SURGEONS are warning the future of six hospitals serving Scotland's island and rural communities is "precarious" with just one trainee surgeon planning to work there.

Already the hospitals in Wick, Fort William, Oban, Western Isles, Shetland and Orkney are heavily dependent on surgeons from abroad as well as locums and visiting city medics to fill gaps.

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A vacancy after one retirement took a year to fill and positions have been advertised in the Western Isles and Wick without success. Wick is surviving with one permanent Polish surgeon who is nearing retirement age.

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Yet without surgical care in such remote spots, the surgeons say women face moving to the mainland for weeks before they give birth and patients with stomach pain - who may not even need an operation - may have to be flown or driven miles to city hospitals to be assessed.

Mr David Segwick, a surgeon from Fort William who helped develop Scotland's rural hospital system, said: "The futures of some of the rural general hospitals is precarious unless we safeguard and promote training for these posts with the support of the bigger hospitals."

Of the 16 surgeons currently working in Scotland's rural hospitals, six are originally from overseas including three from Poland. A further three are locums.


In order to sustain the services they provide, it has been calculated that two junior doctors need to be training in rural general surgery at any one time. But in the last eight years four doctors have completed the training programme and some of these have chosen to work in cities.

Currently there is one junior doctor in Scotland - Dr Stuart Fergusson - who is undertaking the extra training required to provide surgical services to a remote community.

With a generation of junior doctors largely training to specialise in specific medical fields rather than treat a broad range of emergency cases, Scotland's rural surgeons are warning the pool of UK doctors who can operate in Scotland's outposts could "dry up".

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Gordon McFarlane, Shetland surgeon and chair of a working group which examined rural surgery in Scotland, said: "We are shooting ourselves in the foot at the moment as a profession because everyone is trying to get the big sub-specialty post... And it is too easy for the NHS to come and say to a trainee (in a teaching hospital) 'you got on well here, you will make a good consultant, there is a job coming up in our hospital - are you interested?'

"While we do that we endanger the future of the rural general hospitals and the surgeons in those units continue to wring their hands."

He noted even those interested in rural careers spend years completing their basic surgical training in cities or towns so some marry and have children, making it harder to relocate when they qualify.

Furthermore rural surgical training is not recognised as a speciality in its own right, he said, and while a special fellowship to prepare these surgeons for the job has been created in Scotland interviews to enter the final years of surgical training are carried out in London.


Mr McFarlane said: "If you tell a surgeon from the South of England you are interested in rural surgical training they will say 'what's that and are you off your head?..'"

He also described a reluctance among mainland health boards to give up two junior doctors to a career in rural healthcare, suggesting they also needed the manpower.

His working group called for two posts for rural surgical trainees to be earmarked in Scotland and set out a way for mainland hospitals to support surgeons working remotely to ensure they maintain high standards and their range of skills.

Mr Segwick said: "One of the issues which puts people off working in rural general hospitals and threatens their future is the attitude that high quality surgery can only be performed in super specialist city centre units.

"But there are ways, as the report highlights, to ensure that the work in rural general hospitals remains high quality."

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Should surgical jobs remain vacant for long periods, however, he warned there was a danger the services would "be centralised and never return."

Already Mr McFarlane said: "As soon as you get a vacancy you think oh, who on earth is going to apply for this post?"

He warned the collapse of surgical care on the islands could threaten the whole community.

Women expecting babies, he said, would face moving to the mainland weeks before their due date in case they needed an emergency caesarean section. He continued: "That makes quite a difference to the population. It is enough of a disincentive to say "do I want to live on this island any more?"

The Scottish Government's new clinical strategy, published in February, promises "as much care as possible delivered locally" with "complex treatments" delivered in specialist centres.

The number of NHS consultants working in Scotland increased by 170 last year, but there were 320 vacancies at the end of 2015 - more than double the number at the end of 2012.

Fort William: Three permanent surgeons. Replacing a retiree took a year.

Oban: Three permanent surgeons. (One near retirement age.)

Wick: One Polish surgeon (nearing retirement). Supported by surgeons visiting from Inverness who are not necessarily trained in rural general surgery.

Western Isles: One permanent surgeon from Egypt. Supported by two locums.

Orkney. One polish surgeon, another surgeon from overseas plus locum support.

Shetland: Three permanent surgeons. One from Poland. One UK trained and the other born in Germany.