NHS Western Isles is battling ‘eye-wateringly high locum rates’ to keep consultants available in many clinical specialities, according to the board’s chief executive Gordon Jamieson.
And the challenges of keeping posts filled are also being felt through primary health care, where GPs, nurses and other professionals need to feel committed to living an island life if they are to remain in post.
Mr Jamieson was speaking yesterday (Tuesday 23 May) as NHS Western Isles opened advertising for GP posts in Barra, described as ‘a unique, safe and idyllic location (where) a rare opportunity has arisen for two GPs with a sense of adventure and passion for remote and rural medicine to escape the rat race and embrace a more healthy work-life balance with NHS Western Isles.’
He was one of three health board chief executives giving information yesterday to the Scottish Parliamentary health, social care and sport committee, meeting for their periodic scrutiny of NHS boards in Orkney, Shetland and the Western Isles.
Committee convener Clare Haughey MSP asked the three chief executives of the boards: “I know from my time as a health minister that island boards frequently raised the challenge and associated cost of recruiting and retaining staff on the islands. How have your health boards met that challenge and what other challenges do you still face?”
In response, Mr Jamieson described a whole-package approach to attracting and retaining specific individuals, with a focus on providing support for the whole family.
He said: “A lot of people who have come for a job for one member of the family find that their partner cannot get a job, or that they do not have housing and or access to things like childcare.
“A complete package makes a difference to whether people live, work and stay - staying is the really important part.
“We have people who come up to experience the working environment before they sign up to a permanent job.
“We have a try-before-you-buy approach and we are flexible about bringing people up for a few weeks or months and letting them see the environment, the facilities, the community and access to childcare and so on.
“We think that that is the only approach. If we go out to recruit a single individual and we focus only on the success of that, we will fail on a much wider basis.”
Despite these and other measures, Mr Jamieson later went on to explain that, of the hospital’s core team of 16 permanent consultants, about half are long-term locum staff, with permanent consultants in medicine, surgery and mental health just some of those proving hard to recruit.
In attempting to fill those gaps, NHS Western Isles have been using agencies to help recruit locum specialists and, he said: “Some eye-wateringly high locum rates come back.”
He said: “I can give you an example of a specialty where we went out to the market in the past two months. We were looking for locum costs to take someone on for a year and the lowest cost that I got back was £313,000; the highest was just over £1 million.
“I have never come across that before. It is alarming. The costs are very significant. We secured someone at the lower end rather than the higher end of that range, but the costs are an on-going pressure.”
Other issues are affecting recruitment of primary care staff, such as GPs for the nine practices in the Western Isles.
Mr Jamieson said: “We are about to go out to recruit for two GP posts for Barra, and we are selling Barra. The important thing is that we can sell the location so that people want to come to live there.
“In many communities there are very long-serving GPs. However, it is increasingly becoming a bit more challenging to get GPs in the Outer Hebrides.”
Mr Jamieson stressed to MSPs the very different working relationships and conditions that influence the kind of people who can work effectively in island healthcare.
He said: “A couple of years ago, I was on Barra with a chief executive from the NHS in Scotland and a GP who worked in Edinburgh.
“They were talking to me about the GP facilities and service on Barra, and we told them about the range of work that was involved, particularly the acute work, hospital work and retrieval work.
“The GP said to me: ‘There is no way on this earth that I could even contemplate working in a rural location like that, because of the acuity of patient presentations.
“I work in the centre of Edinburgh, and I can refer into the Edinburgh hospital half a mile away. This is a completely different world.’
“The message of that is that there is something about the type of practitioner that is needed for island and remote healthcare.
“Recruiting the GPs for Barra will be a real test, because GPs will look after general medical services, hospital in-patients and out-of-hours unscheduled care. I do not know how many such people are around just now, but we are about to test that.”
The issues raised by all the island health authorities are expected to feed into the Scottish Government’s future planning for a national centre for remote and rural healthcare for Scotland. The committee also intends to carry out an inquiry into remote and rural healthcare.
The image is as used to attract applicants for GP posts in Barra (NHS Western Isles). Advertising is given in full detail here apply.jobs.scot.nhs.uk/Job/JobDetail?JobId=150702.