Published: 24/11/2017 16:30 - Updated: 23/11/2017 15:13

Action urged on north coast to counter 'doctor-free zone' fears


Hugh Morrison - area is becoming a doctor-free zone.
Hugh Morrison - area is becoming a doctor-free zone.


Campaigners are demanding an out-of-hours medic to be locally based to cover the area of  north Sutherland which faces being a “doctor free zone” throughout the night.

More than 50 people attended a public meeting at the Kyle Centre in Tongue on Monday to express their concerns to NHS Highland bosses.

A similar meeting is planned at Farr School in Bettyhill on Tuesday and Melvich in the New Year amid warnings that people could leave over the changes.

GPs will no longer be drafted in at weekends to provide cover for the scattered communities served by the Armadale and Tongue medical practices.

Instead medics based at hospitals in Thurso and Wick will take on after hours responsibility not just for Caithness but also for a 650 square mile area of north Sutherland – a total of around 16,000 patients.

Patients will not have direct access to the service but will have to first ring NHS 24.

The controversial move is a precursor to the entire out-of hours-service for the north coast as far west as Melness being run from February 2018 out of Caithness. 

Health managers say the change is being driven by the soaring cost of providing out-of-hours care, the difficulties in recruiting GPs and the low usage of the service in remote and rural areas.

Community leaders fear hat the distances involved from Thurso and Wick to the furthest reaches of the area are simply too great. It will take a Thurso based medic an hour and a half to drive to Melness. 

Michael Simpson, chairman of Tongue, Melness and Skerray Community Council said the area needed a medic – be it a nurse practitioner or a doctor – to be based locally.

The meeting also told health managers that, despite what they had been told, there was no problem over finding accommodation for the medic, or a base could be incorporated into the new £1.6m health hub to be opening in Tongue in 2019.

Mr Simpson said: “We were told that the cost of locums covering out of hours at weekends alone would be thousands of pounds, something like £120-an-hour.

“There has been a lack of community engagement by NHS Highland. Everybody understands there has to be change but it’s the way it is being handled and explained to the community that has been a problem.

“Elderly people in particular feel frightened and threatened by this. They and others are not being reassured that there will not be a diminution and dilution of services.

“Everybody understands having locums is not sustainable, and there are budget issues, but they could consider having one until February. The ambulances will have paramedics and an advanced nurse practitioner will have a health professional also as a driver.

“We would like an advanced nurse practitioner or doctor to be based locally to reassure people and provide a quicker response.”

A further meeting will be held to follow up the points raised on Monday.

Campaigners in Caithness, however, have welcomed a major cash boost that will ease pressure on the “over-stretched” ambulance cover in the region, claiming it will ultimately save lives.

Nine new paramedic and technician jobs are to be created, while an additional ambulance will be put on duty in the far north thanks to funding being increased to £491,000 from the originally planned £400,000.

The investment, being split between NHS Highland and the Scottish Ambulance Service (SAS), means there will be a 24/7 on-shift service at both Wick and Thurso, which was previously part time, with an additional vehicle on duty for 16 hours a day between the two stations.

The new posts, to be in place by April, will remove the current practice of needing to locate on call staff on rotation at either Caithness General Hospital in Wick or the Dunbar Hospital in Thurso.

Councillor Hugh Morrison, who represents North, West and Central Sutherland, who attended Monday’s meeting said: “For many people the lack of health cover could mean the difference between them staying or leaving. The far north is fast becoming a doctor free zone between 6pm and 8am through the week and throughout the weekends.”

Mr Morrison said a locum doctor is based in Durness from Monday to Friday and covers out of hours in that area.

On a Friday night the GP moves to the Kinlochbervie/Scourie area as his remit is extended to include Assynt as well.

Mr Morrison said: “So from a Friday night to Monday morning he has the area from Elphin to Lochinver, out to Stoer, Scourie, Kinlochbervie, Durness and out to Hope and this also includes the Reay Forest estate.

“Now this also puts pressure onto our ambulance service as its been known for the ambulance to attend to a house visit if the out of hours doctor is one to two hours away. Also the Kinlochbervie ambulance has been covering the Tongue/Bettyhill area as the ambulance there has had to cover in Caithness as the ambulances there are transporting to Inverness, so you get the pattern moving along the coast.”

“Covering from the Wick area is a no-starter, that is when the luck runs out and too far away to take care of anyone. 

“Not having a doctor for out of hours to cover Melness to Melvich is a mistake.

“What price life?

“Through no fault of the doctors or ambulance crews people will suffer over this.

“If nearly £500,000 can be found for Caithness what about Sutherland too?”

And Dr Andreas Herfurt, lead GP with the Armadale practice, has said he has serious concerns and the new system is neither “feasible nor safe”.

Family doctors across the UK were relieved of their responsibility for the out-of-hours service when their contracts were renegotiated with the Westminster government in 2004.

But doctors on Sutherland’s north coast agreed to continue providing cover because they felt no safe alternative was available.

In 2009 NHS Highland offered to provide cover for the Armadale and Tongue practices at weekends and since then locum GPs have been drafted in to the area from Friday evening to Monday morning.

The new out-of-hours team will comprise a GP working out of Caithness General Hospital and four nurse practitioners based at the Dunbar Hospital. The team will work on a rota.

It is understood two nurse practitioners are in place but another two have still to be recruited.

Janette Mackay, chairwoman of Strathy and Armadale Community Council, said last week: “It’s a dreadful situation and I fear for what is going to happen to the people in the north.

“No one is going to want to move here if there are no doctors.”

Sandra Munro, chairwoman of Bettyhill Community Council, said: “I think it is horrendous and is certainly not going to do the area any


A spokeswoman for NHS Highland said:”These changes were approved by the NHS Highland Board in September 2016 and relate to the care you need from your GP practice when it is closed.

“Emergency care is provided by the Scottish Ambulance Service, which has seen recent investment.

“We hope we were able to provide greater understanding for the need to change out of hours now before we hit a crisis.

“This is a complex issue, but the key points are the fact that we have a reducing number of GPs.

“It is costing us more and more to source locum GPs from further afield. This is not good patient care, and is not a good use of money.

“Our plan is to re-invest that money in permanent local teams, with teams of doctors and nurses providing care.

“This is the right direction of travel, but comes with its own challenges around isolation and skills depletion.

“We have had to move quicker than expected, recognising that the local doctors who have been on call for a number of years overnight are no longer able to do this.

“We would wish to publicly thank them for their above-and-beyond commitment to their patients.

“However, we cannot directly replace what they have done and it does mean that we have to provide care differently.

“Over the coming months we will move towards a service based in Thurso covering out west to the Tongue and Armadale areas.

“We have listened to the community and

have some ideas to consider about how to

improve the new arrangements and the transition model.

“We will work up some of these options and be back in touch with them to discuss further.” 

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