Exiting health boss says moves under way to beef up junior doctor numbers in isles

A departing health chief says work is under way to attract more junior doctors to the isles, although financial challenges lie ahead for NHS Shetland after years of breaking even.

Medical director Roger Diggle will be leaving his post later this month and has been heavily involved in targeting more medical students and junior doctors with his dual role as director of medical education.

“Shetland is regarded nationally as being a high-quality training place,” he said.

“Trainees come here, they like it and all the survey reports we get from medical students and junior doctors are all positive by and large.”

Learning posts are allocated through National Education Scotland but Dr Diggle claimed that “virtually never are all of the posts filled with appointees”.

He said: “To make our rota work we need 11 junior doctors and it varies; from the best we’ve ever had we’ve had about nine and the worst is about five.

“Some doctors are here for about six months, some are here for four months and some are here for a GP training programme that lasts four years. If fluctuates on an almost monthly basis.”

Ties are being strengthened with Aberdeen University in a bid to pull in more trainees, and Dr Diggle and other staff have attended events on the mainland to promote opportunities in Shetland.

Expensive agency locums were “not the preferred option” to fill gaps in the rota, he said, and other solutions including using advanced nurse practitioners (ANPs) on the wards have been under consideration.

“We’ve looked at can we use ANPs to support the junior doctor workforce, not replace it but support it,” Dr Diggle said.

“Also they would be trained to be able to to do the role of a junior doctor up to a certain level. A really highly experienced ANP would probably be functioning at the level of a second or third-year junior doctor, which means they are never going to progress beyond a certain point. But they would be more consistent because they would be here permanently and they could take on some of the roles and fill the rota gap.”

NHS Shetland is also looking at how it markets trainee posts to make them more attractive and if accommodation could be provided for shorter-term positions.

GP recruitment continued to be difficult, with shortages nationally and internationally, Dr Diggle said.

However, with a new community psychiatric post being created and beginning in August, GPs will be able to receive all their training in the isles in future, rather than heading south.

The health boss argued that this would making it easier for doctors and families to settle in the isles.

Looking back on his time with the health board since joining in 2011, Dr Diggle saw a lot of positives.

He said: “Overall I think the quality of care that Shetland is delivering is really good. People complain about access to GPs and and to some extent the quality of services they get from secondary care, but compared to the mainland people don’t realise quite how lucky they are.”

He added that NHS Shetland was working with NHS Grampian to ensure patients were not travelling to Aberdeen unnecessarily.

“We’re doing quite a lot of work on gynaecology, eye care and we’re looking at pathways where we can use video conferencing.

“The surgeons here are looking at referrals that might go to Aberdeen and which cases they could manage instead of them going to Aberdeen and so on.”

Looking to the future, the main challenges were in sustainability of the health board, he said.

“That comes in two areas, one is can you recruit the staff that we need to deliver services that we need to deliver? Because if we can then that helps with financial viability.

“We’ve managed to break even from a financial perspective every year that I’ve been here.

“A proportion of the savings that we had to make have been one-off savings that have helped us to break even.

“The financial pressures this year and the coming financial years is quite high. Part of the expenditure if we could get rid of … is to avoid the number of locums we have to use.

Cutting the money spent on locums would help in future, Dr Diggle said, with GP locums receiving twice as much money than a permanent GP, junior doctors locums on double or two-and-a-half times pay, and locum consultants being “particularly expensive”.

He said: “The other challenge is the model of remote and rural health care that island boards have.

“It’s completely different to the rest of the UK and the rest of the western world is aspiring too, because the generalists we require are not being trained.

“There’s the intention to change doctor training and the plan is over the next five years or so all of the hospital specialities will change.”

That would mean doctors could be generalists and then specialise later. But Dr Diggle said frankly it would be 10 years before there were any real benefits.

He added: “There’s going to be a period for remote and rural healthcare that I think will get quite difficult and that’s not just for Shetland.”