Embracing island life as a GP in Shetland
Dr John Fishwick describes how working three weeks at a time on a remote island has kept his interest in general practice alive
How did you get your role?
I am a GP on the island of Whalsay, one of the most easterly of the Shetland isles. I retired from English general practice in 2015. My interest was awakened after reading an article by a GP, Dr Wilf Treasure, who made island life sound idyllic. I contacted him to see if he would be interested in having a regular locum. Sadly, Wilf died before we could finalise plans. However, I happened upon a health authority advert for a third member of a rotating GP team to work on Whalsay. I applied and was fortunate to be offered a 17 week contract encompassing five return flights per year from Southampton (at any one time there is one GP on the island). I have now completed three tours of duty of three to four weeks each
Who do you look after?
I look after two islands; the main island where I live is 7x5 miles with a stable non-tourist population largely dependent on the fishing industry, with a population of 1,150. My second island is more remote with a population of 50. This island is cared for by a resident nurse, we talk regularly regarding clinical issues and she does have (albeit unreliable) internet access. Several large pelagic fishing boats operate from the island and use us as a point of contact if they have a crisis at sea.
What is your working day like?
My day starts at 08.30 sorting path results, and morning surgery is perhaps 12 patients in 15 minute appointments with a similar number of phone or prescription queries. There will often be one or two visits followed by a reliable lunch break (a luxury in 21st century primary care). The afternoon will be dealing with queries, acting on any requests in the hospital post and perhaps a short afternoon surgery of two hours before heading home to my bothy (the small building where I live) at about 16.45.
Although I’m on call for 24 hours a day when in post, the reality is that calls are rare, perhaps two per week outside of normal working hours and always need taking seriously.
The surgery staff are all born and bred on the island, they know the islanders intimately and are a great support and asset. There are 10 staff in total and an attached dental surgery with their own team. Coffee time is attended by all and as likely to contain the trials of delivering a lamb at night, tales of the Julian calendar celebrations or exploits of the Jarl squad (who are the Vikings in the Shetland festival Up Helly aa), as medical chat. All this is delivered in a broad brogue as Norse as it is Scottish, at times barely intelligible.
What about the administration side of things?
There is no sign of the evil twins LES or DES and whilst there is encouragement to engage with QOF there are no penalties accrued –perhaps unsurprisingly I find myself voluntarily engaging in supporting a carers initiative, seeking out fragility fractures, encouraging cardio-occlusive disease scoring, approaching the island’s volunteer ambulance and fire crews for mock crises /accident practice amongst other initiatives simply because I now have the time and energy to do so and seek the professional satisfaction of doing the job well.
Crucially there is a sense of support and collaboration from the health authority rather than the antagonism, disapproval and conflict that seems to emanate from Whitehall. Most people working in health care on Shetland wear many hats, these people are true generalists, the surgeons deal with tonsils, prostates and knees with equal aplomb, the physicians treat croup, acute coronary syndrome and psychosis. Aberdeen is our local tertiary centre and my experience is that they are very supportive by telephone when difficult decisions or interventions need consideration. The air ambulance and coastguard helicopters can be called upon but more often it is a case of the ferry crew helping fellow islanders by mobilising the ferry which can operate in most but not all weathers. There are occasions when there is no choice but to do your best and wait for the weather to break.
What is island life like?
Whalsay is a thriving community where the nuclear family remains intact and vibrant, young people strive to return to the island of their birth and the sports teams and fund raising/community bonding ventures are embraced and supported by the community. Ferries run to Shetland mainland from 6am until 11pm helping assuage the sense of remoteness. The islanders very much appreciate their island surgery and primary health care team and take care to use us appropriately.
The natural history is stunning with otters and cetaceans seen most days (if you look in the right place!): divers, puffins and phalaropes nest and the migrant birds can be outlandish. There are arctic relicts of flora to be found amongst the predominant heather and sphagnum .The lochs yield trout up to six pounds with some lochs on Shetland holding char and sea trout.
Has this helped you stay in general practice?
For me this has been a perfect step down from the barely sustainable pace and pressure of English general practice to a setting where family primary care medicine can once again be practiced with enjoyment and reward. Whilst the islands would prefer their own full time dedicated GP as in previous years they understand that this role is often no longer acceptable to young doctors and are welcoming increasing numbers of doctors nearing the end of their careers but not yet ready to hang up their stethoscopes refreshed by working in this supportive environment .