Wanted: doctor for rural practice in the beautiful Highlands of Scotland. Salary £90,000 a year. What’s not to like ? And yet the Highland Health Board cannot fill 21 such vacancies. One GP post in Thurso, for instance, has been vacant for nearly three years. This crisis in general practice comes at a time when the NHS is supposed to be changing its emphasis from acute hospital-based treatment to primary care in the community. Things are obviously not going well.
The Royal College of General Practitioners in Scotland estimates there will be a shortage of between 600 and 900 GPs over the next five years as serving GPs retire and others go part-time because of the mounting pressures of the job. The issue was highlighted this week by Dr Michael Foxley and he should know. He was a GP in Fort William for over 30 years and was leader of Highland Council. He now sits on the board of NHS Highland. “When I was a young GP,” he said, “we were proud to work in a local community where we would get patients turning up on our doorstep in the middle of the night. The current generation of doctors don’t like that.”
He suggests increasing the salary of rural doctors. But in my book at least, £90,000 is already outrageously high and it might be the reason why so many doctors are able to retire early or work part-time. Increasing the salary might even result in fewer GP hours being worked. Another solution would be to increase the number of doctors being trained at Scotland’s five medical schools. But this would take several years. And we would have to lower the standard of entry for Scottish students (about half the total) which the universities might say is unfair and unwise.
Another solution is to take the pressure off doctors by employing more nurses and paramedics in local medical practices. Patients might well take to this idea if they could get an appointment immediately rather than having to wait 48 hours – the current target (which a third of practices don’t even meet). My own GP practice here in Edinburgh offers same-day appointments but you have to sit in the waiting room among some pretty unhealthy looking people for two or three hours to be seen.
It’s the old medical problem of great expectations. We all want perfect health all the time. But the population is growing, and growing older, the treatments are becoming more sophisticated and more expensive, and the blame culture has added to the bureaucracy. And for all the talk of moving resources from hospital treatment to “primary care” there’s been less than a 2 per cent increase in the primary care budget each year since 2006 and less than a one per cent increase in the number of GPs.
Still, we are lucky not to be living in Africa or Greece or the Middle East where GP waiting times are the least of people’s worries. But Scotland did have a glancing blow from international troubles this week. Scottish holiday-makers arrived home with horrific tales of the terrorist shooting in the Tunisian resort of Sousse. Two middle-aged Scottish couples were among the 30 UK citizens killed, James and Ann McQuire from Cumbernauld and Liza and Billy Graham from Perth. Never seek to know for whom the bells tolls.
The Scottish Parliament may be on holiday but the Westminster parliament is ploughing on with its plan to exclude Scottish MPs from voting on purely English matters. The opposition parties are furious because it would give the Conservatives easy majorities on whole swaithes of policy, like health and education. The idea is that an English-only grand committee would have a veto over legislation deemed to relate to England only. The SNP have dismissed it an “incoherent” plan and they are to suspend their self-denying ordinance of not voting on English matters, saying spending on health and education in England has a knock-on effect on Scotland through the Barnett Formula or block grant. As Gilbert and Sullivan would say, “Here’s a pretty how-do-you-do.”
As if delving into the deep mysteries of Westminster were not frightening enough, how about going down into Hades itself. Researchers at the Scottish Association for Marine Science based in Oban, are involved in a project to send robots down to study the strange life-forms that exist in the 6km deep trenches at the bottom of the Pacific Ocean. Apparently the “Hadal zones”, where tectonic plates meet, are especially rich in primitive organisms which would die if brought to the surface. I wonder what surprises await the brave researchers of Oban.
The question of the week is how long will this blistering summer last ? It’s been several days now. The temperature reached 29 degrees in Kinloss on Wednesday, 25 was not unusual elsewhere. There have been thunderstorms overnight. But I expect, before the weekend is over, we’ll be pulling on our Shetland jerseys again.
