Recruitment and Retention of
Health Care Providers in
Remote Rural areas
Status report for Western Isles
Authors:
Deanne Gilbert
Martin Malcolm
Andrew Sim
[September 2011]
Contents
1 Introduction
3
2 Geography
3
3 Demography, socio-economic trends and population health impacts.
6
3.1Demographics
6
3.2
3.1.1Population Projections
6
3.1.2Age distribution of population
6
3.1.3 Migration Trends
7
Life expectancy / neonatal mortality
8
3.3Socio-economic challenges and Rural Deprivation:
9
3.3.1
Employment status
10
3.3.2
Income deprivation
10
3.3.3
Rural deprivation
11
3.4 Health Impacts from demographic, geographical and socio-economic challenges
12
4 The organisation of the health care services
14
4.1 Primary health care
14
4.2 Hospitals / Specialised service
15
5 Health care professionals
17
6. Urban comparison area
19
6.1 Demographics
20
6.2 Healthcare Services
21
6.2.1 Hospitals
21
6.2.2 Community Hospitals
21
6.2.3 Community Health Partnerships
22
6.3 NHS Grampian Staffing (healthcare professionals)
23
7Education and training
24
7.1 Medical Education
24
7.2 Nurse Education
24
7.3 Other Education
24
8 Vulnerability and sustainability of Services
25
Page 2 of 28
1
Introduction
This report provides baseline information about the Western Isles of Scotland. It forms the
basis for comparisons in the area of recruitment and retention of Health Care providers. The
report includes general information about the islands including; geography and demography, the
organisation of the health care services and health care staff
2
Geography
The Western Isles is a chain of 150 miles of sparsely populated islands in the Atlantic Ocean 30 miles off
the Northwest coast of Scotland with 280 townships. The archipelago of Islands is also known as the
Outer Hebrides and officially called by the Gaelic name, Na h-Eileanan Siar. The main islands are - from
north to south - Lewis, Harris, North Uist, Benbecula, South Uist and Barra. The islands have an extensive
coastline, approximately 2,500km in length, and there are many sea lochs, bays and inlets. The
settlements on Lewis are on or near the coasts or sea lochs, being particularly concentrated on the north
east coast. The interior of Lewis is a large area of moorland from which peat is traditionally cut for fuel.
The southern part of Lewis, adjoining Harris, is more mountainous with inland lochs. Stornoway is the
administrative capital of the Outer Hebrides and located on the east coast of Lewis. Stornoway is also the
main transport hub with an airport, ferry terminal and bus services on the Outer Hebrides.
The Outer Hebrides have a unique culture and tradition. Most communities in the Outer Hebrides use
the Scottish Gaelic language. With only 26,000 inhabitants and 8.5 people per square kilometre the
Western Isles are one of the most sparsely populated areas in Scotland.
Page 3 of 28
There are 12 populated islands in the Outer Hebrides: Lewis and Harris 19,918, South Uist 1,818, North
Uist 1,271, Benbecula 1,219, Barra 1,078, Berneray 130, Scalpay 322, Great Bernera 233, Grimsay 201,
Eriskay 133, Vatersay 94, Baleshare 49.
Climate
The Western Isles have a marine climate dominated by ‘North Atlantic Drift’, with only slight
temperature changes throughout the year. Winters are rarely cold and snow is almost non-existent.
Climatically the dominant features are wind and rain, December being the wettest month of the year.
In contrast to the winters, when the days are quite short, in the summer the actual daylight hours are
extremely long with lots of daylight with barely two hours of darkness midsummer due to the northerly
latitude of the Islands.
Travel
The Western Isles are accessed from mainland Scotland by ferries and airplanes. There are ferries from
Uig on The Isle of Skye to Tarbert on The Isle of Harris, from mainland Scotland, Ullapool to Stornoway
and from Oban to Barra and Oban to South Uist. There are airports at Stornoway in Lewis, Benbecula and
Barra, with flights to and from Aberdeen, Edinburgh, Glasgow and Inverness on the Scottish mainland
and inter island flights to Barra and Benbecula.
The Western Isles has a good bus service. Many of the smaller islands are linked by road causeways and
bridges, which have been built over a period of time.
Off Island transport is dependent on good weather with the Islands often “cut off” in winter.
