Shubs continues his journey discovering the realities of rural General Practice in Skye, Scotland.
Sometimes you've just got to get on and do stuff because there's no-one else to do it
Dr R Moss circa 2018
I joined Richard for his 'duty doc' morning - initially filled with going through the large wad of 'out of hours' communications notes that came through from the weekend about patients who had used the service from friday night to monday morning.
There were then a couple of emergency appointments - one requiring admission. For the patient, who was not keen to go all the way to Inverness (and who could blame them - almost 3 hours one way), a chunk of time was spent explaining why care could not just be arranged in the local community hospital where they had been the week prior. Richard explained to me that where they could, they would try to manage things with remote specialist input. Richard did his own ECG (I definitely could not remember how to do this!) with no issue. "Sometimes you've just got to get on and do stuff because there's no-one else to do it" Richard spoke with Yorkshire accent-tinged, Buddha-like grace as I marvelled at the confidence with which he placed the wires. At which point the ECG printer malfunctioned and we had to call the practice nurse anyway.
Once the transfer was arranged Richard showed me the local community hospital next-door to the surgery - there was a step-down/rehab ward and walk-in centre/minor injuries unit. A GP from the surgery was designated to work daily with nurses to provide in-hours clinical cover for the patients there, as well as attend to 'walk-in' cases.
Remote links to specialists in Portree Community Hospital (run by GPs)
Richard discussing the main challenges working as a rural GP in/on* Skye
*answers on a postcard
As we wound down for the evening, I took a walk just by Richard's house as the sun set.
Chez Richard - Not a bad place to call home
This is proper, full-on Generalism
Dr Al Innes circa 2018
Visiting the OOH/Emergency Department
The morning greeted us with magnificent sunshine.
Today I was to meet Al Innes, who had set up the out of hours service on Skye and the service that also ran the Emergency Department and local community hospital in Broadford.
I was really keen to discover what the challenges were working acutely in the remote setting, and to find out what sort of skill-set and mind-set were required to deliver this 'Full on Generalism' - as Al had described it.
Al did not disappoint. I was struck by his pragmatism and humour as he took me around. Essentially, Broadford community hospital, staffed by various allied health professionals, (with medical cover being provided by the GPs) offered -
20 Acute Inpatient Beds
I have worked in GP surgeries larger than this building. And I have seen resus rooms larger than the Emergency Department. Intrigued, I sat down with Al to discuss further after we toured the hospital.
Al Innes - Full on Generalist | Part 1
Al Innes - Full on Generalist | Part 2
After meeting Al, and charged up from all the sunshine, I decided to do a bit of walking to reflect on things so far.
Sligachan | Around Broadford | The Old Man of Storr | Quiraing
That evening Richard took me sailing in Portree harbour. If his sailing was anything like his driving, I knew I'd need a waterproof camera. Once he'd got the hang of things, we had a chat about the Scottish GP contract whilst careering around the harbour. The sound on the recording equipment was a challenge, but hopefully you can forgive the wind and make out the conversation:
We set off early. I was joining Richard for a morning surgery on Raasay - the adjacent Isle with a satellite surgery reachable by ferry.
On the ferry to Raasay, looking back at Skye
The satellite surgery was run once a week. After a chat with Richard, I set off to explore the remoteness of Raasay and had the chance to reflect on what I'd discovered so far.
My last stop in Skye was meeting Dr Sarah Elliot who had done the rural GP Fellowship that I'd heard so much about, so I thought it would be great to talk to her about her experiences doing it. She had moved into a caravan with a magnificent view so it made sense to pitch up there and record! We talked at length about why she did it, but more importantly why she stayed.
Inspired by Sarah, I set off to leave Skye and make the journey back to Inverness.
Check out the third and final part of my journey here.