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While studying at Glasgow Medical School I undertook a student elective in Stornaway on the Outer Hebrides and that first triggered my interest in rural practice. My FY1 was in Stirling, FY2 in Glasgow and GP training in Ayrshire - my GP placement was actually in Kilmarnock so a busy town practice. It was my GP trainer who said to me “go and have a look at Arran as an example of rural practice". 

In 2010 I started the Rural GP Fellowship in Arran and, five years down the line, I’m a partner in Arran Medical Group. The GP rural fellowship was the big enabler for me and I can’t praise it highly enough. It’s open to anyone who’s a qualified GP and wants a supported year to go and find out a bit more about rural practice - it’s aimed mostly at recently qualified GPs.

At Arran Medical Group, we’ve got 3 base surgeries, we operate another 3 branch surgeries on top of that and we also have the community hospital. Arran itself is about the same size as greater Glasgow. It takes about 2 hours to drive round it and we’ve got 5000 people here but it goes up to 25,000 in the summer so we cope with big changes of population.

The group has eight GPs and a team of 40 in total including practice nurses and admin teams to support all these sites. A typical week for me can involve being in Lamlash, a fairly busy, large village practice and then can take me up to Lochranza, with a population of 200 people. We open that place ourselves and you get the occasional deer peering in the window mid-consultation – it’s a unique place to work.

On-call work includes A&E, response for NHS24, dealing with up to 17 inpatients including a high dependency unit, police calls and any BASICS pre-hospital requests as well.

We’re highly supportive of the Rural GP Fellowship and provide taster weeks for GP trainees; we like to be positive about people coming over to take a look because we find it’s actually quite addictive once you’re here.

The medicine is really stimulating and there’s no shortage of interesting cases. 90% of what we do is general practice like anywhere else but the extra 10% totally stretches out these extremes. It’s why the Rural GP Fellowship is so good - when you’re a new GP you’re qualified in general practice but you’ve still got a lot of experience to get.  Plus you’ve got these additional aspects of rural practice which keep the job quite stimulating – so it’s important to have a ‘wise owl’ to call upon! We take a lot of care to make sure our GP Fellows are supported. If they’re on-call, we’re always available to offer them advice and assistance.

Working as part of the team in Arran is very rewarding - there’s a lot of teams that we work in here. We are already integrating health with social care because we work so closely together anyway. We also work closely with our secondary care colleagues on the mainland so if we want to refer someone over acutely we tend to speak to a consultant.  Our A&E colleagues in Crosshouse are supportive and the Emergency Medical Retrieval Service has revolutionised the treatment and transfer of critically ill patients in rural Scotland.

One of the biggest challenges is connectivity. There’s real impact on health now and we can demonstrate that – we have patients who can’t phone 999 because the landline’s down and they’ve got no mobile phone coverage. We are making progress with this and have set up ConnectArran, a campaign to try to improve connectivity and raise awareness of the real effect of the lack of connectivity.

We’re also looking into innovative ideas and GP is great for that - innovation in smaller groups is often easier. As a GP partnership we have lots of control over how we deliver services.  We know the area well, and we get a lot of support from our patients, most of whom are understanding of the challenges of delivering rural healthcare.  We find that it is really important to have this understanding and we take advice from our Patient Participation Group on a regular basis.

Student teaching is really important to me as is recruitment to general practice as a whole so I do a lot of things with that just now. I also have roles with the Rural GP Association Scotland, with RCGP Scottish Council and I take part in CPD events for BASICS Scotland – maintaining links with confreres in other parts of Scotland is important to reduce professional isolation, which can be an issue in remote and island practices. With email and video conferences, I can connect easily with colleagues on the mainland.

I have interests in emergency care so we’ve set up something called Arran Resilience to bring all the emergency teams together and I’m a member of Arran Mountain Rescue Team. It’s good fun! I like, whenever I can, to get out and about in the hills and to go sailing. I’m a keen photographer and there are some fantastic views here.

I think we should be optimistic about the future of general practice. We need to be very clear to government about the challenges that we have but also need to be very clear to students about how it’s still a very exciting and stimulating career. We certainly need to take innovation by the horns and make sure that we’re providing leadership for that but fundamentally, we’ll always be there as the primary contact for worried and anxious patients.  I think that so long as we can keep that clear in our sights, everything else will then follow suit.