Remoteness challenge
The effects upon both service delivery and many aspects of the health status of the population from the
islands demographic and socio-economic position are inextricably linked to the geographic challenges
faced. This is felt in terms of both the Western Isles remote islands status and the overwhelmingly rural
nature of its communities.
Page 4 of 28
Scottish Government 8 Fold Urban-Rural Classification Map, 2007-08
Source: Scottish Government8 Fold Urban-Rural Classification Scheme, 2007-08
Seventy eight percent of the Western Isles’ population live in areas classified as very remote-rural
compared to 3.2% in Scotland as a whole, this is the largest remote-rural proportion of any health board
area.1 The Western Isles has the second lowest population density at 8.5 persons/square km of all
Scottish health boards , the Scottish average is 65.2 persons/sq. km.2These remoteness and sparsity
factors of the Western Isles population place obvious challenges in delivering health services particularly
where the focus of government policy is to provide care as near to the patient as possible. The
1
Scottish Government 8-Fold Urban-Rural Classification Scheme
2
General Registrars Office Scotland
Page 5 of 28
implications of such factors for the population’s health are felt in terms of accessibility of services and
also in other direct impacts on a person’s health arising from the economic vulnerability and social
isolation of their remote-rural situation.
3
Demography, socio-economic trends and population health impacts.
3.1 Demographics
Demographic trends have a clear impact on workforce planning and population health needs both
through the overall changes in population size and in the age/gender composition.
3.1.1
Population Projections
The Western Isles’ population has experienced significant decline for a number of years with falling birth
rates being the main factor. This is forecast to continue into foreseeable future (See graph below) with
the Western Isles Health Board area expected over the next 25 years to have the second largest
percentage decrease in Scotland.
Projected % Change in Health Board Populations, 2008-2033
25
20
% Change
15
10
5
0
-5
-10
Shetland
Western
Isles
Greater
Glasgow
& Clyde
Ayrshire &
Arran
Dumfries
&
Galloway
Lanarkshire
Tayside
Fife
Highland
Orkney
Grampian
Forth
Valley
Borders
Lothian
-7
-4
-2
-2
-1
5
10
10
11
12
12
13
16
19
%Change
3.1.2
Age distribution of population
The latest population estimates for 2009 and projections to 2033 are shown below as population
pyramids (Figures 1a-b). These show the increasing aged profile of the Western Isles population with
2033 projection set to become a mushroom shaped profile with the largest proportion of the
population in the 55+ age groups and the 5 year age bands under 16 becoming the lowest age
groups. This is a typical profile of a population in demographic decline.
Page 6 of 28
3.1.3 Migration trends
Recent net migration trends have shown a small increase in net migration to Western Isles.
However, the overall trends mask varying patterns among the different age groups in the Western
Isles.
Western Isles and Scottish Rates/1,000 persons net migration, 2005-10
Total net migration
10.00
8.00
Not specified
SCOTLAND
6.00
Western Isles
4.00
2.00
0.00
-2.00
2005
2006
2007
2008
2009
2010
Year
Looking at average annual migration trends for in/out and net migration shows a quite marked
deviation from overall trends for those aged around 16-24 (see chart below).
Page 7 of 28
The biggest net loss of people is in the 17 to 20 age group – particularly young women. This is common
across all Scottish island health boards though it is greatest among Western Isles population. Out
migration of young persons is to some extent compensated by immigration but the net effect remains
negative. In-migrants to Western Isles after period of increase has been declining in recent years and
this is particularly among overseas working age in-migrants. This is reflected in the drop in National
Insurance Number allocations to overseas nationals working in the Western Isles since 2007 particularly
in the EU Accession States which has dropped from 80 to 30 in 2009 (Source: DWP)
3.2
Life expectancy / neonatal mortality
In recent years life expectancy has been improving for both men and women within the Western Isles,
but there remains significant variation between men and women and between Western Isles and the
national average. Life expectancy in the Western Isles for latest period is significantly worse for men
than women by approximately 9 years at birth(Fig. 4). While women have significantly greater life
expectancy in Western Isles compared to Scotland as a whole men on the other hand have a significantly
lower life expectancy.
