THERE has been uncertainty and concern around surgical care in the more remote parts of Scotland for some time, with several health boards increasingly struggling to fill their vacancies, but in some areas, the situation is now on a knife-edge.

Take the Western Isles, for example, where there is only one permanent surgeon, supported by locums. It is the same on Orkney, and in Wick, the town’s only surgeon is nearing retirement. We have reached the point where the future of some rural general hospitals is in serious doubt.

The problem is not money (there is funding for the jobs that need filled) – it is staffing, and to some extent that is understandable – it will always be harder to attract staff to remote areas where a doctor will be more isolated and more likely to work long hours without the support network they could expect elsewhere. Young doctors also train in cities and towns so that by the time they are ready to decide their future, they are likely to have married, or had children, or otherwise put roots down. Even those who may be considering a career in a rural area may simply have become used to life in the city by the end of their training and change their mind.

The way doctors are trained is also an issue. Surgeons working in remote areas need to be able to treat a broad range of emergency cases, but the emphasis in training is on finding a specialism. The direction of travel in the NHS is also towards centralising in specialist units staffed by experts, which can work extremely well for many patients, but it has a disproportionately negative effect on patients who live further away. In those areas, there is still a need for the qualified, experienced generalist – not least because rural communities will only attract people to live there if the local services, including the hospitals, are reliable and good.

Of course, no one can force doctors to move to the country, but a number of measures could help. The first would be to rescue the reputation of rural surgery by promoting it to young doctors and recognising it is a specialism in its own right; it would also help to expose doctors much more to rural areas during their training as it is more likely they will want to settle in such places if they have enjoyed working there before. Big hospitals could also help rural surgeons maintain and improve their skills by undertaking routine surgery too.

The Scottish Government should also consider the idea of some kind of premium payment for doctors who work in remote areas in recognition of the fact that, while they may be living in some of the most beautiful parts of Scotland, the stresses and strains can be much greater. The government wants to deliver as much care as possible locally, but the danger of the current attrition in rural surgery in Scotland is that the jobs will disappear from rural areas never to return.

Technological development may, in time, play a part in linking patients in rural areas to the specialist units, but it is not a panacea – neither is it a replacement for rural surgeons able to offer a wide range of surgical care. The hospitals serving Scotland’s island and rural communities depend on their surgeons. But so too do the communities themselves.