surely one of the most breathtakingly picturesque stretches of
water in Europe. South East Cowal is the home of Cowal’s only major town, Dunoon, the location of amazing historic
botanical gardens with a coastline indented with sea lochs and peppered with many lively small communities. South West Cowal is “Argyll’s Secret Coast”, a remote and beautiful stretch of Cowal Coastline taking in the spectacular Kyles of Bute and the picturesque town of Tighnabruaich. It is a great area for outdoor activities, especially sailing, as well as excellent hospitality, yet is less than two hours from the central belt of Scotland.
For more details visit: NES Scotland
Picture by Ian Robertson, used under Creative Commons licence
Healthcare covering one whole corner of Scotland
The North area is part of the North & West Operational Unit within NHS Highland. The North area manages community health and social care services in Caithness and Sutherland for around 38,137 people across 7,882 square km.
We also provide some acute services, including a wide range of out-patient and in-patient services at our local hospitals. Caithness General Hospital in Wick is designated as a Rural General Hospital and has consultant-led surgical, medical and obstetric and gynaecology teams. Services available include A&E, Assessment & Rehabilitation, General Surgery, General Medicine, Obstetrics and Gynaecology, Palliative Care, Renal Unit, CT Scanner and Theatre. A wide range of associated services are available including Day Surgery, Dietetics, Physiotherapy, Occupational Therapy, Radiography etc. There are also a wide range of visiting services from Raigmore Hospital, Inverness.
In addition there are four GP led Community Hospitals: Wick Town & County, Dunbar Hospital, Thurso, Lawson Hospital, Golspie (including the Cambusavie Unit) and Migdale Hospital, Bonar Bridge. As well as 17 GP practices, there is a wide range of community services including community nursing, mental health services, allied health professionals, community dental and community pharmacy.
The area has a very varied landscape from mountain to the lonely flow country and some spectacular coastal scenery, which will appeal to someone who loves the outdoor’s. This post offers the opportunity to live and work in some of the UK’s most beautiful and unspoilt countryside.
Photo courtesy of Gary Sutherland, under Creative Commons licence.
A great place to learn
Arran is a unique place to work and live. It is the seventh largest island in Scotland, home to mountains and 57 miles of coast, and covers an area larger than Greater Glasgow. Our population of around 5,000 quickly increases to a peak of over 20,000 during the spring and summer months, which keeps things rather busy.
Primary health care is delivered by Arran Medical Group, from three surgeries and four branch surgeries, by a team of more than 40 clinicians and administrative staff.Hospital care is provided at Arran War Memorial Hospital, which the GPs are also involved with. There are visiting consultants for some clinics, and we enjoy good links with our colleagues at Crosshouse and Ayr Hospitals for advice and transfer of particularly unwell patients. There are close links between all multidisciplinary teams, from mental health to social work and education.Working on Arran demands generalist skills. As a GP, you could quite literally be seeing a patient with diabetes one minute, and attending a road accident or applying a plaster cast the next. The island is rich in learning opportunities, and we’re keen to make this available for those who are studying or training – both in nursing and medicine.
Most of our students come from planned placements but each year we are able to take on a handful of elective students. More detailed information is available about the GP Rural Fellowship from the NES Rural Fellowship page.
Photo (c) David Hogg
A rural archipelago
Orkney is an archipelago of islands with a total population of 20,000. In 2010 NHS Orkney created an Isles Network of Care designed to deliver high quality health services to nine outer isles communities and to support the practitioners providing the services. Primary care services on these islands are delivered by either GPs or Nurse Practitioners. Successful Rural Fellow applicants to Orkney will provide backfill cover to the permanent GPs on these islands to allow the incumbent to take annual or study leave and spend time working on the mainland of Orkney.
The Rural Fellows will therefore provide an important element to the Network of Care. Whilst providing services on the outer isles the Rural Fellow will be supported by the Network of Care, which will include, the Fellow’s base location, the local community, the Primary Care OOH service and 24-hour emergency support from the Balfour Hospital in Kirkwall. The positions have been designed so that individuals can gain experience of remote single-handed practice whilst always being confident of support from experienced practitioners.
The document “Isles Network of Care” provides further information as to how the system works.
The Balfour Hospital, Kirkwall is designated a Rural General Hospital with Consultant-led services in Medicine, Surgery, Anaesthetics and Obstetrics and Gynaecology, along with other nurse led services such as cancer & palliative care (including the local delivery of chemotherapy), rehabilitation and renal dialysis. The Balfour Hospital enjoys particularly
close working relationship with Aberdeen Royal Infirmary. The Balfour Hospital also has two full time Rural Hospital GPs and two Rural Track GPST posts.
Over recent years NHS Orkney has taken an active role in pioneering new ways of delivering healthcare to a remote and rural community. Videoconferencing is used routinely in clinical, educational and managerial settings.
Photo by She_Who_Must (creative commons licence)
GP Rural Fellowship, GP Trainee Taster Weeks, GP Training, Student Elective, Student Placements
Student Elective, Student Placements
GP Rural Fellowship, Hippokrates
GP Trainee Taster Weeks, GP Training, Student Elective
GP Rural Fellowship
GP Rural Fellowship
GP Rural Fellowship
GP Rural Fellowship
GP Rural Fellowship
GP Rural Fellowship
GP Rural Fellowship
GP Rural Fellowship, GP Trainee Taster Weeks, GP Training, Student Placements
GP Rural Fellowship