Page 8 of 28
: Life expectancy at birth, 95% confidence intervals for NHS Board areas, 20072009 (Males and Females)
SCOTLAND
Borders
Grampian
Dumfries & Galloway
Lothian
Highland
MALE
Tayside
FEMALE
Shetland
Forth Valley
Fife
Orkney
Ayrshire & Arran
Lanarkshire
Western Isles
Greater Glasgow & Clyde
68
70
72
74
76
78
80
82
84
86
Years
3.3 Socio-economic challenges and Rural Deprivation:
The Western Isles face undoubted socio-economic challenges such that resource deprivation is a very
real aspect of life for some of the islands population. This can include low household income and access
to affordable and good quality housing. Hence, Western Isles has the 3rd lowest average household
income in UK at just £23,400 out of total of 121 areas3 while over 10% homes in Western Isles are ‘below
tolerable standard’ compared to 0.5% for Scotland as a whole.4
The Scottish Index of Multiple Deprivation (SIMD) is currently the main measurement used by the
Scottish Government to rank communities by their level of deprivation according to a number of factors
including employment, income, housing, education & training, geographic access and crime. The
Western Isles does not have any communities recognized as falling within the most deprived group,
which affects the resources made available for regenerating communities and targeting inequalities. It
has been recognized that this area-based deprivation measure is not suited to identifying rural
deprivation which is not concentrated in particular areas as tends to be the case for more urban
communities.
3
Wealth of Nation Report, 2003
4
2002 Scottish House Condition Survey, 2004
Page 9 of 28
3.3.1
Employment status
Thirty eight percent are employed in the public sector, of which the majority are women (55.9%);
62.1% are employed in the private sector, of which the majority are men (75.4%).
The employment rate level for 2010 was 11,400 (68.7%). The Outer Hebrides had the highest
percentage change over the last 2 years, - 8.7% (-1,600).
Employment rates (16-64) by local authority, Scotland. Change over two years (2008-2010)
3.3.2 Income deprivation
The Western Isles is among the most income deprived areas within Scotland (see chart below).
Rate Income deprived/1,000 working age population
450.0
400.0
350.0
no./1,000
300.0
250.0
200.0
150.0
100.0
local authority area
Note: Income deprived based on no. of income deprived persons in SIMD2009.
Page 10 of 28
Aberdeenshire
Aberdeen City
East
Renfrewshire
East
Dunbartonshire
Shetland Islands
Perth & Kinross
Orkney Islands
Edinburgh, City of
Moray
Stirling
East Lothian
Midlothian
Scottish Borders
Highland
Argyll & Bute
Falkirk
Angus
Fife
West Lothian
Scotland
South Ayrshire
Dumfries &
Galloway
South Lanarkshire
Eilean Siar
Renfrewshire
Clackmannanshire
East Ayrshire
Dundee City
North Ayrshire
Glasgow City
West
Dunbartonshire
Inverclyde
0.0
North Lanarkshire
50.0
3.3.3
Rural Deprivation
The link between such socio-economic deprivation and health outcomes is well known and the
targeting of rising health inequalities is a challenge in the Western Isles. The remote and rural
nature of Western Isles’ communities makes the challenge yet more difficult as deprivation here is
not found in the concentrations seen in urban areas. Such urban concentrations can be readily
targeted. In the Western Isles with more heterogenous communities deprivation is found on
individual basis and as a result is often less visible. The challenge for services is how to tackle the
inequalities that exist in a targeted manner given their geographical distribution.
In recognition of the challenge of identifying rural areas of deprivation the Office of the Chief
Statistician produced a methodology based on the existing SIMD and Rural classified areas to identify
those rural areas with greatest levels of deprivation in terms of income, employment and
accessibility. Areas within the Western Isles featured strongly as those most deprived across rural
Scotland. (see map below).
Source: Office of Chief Statistician and Ordnance Survey
Page 11 of 28
3.4
Health Impacts from demographic, geographical and socio-economic challenges
There are a number of population health impacts facing the Western Isles arising from a combination
of our ageing population, remote geography both from mainland centres and within the islands, and
the comparatively low socio-economic position and dispersed rural deprivation of our communities.
The Western Isles already has one of the highest proportions of older people of any area in Scotland.
