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At the heart of general practice since 1960

Meet the UK’s most remote GPs

Dr Naomi Reifenberg explains how the challenge of being a half-day’s travel from the nearest hospital is outweighed by the rewards of a varied workload

Name Hillsgarth Surgery, Unst, Shetland Islands

List size 600

Full-time equivalent GPs 1

Nearest hospital 2-hour drive

Working in Unst provides great professional satisfaction

Our work is varied and challenging, and GPs get to use the whole gamut of their medical skills from good bedside manner to emergency medicine. We’re on call for all emergencies and look after patients all the way to the helicopter – or the mainland if necessary.

Distances between services are a problem

Agencies such as Women’s Aid and drugs and alcohol services are based in Lerwick, Shetland’s main town, which is two hours’ drive away, and patients have poor access to the range of services that the average practice would be able to provide. But we know all our patients well and we offer the advantage of great continuity of care.

Confidentiality is a major challenge

We have a system that ensures staff don’t have to handle any records or results that relate to their families or close friends. Having two part-time practice managers allows them the option to take over from each other when confidentiality becomes an issue, and we also offer patients the chance to specify that only a GP or nurse can read their records.

Staff consult with the doctor on the neighbouring island of Yell if they have a problem that they wish to keep confidential.

We don’t have to compete for funding in the way practices might have to down south

However, we need to budget for equipment like centrifuges and for near-patient testing because we are such a long way from hospitals and pathologists. We don’t get the economies of scale that big practices get, but we find ways to reduce costs.

Technology helps us deal with the problems of remote medicine

We stay in touch with other GPs in Shetland by using videoconferencing equipment. We encourage consultants to offer review appointments and we facilitate this with consultants via video link, as well as with the A&E department if we need help treating an unusual injury. It takes more than a day to travel to hospital in Aberdeen and back, so if the appointment’s only supposed to be 10 minutes this saves patients time and saves the health board money.

Temporary patients are taking up more appointments at our practice

Shetland and Unst are attracting more tourists and particularly in the summer months we face a rise in workload. Last week, we had three temporary patients during one morning session. Non-local patients usually attend for acute problems or minor injuries, but they often want to discuss chronic problems or general health ‘while they are here’. But we don’t get reimbursed for treating them, and it would be inappropriate to do so.

Most GPs in this environment love what they do

It used to be that the islands were a second choice for new GPs, who came only when they couldn’t find a position in towns and cities. But now GPs can see the attraction of rural practice – particularly those who are looking to get out of mainstream general practice and go back to more traditional family medicine.

We usually find prospective GPs through word of mouth or candidates get in touch directly. We recently had a GP spend a couple of weeks with us on sabbatical, which helped a lot.

There are advantages to having a small pool of candidates for vacancies

Our practice staff are often overqualified (our receptionist has a PhD, for example) and we also have the advantage of knowing most candidates in a personal capacity before we recruit them. That said, we obviously have fewer candidates to choose from.

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Readers' comments (5)

  • Sounds like where I work in a remote area of canada, cormorant island, a ferry ride away from port Mcneill in north vancouver island. I used to work in the NHS but then came to canada and as in Shetland the working life is far more independent and satisfying

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  • Azeem Majeed

    The medical students from Imperial College London who undertake their Year 6 GP placements in the Shetland Islands have all said they have had a very positive experience and have greatly enjoyed these placements.

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  • I had the fantastic opportunity of visiting Naomi's practice as a student - I enjoyed it so much I have now relocated from London to Scotland. It also made me realise that excellent (if not better) care can be achieved even in very challenging environments.

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  • Vinci Ho

    It is ironic that in such practice , there is even more up, close and personal contact with consultant colleagues . The quality and efficiency on managing this 600 patients are presumably even more superior than the mainstream GP practices in cities. Of course , there is also the question of whether funding is balanced and protected.
    Government and policy makers should look at the lessons learnt from these practices in terms of funding and organisation

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  • John Glasspool

    I'd have been much happier looking after 600 patients in Shetland than 1800 in Southampton.

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