Health / ‘Remote yes, but not isolated’ – meet the health board’s newest consultant surgeon
NHS Shetland says it is slightly more confident in its recruitment efforts
Photo: Hans J Marter/Shetland News
IT IS the enjoyment of doing something different every day, being part of a small team that can make a real difference and, of course, the pull of island life.
Meeting for a chat in Gilbert Bain Hospital’s cafeteria earlier this month, NHS Shetland’s newly appointed consultant rural general surgeon Dr Pete Alexander is happy to reflect on the first few weeks in the job.
Inspired by the variety of work and the strong community spirit, he has hit the ground running since starting in the post on 6 August.
And yes, the breadth of what is required in terms of knowledge and experience is daunting, he freely admits, but “that’s what drew me here”.
It comes as NHS Shetland is quietly confident on having begun to turn the corner on the well-publicised difficulties of attracting consultants, GPs, dentists and other medical professionals to work and live in the isles.
Health board boss Brian Chittick is well aware of every board meeting hearing of the unsustainable cost of employing locums. However, the work that goes on to alleviate the situation is often not visible to the wider public.
The cost of employing agency staff is on average between 1.1 and 1.4 times higher than the cost of a substantive employee, so every post that cannot be filled on a permanent basis puts additional pressure on the already underfunded health service.
So far, during the first four months of this financial year (April to July), NHS Shetland has already spent £900,000 on agency locum workers.
However, there have also been some successful recruitments to senior posts, and this is making Chittick feel more positive about the future.
While there were five vacant GP posts across the isles in 2023/24, that number has now reduced to one, with three GPs appointed alone this year: one in Lerwick, one in the West Mainland on a rotational basis and one for Scalloway. A new GP for Yell was appointed last year.
There is also a newly appointed consultant anaesthetist, but other crucial roles such as consultant psychiatrists, consultant physician and a consultant in obstetrics and gynaecology continue to be filled on a locum basis, some at a significant cost to the public purse, as was reported by Shetland News here.
In Pete Alexander’s case it is perhaps no big surprise that he has chosen island life and a medical career that requires a ‘generalist’ skills set to meet the wide and diverse healthcare needs of the local population.
Having family ties here – his uncle is former consultant surgeon Gordon McFarlane, who retired in July 2024 – he has now relocated with his wife and three children to Gulberwick.
Born in Cardiff, and brought up in South Africa and Inverness, the 39-year-old first came to Shetland as a student.
He was appointed to the position back in 2023 but had to complete a two-year fellowship to gain the competency required before he could take on the role last month.
It is a long journey through university education, working long hours as junior doctor, followed by years of surgical training and a two-year fellowship before finally becoming a consultant surgeon.
It is a profession that comes with a high degree of responsibility, as Dr Alexander says “you are taking decisions that are affecting people and that could be life-changing for them”.
He describes the variety of work and the opportunity to do different things every day while part of a small team and living in a small community as the main reasons that attracted him to Shetland.
“People see it as a quite remote location, but it is not isolated,” he continues, citing the close working relationship between clinicians in Shetland and Aberdeen, while a regular exchange with others in the “rural surgical community” is happening via the so-called Viking Surgeon’s Association Conference.
And so, the team at the Gilbert Bain is required to carry out a remarkable variety of operations ranging from surgery of some types of cancer to hernia operations and gall bladder procedures.
They are also required to attend to all kind of fractures while also stabilising patients in preparation for transfer south, as well as covering evening and overnight shifts, carrying out crisis management and responding to accidents and emergencies.
Meanwhile while sitting down with Shetland News to discuss the challenges of recruiting health professionals to smaller rural and island health boards, Chittick is happy to reflect on his own story.
He came to Shetland as an NHS dentist in 2015, became the health board’s dental director and then its medical director in 2020 before being appointed as chief executive in 2023 following the departure of Michael Dickson.
“For me, one of the real bonuses working in Shetland, in any profession in the health board, is that you can really make a difference for your community because we are so close to that community,” he says.
“You nip down to Tesco and get feedback from two or three people about the service you are providing. And that is what keeps you alive and at work.”
He says that there are of course many different reasons why many health professionals do not feel the same island pull he experienced, including:
- the uncertainties Brexit created, and the subsequent changes in international workforce recruitment,
- the shortage across the UK in some professions such as psychiatry,
- a different life/work balance people aspire to today and
- the demographic changes with a rapidly ageing population and fewer people available to do the crucial health and care work.
In response, NHS Shetland tries to be as flexible as possible in providing job opportunities in the isles including additional professional development opportunities for those who are coming north, taking on roles on a rotational basis, ‘agile’ and hybrid and remote working, while there are also efforts to grow the isles’ own workforce in addition to offering modern apprenticeships.
Initiatives such as Rediscover the Joy and the Viking Conference have shown some success and are beneficial for those participating, Chittick says.
Rediscover the Joy consists of a pool of GPs signed up to working in rural health boards including Shetland. That gives them the chance “to dip their toe into the water” of working in Shetland without committing before knowing what it really entails.
“It has led to some GPs coming to work for us substantively,” Chittick confirms.
Held in Shetland last year, the Viking Conference, meanwhile, is an annual event for the rural surgical community to share expertise and refresh knowledge. It also provides an opportunity to inspire and promote rural healthcare to medical students and foundation year doctors.
“Realising that the skills set for remote and rural care is different and ensure that our staff gets exposed to that training as early as possible […] is reaping some benefits,” Chittick continues.
“I think we are engaged in the right conversations, we are nudging the system to realise that rural care is different, and we are getting skills into the workforce to support that.”
Meanwhile, locums and agency workers will continue to fill vacant posts to keep the health service going.
“While we have long-term locums in post, we are always trying to recruit and get that substantive and make it more sustainable,” Chittick says.
“By using the same locums, patient experience is better, makes it safe and gets consistency. And these are services that we have to provide for an island community.
“It is perhaps not the most cost-effective but probably the most quality effective for our patient base and our community.
“I feel it is getting better right across the whole system. We still have our pinch point areas that we know are challenging us round about some of the specialities and some of the tensions between being a specialist and being a generalist.”
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