With this expected to increase the impacts upon a range of chronic long term conditions are
projected to be significant. The table below indicates the projected rise of prevalent cases within the
population for selected conditions and those where there is a relationship to ageing have the largest
expected increases eg. Dementia, CHD, COPD. These figures are based on the projected population
figures and do not take account of improvements in healthcare, diagnosis, etc. which may expect
further rises in numbers of persons living longer with a range of such conditions.
Projected Persons living with Long Term Health Conditions in Western Isles 2008-31
CHD
COPD
Asthma
Diabetes
Dementia
All selected LTCs
2008
1136
567
1337
1128
509
4676
2031
1510
724
1298
1365
839
5735
% change
32.81
27.72
-2.88
20.98
64.85
22.65
The impacts on healthcare delivery from such increasing prevalence levels among our ageing population
based on current models of delivery are seen in the large rises in unscheduled hospital care for the
elderly. In past 10 years the Western Isles has seen the highest increase of such admissions to hospital
among its elderly population (see chart below). Such rates of emergency admissions will increase further
with pressures described above from our ageing population. Alternative healthcare approaches are key
to slowing down this unsustainable trend and are very much the focus of much of the work of the both
the health and social services designed to intervene earlier in a person’s health problem so anticipating
and avoiding acute crises that result in hospital admissions.
Page 12 of 28
Ageing population and healthcare impacts – emergency care
% change in Rate of Emergency Hospital Admissions for persons
65+, 200/01 to 2009/10
35%
30%
25%
20%
15%
10%
5%
he
t la
nd
B
or
Fo d e
rth rs
V
al
D
l
um
G ey
ra
fri
m
es
& pia
n
G
al
lo
w
a
H y
ig
hl
an
d
Ta
y
A
si
ll
de
S
co
Lo
tti
sh
th
ia
R
es n
G
re
id
en
at
er
ts
G
la
sg
ow Fif
e
&
C
La lyd
e
n
A
yr ark
sh
s
ire h ir
e
&
A
rr
an
O
rk
W
e s ne
y
te
rn
Is
le
s
0%
S
-5%
-10%
-15%
Page 13 of 28
4. The organization of the health care services in the Western Isles
Organization of the health
care services
•
•
Primary health care
– 10 Practices all run by independent
contractors working to a national
contract with some local contractual
elements related to local issues.
3 Hospital sites
– 3 sites.
– 1 Rural General Hospital
– 2 Community Hospital
x2
4.1 Primary Healthcare
There are 10 GP practices run by independent contractors working to a national contract (with 36
(headcount) General Practitioners) throughout the Western Isles providing primary care services to the
community. A number of GPs provide additional support in specialist areas such as Dermatology,
Cardiology, Learning Disabilities, Child Protection, Public Health, Anaesthetics, General Surgery and
Paediatric services, in partnership with the Western Isles Hospitals. The GPs and their staff work closely
with a range of community health staff such as district nurses, community midwives, health visitors,
Allied Health Professionals (Physiotherapy, Speech & Language Therapy, Occupational Therapy, Dietetics
and Podiatry), community mental health services and health promotion services. Community based
dental services are also provided across the islands
Page 14 of 28
4.2 Hospitals / Specialised service
NHS Western Isles NHS has 3 Hospitals.
Western Isles Hospital, a Rural General Hospital, is located in Stornoway. It was opened in 1992 with
a range of hospital acute specialities, psychiatry and care of the elderly. Consultants (17) – Medicine,
Surgery, Orthopaedics, Anaesthetics, Paediatrics, Obstetrics and Gynaecology, Psychiatry, Radiology.
Some consultant led services are provided in the Western Isles hospital by consultants based in
mainland hospitals. The hospital also includes diagnostic facilities, day hospital, laboratory and Allied
Health Professionals and other service.
Delivering for Remote and Rural Healthcare (SG, 20085) provides models for staffing, education,
transport and emergency care for remote and rural areas as well as designating the Western Isles
Hospital (WIH) as one of 6 Rural General Hospitals (RGH) in Scotland. Each RGH will offer, as a minimum,
the core services of medicine, general surgery and anaesthetics. The provision of other services over and
above those minimum core services are dependent on local circumstances and health needs of the
population.
