I have had a pretty varied roster in the Balfour lately, flicking between women’s health clinics, A&E, and theatre. Everyone is, as always, very welcoming, and I have found it helpful to try and see things that I hadn’t had a huge amount of experience in otherwise.

Given the variation in demographics and population size (ranging from 50 – 12,000 people) on the isles, there are differing levels of demand on each GP practice. One demand that doesn’t change is the potential for emergency situations. As the crow flies, all of the isles are reasonably close to mainland Orkney, with none being more than a 15 minute plane ride away. (As an interesting aside, the world’s shortest commercial flight operates in the Orkney Isles – Papa Westray to Westray has an air time of ~1 minute). But none of the isles are logistically close at all in terms of emergency medical care. There are ferries, but they require reasonable sea conditions. There are no aircraft on Orkney that are medically equipped for retrieval, these are all based on mainland Scotland. So everyone working in medical care on the isles has to be pretty happy dealing with anything for at least a couple of hours. Ongoing teaching and reflection on cases is just one of the ways that this is addressed in Orkney.

We were lucky enough to attend the outreach session from the Scottish Air Ambulance service with GPs, nurse practitioners and nurses from within the Balfour and from the outer isles. Scotland, interestingly, has a nationalised air ambulance service. Air transfers and retrievals are not run by different helicopter trusts from different regions like in England (and NZ) – but are a government funded group based out of Glasgow that service all of Scotland. They have about 30 consultants from all over Scotland who travel to the Glasgow base for 1-2 days a month when they are on call for this service. There are registrars and advanced paramedics who provide 24-hour cover at the base as well. Each of the consultants has a rural hospital or area that they are responsible for going to each year to provide ongoing training and discuss cases that have come from that hospital in the previous year. So on the day we attended, there were discussions centred around the cases that had been flown from the Orkney Isles and education session specific to the Orkney Isles that might not be as relevant to other areas around Scotland. It was a superb day and both of us walked away with dreams of working as a registrar on this service one day in the future.

We have also had a fascinating time chatting with the head of the Orkney Isles GP network about how they get GPs to come and stay. As mentioned above, the Orkney Isles network GP practices are staffed by a combination of nurse practitioners and GPs. There are individual practitioners assigned to each island, and when they are on leave their absence in the first instance is filled by the rural GP fellow or by other GPs within the network if possible before locum cover is called in. Recruitment for these positions in recent years has been predominantly driven by the community not the GP practice. The community are given the responsibility of hosting the potential employees and showing them around on a weekend in their island. In some instances it sounds like the GPs and their families have been billeted with a family. Given the desire of most rural communities to have a strong working relationship with their health-care providers, and a want for continuity of care, giving some responsibility of recruitment to the community seems like a great idea. The GPs and the rural GP fellow who we have spoken to told us they were sold on the Orkney Isles very quickly once they were whisked around the sights and delights of the particular island they are working on. I imagine that it would be a pretty nice feeling having a whole community embrace you from day 1 and it would be hard to turn down any job offers subsequent to this!

And so our time on the Orkney Isles has come to an end and we are now moving on to Denmark to ride bikes and partake in a bit of immunology research. We have had a great time here on Orkney and are sad to leave. But I am sure we will be back!