I grow increasingly concerned for the future of small rural practices, particularly those in the Scottish islands. There is a clear probability that as the GPs presently in their single-handed posts retire, they will not be replaced and primary medical care for the island communities will be provided by resident nurses with GPs visiting the islands regularly but infrequently (once a week or, more likely, less often).
The effects of these changes will be twofold: they will save the NHS money (this is doubtless the driving influence) and they will radically alter the role of the doctor in the isles. No doubt the patients will be well and compassionately cared for by nurses, and the nurses will have at their disposal all the emergency paramedic and evacuation facilities. However, the traditional model of health care by a doctor–nurse duo, providing different and complementary skills, has been a very successful one and the standard of medical and nursing care received by islanders is exceptionally high. A nurse on her own would be hard-stretched when she finds herself acting as both nurse and doctor.
Many of the isles have, in recent decades, shown a worrying trend towards falling population: below a critical number the community loses its teacher, its minister, and its doctor, and the character of the community is altered significantly. Incomers, both retired people and young families, have done much to keep the islands alive but they will be less likely to settle in the absence of a school, a kirk, and a surgery.
While it may be thought hard to justify the costs of a GP exclusively for a list of 200 patients or fewer, I think we should acknowledge the immense emotional and social support given by a resident doctor. At least let us achieve a compromise whereby a partnership of two or three GPs look after, say, four or five islands; such a partnership arrangement would allow more frequent island visits and adequate time off for the doctor. With such a scheme, the doctors would remain as day-to-day players on the stage of island life and it would certainly be much easier to attract new GPs to remote practices.
The whole future of the island GP needs an urgent review lest, by default, one island after another loses its doctor and this excellent feature of British general practice is lost for ever.
- © British Journal of General Practice, 2008.