The Uist & Barra Hospital, a Community Hospital run by general practitioners, is located in
Benbecula; it was opened in 2001. It provides a local service for the population of the Southern Isles
(North and South Uist, Benbecula, Barra, Berneray, Grimsay, Eriskay, Vatersay and Baleshare. The
Hospital has 29 beds, and provides care of the elderly, respite care, GP acute care and midwifery led
maternity services. Many of the Consultants from the Western Isles Hospital, and some from
mainland Health Boards, visit the Uist & Barra Hospital to provide outpatient services.
St Brendan’s Hospital, a Community Hospital with 5 acute beds, is located in Castlebay on the Isle of
Barra and is in a shared building with the Local Authority Residential facility. It is supported by the
local GP Practice to provide care of the elderly and other services.
5
The Scottish Government, Edinburgh 2008. Delivering for Remote and Rural Healthcare. The final Report of the Remote and Rural Workstream.
Page 15 of 28
Orthopaedics
Lewis
Surgery
Medicine
Psychiatry
Obs & Gynae
Paediatrics
Harris
.
Stornoway
Oncology
Respiratory Medicine
Gastroenterology
Urology
Ophthalmology
ENT
North Uist
.
Inverness
Additional
pathways
.
Stroke Thrombolysis
South Uist
Aberdeen
Barra
Paediatrics
Psychology
Diabetes
Plastic Surgery
Neurology
.
Glasgow
Cardiology
Orthopaedics
MRI
Western Isles
Clinical Pathways
Dundee
Edinburgh
.
CAMHS
Assisted Conception
.
Radiology Obligate
Network
NHS Western Isles has external agreements with other Health Boards, primarily Highland Health Board
and Greater Glasgow and Clyde Health Board, for the provision of care to Western Isles residents. This
includes services such as Ear Nose & Throat (ENT) Surgery, Dermatology, Respiratory Medicine, Child
Psychiatry, Rheumatology, specialised Paediatrics, Ophthalmology, Oral Surgery, Neurology, Oncology
and Urology. Referral pathways for other spcialities are with other NHS Scotland Health Boards - for
example Child and Adolescent Mental Health Services and Assisted conception with NHS Tyside and
Stroke Thrombolysis with NHS Grampian.
NHS Western Isles works closely with a range of other statutory bodies (e.g. Comhairle nan Eilean Siar
(CNES), NHS 24, the Scottish Ambulance Service) and voluntary sector services to ensure the best
possible health care service for the Western Isles population.
Page 16 of 28
5 Health Care Professionals
Sept 2011:
Headcount
1050
(Including General Practitioners (1086)
WTE
838.71
Staff in Post - WTE (30th Sept 2011)
Staff Group
Staff in Post at Aug
2011 (wte)
Medical (not including GPs)
21.56
Dental
17.45
Medical & Dental Support
46.20
Med & Dental Total
85.21
Nursing & Midwifery (Band 1 -4)
81.38
Nursing & Midwifery (Band 5+)
269.55
Nursing & Midwifery Total (wte)
350.93
AHP (Band 1-4)
16.31
AHP (Band 5+)
50.82
AHP Total
67.13
Other Therapeutic Service
9.78
Personal & Social Care
17.31
WIHB - Employments by Job
Admin Services
Family
AHP
2%
1%
16% 18%
1%
Healthcare
Science
Med & Dental
7%
1%
44%
5%
5%
Med & Dental
Supp
Nur & Mid
Health Science Services
11.77
Support Services
119.44
Admin Services
166.14
Management (Non AFC)
11.00
Other Total
335.44
Band
Not AFC
8c
Administrative Services
8b
Allied Health Profession
8a
Health Science Services
7
Medical & Dental
6
Medical and Dental Support
5
Nursing and Midwifery
4
Other Therapeutic
3
2
1
TOTAL
Page 17 of 28
838.71
Personal and Social Care
Senior Managers
Support Services
WIHB Staff by Age Group
200
180
160
140
120
100
80
60
40
20
0
11.45
9.25
8.70
4.44
18.18
8.27
1.90
30.77
10.53
5.36
SUPPORT SERVICES
OTHER THERAPEUTIC
MEDICAL AND DENTAL
ADMINISTRATIVE SERVICES
0
20
40
78.43
60
80
100
Turnover rate: (including medical trainees - 11.45%.Without medical trainees 6%.)
N.B. Small numbers of staff can give a “false” picture – i.e. Healthcare Science – 30.77% = 1 leaver and one new
start.
