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CAMHS won't see you now

CHD framework may have widened age inequalities

Although the GPs in Charles Kennedy's constituency practise in a unique landscape, their concerns mirror those in hurly-burly urban surgeries ­ Rob Finch reports

From Loch Ness to Glencoe and the Isle of Skye to Ben Nevis, Charles Kennedy's Highland constituency is one of outstanding natural beauty.

The attraction for GPs to work and bring up their family here is obvious ­ a great outdoor lifestyle, low crime rates and good schools.

And in the past year, being a GP in the Highlands has become even more attractive for one particular reason ­ the out-of-hours opt-out.

'It's made a huge difference,' says Dr Peter Wilkes, whose three-partner practice in Drumnadrochit nestles in a valley on the shores of Loch Ness. 'For most of my working life I've done a one in three. The on-call was the big disadvantage to being up here. In many ways life couldn't be better now.'

The workload pressures that are crushing many GPs are certainly far less of a factor. Since dropping out-of-hours, Dr Wilkes estimates his workload is now one-third less than the average GP.

But he is less happy about other effects of the contract.

'During the time I've been a doctor, the level of bureaucracy has seen a huge rise. I have no confidence in NHS management at all. I think they could get rid of 30 per cent of it and it would function better.'

Premises is also a major problem. The practice may be in an idyllic spot, but it's in a far from ideal building. Some of the staff operate out of two portable buildings in the surgery car park, a situation Dr Wilkes says upsets older patients in particular.

'In a small community the practice does act as a focal point. The older residents grumble about changes. They don't realise they had a gold-plated Rolls Royce of a service but that it wasn't sustainable.'

Boundary changes mean Drumnadrochit drops out of the Ross, Skye and Lochaber constituency at this election.

Fort William, 50 miles away and the largest town in the Highlands, comes in. There, Dr Michael Foxley echoes many of Dr Wilkes's problems.

He also uses a portable building because his premises are 'bursting at the seams'. He also hates the spiralling bur-eaucracy in general practice, particularly the tick-box medicine of the new contract. But workload and out-of-hours are more of a problem. 'I now regularly work a 12-hour day on Friday and at least half of it is paperwork,' he says.

As deputy convenor of the Highland Council, which means his telephone number is available to the public, Dr Foxley also finds that opting out of 24-hour responsibility does not always mean an uninterrupted time away from the practice.

'I still regularly get one or two medical calls on the weekends when I'm not on-call because they can't get through to NHS 24,' he says.

Further north, in the sleepy market town of Dingwall, the chair of Highland LMC, Dr Paul Rasdale, extols the benefits of Scottish devolution.

GPs, he says, have been able to avoid the 'nonsense' of some of the initiatives put forward by the Department of Health in England ­ notably Choose and Book. 'Choose and Book is a distraction that is irrelevant to Scotland,' he says.

Just how pointless Choose and Book would be for GPs in this part of Scotland is clearly demonstrated at Dr Steve McCabe's practice.

From his consulting room in the Portree Medical Centre on the Isle of Skye to the same general hospital to which Dr Rasdale refers, in Inverness, is a 250-mile round-trip, often along single-track roads. Going to a hospital further away wouldn't bear thinking about.

Working in Skye, Dr McCabe says, is 'like being on holiday', because of the incredible beauty of the island. Dropping out-of-hours commitments also makes life considerably easier.

But Dr McCabe is deeply concerned by the social and health problems on the island, many of which stem from its isolation and fragile economy.

He says: 'The main problems are alcohol and mental health. Alcohol is ingrained in the culture ­ it's omnipresent.'

The stories told by GPs in Charles Kennedy's constituency reveal that although they practise in a unique landscape, a world away from the hurly-burly of most urban surgeries, their concerns are much the same.

As a demonstration, Dr McCabe says he has got change fatigue. 'The problem is that every four years we get a government that wants to change things. I'm fed up with being reformed ­ I feel a bit like plasticine.'

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