Page 18 of 28
6. Urban comparison area
The Urban area for comparison will be the city of Aberdeen. Aberdeenshire is one of the 32 unitary
council areas in Scotland. Aberdeenshire council area does not include the City of Aberdeen, now a
separate council area, from which its name derives.
Grampian was a local government region of Scotland from 1975 to 1996. It is now divided into the
unitary council areas of: Moray, Aberdeenshire and the City of Aberdeen. Grampian continues to have a
joint police service, fire service, and electoral, valuation, and Health boards.
Aberdeen City is the 3rd largest and one of the most densely populated cities in Scotland, with a
population density of 1,151 persons/sq km. Population density within Aberdeenshire sits at 36
persons/sq km with approximately 63% of the population living in the main towns. This reflects the rural
nature of the region.
Page 19 of 28
6.1 Demography
The estimated population for Grampian 2009 was 544,980, an increase of 1% from 539,630 in 2008. The
population of Grampian accounts for 10.4% of the total population of Scotland. The population currently
has a relatively high proportion of under 20s and fewer over-65s compared with the Scottish average,
reflecting employment-driven in-migration in recent decades.
Area
2008
2009
% Change
Scotland
5,168,500
5,194,000
0.49%
Grampian
539,630
544,980
0.99%
Aberdeen City
210,400
213,810
1.62%
Population Projections 2008 to 2033
By 2033 the population of Grampian is projected to be 605,307, an increase of 12.71% compared to
2008. The population of Scotland is projected to increase by 7.27% between 2008 and 2033.
Area
2008
2033
% Change
Scotland
5,168,500
5,544,410
7.27%
Grampian
539,630
605,307
12.17%
Aberdeen City
210,400
219,630
4.39%
Page 20 of 28
6.2 Health care services
NHS services for the Grampian region are provided by NHS Grampian, and are overseen by one single
NHS Board. NHS Grampian covers an area of over 3,000 square miles of city, town, village and rural
communities.
The Board is supported from headquarters at Summerfield House in Aberdeen. Senior managers for the
functions which cover the whole of Grampian are based here, including financial overview, corporate
planning, and central responsibility for protection and promotion of public health.
NHS Grampian consists of acute services, corporate services and three Community Health Partnerships
(CHP) and works closely with the local authorities. NHS Grampian is also very closely linked with both
the University of Aberdeen and The Robert Gordon University, especially in the fields of research,
workforce planning and training. Care is provided throughout Grampian in 9 main hospitals, a 17
community hospitals, 84 GP Practices and various other specialist care units.
6.2.1 Hospitals:








Aberdeen Royal Infirmary is NHS Grampian's largest hospital, situated at Foresterhill, Aberdeen.
Royal Aberdeen Children's Hospital and Aberdeen Maternity Hospital are also housed at the
Foresterhill site.
Woodend Hospital caters for many patients, including the elderly.
Royal Cornhill Hospital provides inpatient and community support for mental health services.
A large number of outpatients are seen at the Woolmanhill Hospital in the city centre.
Roxburghe House is a new purpose-built unit providing palliative care for terminally ill patients.
Dr Gray's Hospital is the district general hospital based in Elgin, Moray.
Children with special needs are cared for at the Raeden Centre jointly with Aberdeen City
Council.
The Oaks is a another purpose-built unit which provides specialist care and support for people
with cancer and other progressive illnesses in Moray.
6.2.2 Community Hospitals:
Community hospitals are hospitals where most patients are admitted, and cared for, by their own GPs.
They normally deal with :




Acute medical care where patients cannot be cared for at home, but where the expertise and /
or the specialist diagnostic facilities of a major specialist hospital are not required.
Post acute care including rehabilitation.
Casualty services.
Palliative care.
They may also have :
Page 21 of 28





Diagnostic facilities (such as x-ray, ultrasound, sigmoidoscopy, cardiac assessment,
telemedicine).
Therapeutic facilities (such as physiotherapy, occupational therapy, minor surgery, day hospital).
Facilities for joint teams (such as community nursing teams and social work / care management
teams).
Specialist out patient clinics.
Intermediate care clinics.
Hospitals often share expertise and equipment and offer services to patients not normally in their area.
6.2.3 Community Health Partnerships:
CHPs are co-terminous with council areas and represent a district or area within the region. A CHP
manages a wide range of community based health services and, in partnership with local councils,
provides a focus for the integration between primary care, specialist services and with social care to
ensure that local population health improvement is placed at the heart of service planning and delivery.
The CHP is responsible for many services already delivered jointly by health and social work staff
including: older people, learning disability, mental health and drug and alcohol services. The CHP also
works closely with local GPs, pharmacists, dentists, opticians and specialist staff from local hospitals.
Page 22 of 28
6.3 NHS Grampian Staffing
NHS Grampian Current Staffing (wte)
Total
10885.20
Administrative Services
1726.20
Nursing/Midwifery
4967.50
Allied Health Profession
874.80
Other Therapeutic
291.20
Healthcare Sciences
438.40
Personal and Social Care
77.90
Medical and Dental
627.60
Senior Managers
127.20
Medical and Dental
Support
203.60
Support Services
1550.80
Note: the above Medical and Dental figure excludes training grades and GP sessional
The following Table is a breakdown of Medical and Dental Staff. (headcount)
Total
1330
Associate Specialist
48
Career Start GP
11
Clinical Director
3
Asst Clinical Director
1
Consultant
447
Dental Officer
36
Dental Trainee
6
FTSTA
15
FY1
108
FY2
105
Limited Specialist
1
Medical Director
1
Para 94
9
Salaried 2C GP
40
Salaried GP
4
Salaried OoH GP
23
Senior Dental Officer
13
Salaried GDP
11
SHO
5
Specialty Doctor
51
SPR
63
Staff Grade
4
STR
275
STRCT
50
In addition to the above there are approximately 123 GPs carrying out sessional work within
Community Hospitals.
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7 Education and Training
7.1 Medical Education
Undergraduate medical training is the responsibility of Universities throughout Scotland. Workforce
planning for intake numbers to University is the responsibility of the Scottish Government Health
Department, informed by local NHS Board workforce planning. NHS Education for Scotland (NES) are
responsible for the design, development, commissioning and Provision of post graduate medical training
in Scotland. The delivery of postgraduate medical training requires a partnership approach between
Deaneries, NES and local Health Boards. The quality of the training is overseen by the General Medical
Council (GMC). There are four Deaneries in Scotland – the North Deanery is responsible for 5 Health
Boards: Western Isles, Orkney, Shetland, Grampian and Highland. All North of Scotland Deanery
Foundation Programmes (134 posts) offer as a minimum 4 months in a remote or rural placement,
Aberdeen-based with a placement in one of the 6 Rural General Hospitals (RGHs). NHS Western Isles
works with the North Deanery and is a Local Education provider – offering training placements across all
specialities for doctors in Foundation years (FY) one and two and Specialist Trainees (ST). Modernising
Medical Careers (MMC) and the new junior doctor appointments process, UK MMC Career Framework,
effective from 01 August 2007, have resulted in delays in matching junior doctors to training positions
and have left boards with unfilled posts. This appears to have had a disproportionately large effect on
remote and rural and island Health Boards.
7.2 Nurse Education
Stirling University Campus is sited within NHS Western Isles Hospital. The University delivers pre and
post registration nurse training. Members of staff from Stirling University have honorary contracts with
NHS Western Isles and NHS Western Isles staff have honorary contracts with Stirling University. The
funding for nursing and midwifery students comes from the Scottish Government's Health budget. The
NHS commissions the number of nursing and midwifery students using mechanisms calculated to meet
the healthcare sector's workforce requirements for the future. At present the non means tested bursary
is £6578 p.a. On average the NHS Western Isles campus recruits 17-20 undergraduate nursing students
p.a. Recruitment comes mainly from the local area, with applications received from: school leavers,
Further Education and Higher Education graduates, mature students, those who have completed Access
courses, from those who are revising their career aspirations and re-joining the workforce.
6.3 Other Education
Other types of health care education can be studied across Scotland and the United Kingdom;
placements for students are available in many of the Allied Health Professions in NHS Western Isles.
Most of the health care professionals are trained at a university level. Most university studies take
minimum 4 years at Bachelor level.
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8
Vulnerability and sustainability of services:
8.1 Medical
The Board faces significant recruitment challenges in Medical training grades and succession planning of
some trained medical and surgical posts. A number of initiatives are being developed via key work
streams of the Acute Strategic Planning group – particularly in relation to Paediatrics, Orthopaedics, and
Obstetrics and Gynaecology. Work is ongoing in conjunction with the North of Scotland Planning group
(NoSPG), the Remote and Rural Implementation group (RRIG) and the Remote and Rural Healthcare
Alliance (RRHEAL) to look specifically at medium to long term workforce needs and solutions. and with
other Health Boards via the development of Service Level Agreements and Obligate networks.
Specific examples where recruitment has proved challenging for NHS Western Isles include;
 2009. Failure to attract a single applicant to interview or a Consultant Surgeon vacancy.
 2010. Failure to attract a single candidate to interview for a Consultant Physician vacancy.
 2011. Three vacant posts for Junior Doctors in training. Despite repeated advertisements, only
one of these posts is currently filled.
 Variable quality and suitability of locum doctors; as the health care environment – covering
multiple specialties in very small teams – is unfamiliar to many doctors whose experience has
been previously in large teaching centers. This has meant that even though the doctors have the
necessary skills and competencies on paper, they often find it challenging to adapt quickly to the
local situation and require a significant amount of additional support and supervision, and have,
on a number of occasions, decided to leave before the conclusion of their contracted period.
 Vacancies for Island GPs requiring repeated adverts, and successful applicants leaving after a
relatively short period.
 Retention of some key staff has been problematic for non professional (family) reasons.
8.2 Pharmacy
There have been problems recruiting to registered/qualified Pharmacy posts from November 2000;
some current vacancies having been vacant since March 2007, filled by successive locums. Difficulties
include distance to mainland centres, cost of travel, and perceived isolation both socially and
professionally; this coupled with the national shortage of specialised clinical pharmacists has placed us at
a disadvantage when recruiting to these posts. Various approaches have been used to fill these posts
including reviewing and re-grading of posts and development of the service to improve the skill mix
within the department Locums have been used for long periods, but these are also becoming
increasingly difficult to obtain. Community Pharmacy can and do offer more lucrative packages for newly
and recently qualified staff than NHS are able to offer which causes additional difficulties in attracting
staff to these posts. These packages are not always just financial but also provision of accommodation
has also been used to attract staff. If newly qualified pharmacists want to work in Secondary care and are
willing to move around the country etc to gain valuable clinical experience then locum opportunities are
many and varied, the locum gets paid more with little or no responsibility to the employing organisation.
Page 25 of 28
8.3 Other
NHS Western Isles experiences recruitment difficulties/challenges across a number of health care staff
involved in both direct and indirect patient care, particularly in the more remote and rural areas. For
example – recruitment of nursing staff in Lewis and the Western Isles hospital does not present a
problem – but, in Uist and Barra recruitment to nursing and Health Care Assistant posts can be a
challenge. Recruitment and retention of Domestic Assistants and other support staff is a challenge in the
smaller remote hospitals and clinics.
Page 26 of 28
Appendix: 1
JOB FAMILIES & SUB JOB FAMILIES (NHS Scotland)
(red – employed by NHS Western Isles)
JOB FAMILIES
Allied Health Professions
SUB JOB FAMILIES
Dietetics
Occupational Therapy
Orthotists
Podiatry
Physiotherapy
Radiography
Speech & Language Therapy
AHP Training/Administration
Administrative Services
Finance
Human Resources
Office Services
Patient Services
Information Systems/Technology
Health Science Services
Clinical Sciences
Biomedical Sciences
Clinical Technology
Medical & Dental Support
Theatre Services
Dental Nursing
Dental Technology
Oral Health
Physicians Assistant
Nursing & Midwifery
Bank Nursing
General (Acute) Nursing
Care of the Elderly Nursing
Paediatric Nursing
Mental Health Nursing
Learning Disabilities Nursing
Midwifery
Community General Nursing
NHS24 Nursing
Nurse Training / Administration/ Management
Public Health Nursing
Treatment Room/Practice Nursing
Other Therapeutic
Optometry
Pharmacy
Page 27 of 28
Play Specialists
Genetic counselling
Personal & Social Care
Health Promotion
Hospital Chaplaincy
Social Work
Support Services
Hotel Services
Sterile Services
General Services
Estates
Portering Services
Stores Services
Page 28 of 28