26
Rural surgery
Rural General Surgery in Scotland Perspectives from a general surgeon based in the United Kingdom The rights of every individual in society to local and accessible health care provided by the state, regardless of ability to pay, were important recommendations of the Dewar Report to the Scottish Highlands and Islands Medical Services Committee in 1912. Shortly thereafter, well-organised medical services were established in rural Scotland and this report formed the blueprint for setting up the United Kingdom (UK) National Hospital Service, 36 years later. Remote and rural surgery is delivered in six locations in Scotland: three on islands and three on the mainland. The Island Rural General hospitals (RGH) are situated in Lerwick on Shetland, Kirkwall on Orkney, and Stornoway on the Isle of Lewis; on the mainland they are in Wick, Fort William and Oban. Each hospital has strong links with a city centre hospital for those requiring more specialist care. Each hospital serves a base population of between 20,000 and 44,000 people. However, they are all based in popular tourist destinations. For example, each year, at least one million visitors pass through Fort William, where I have practised for 21 years.
With such small base populations, which are used to determine the hospital workforce, the provision of surgical and medical services is challenging. Here in Scotland, as in Australia and New Zealand, increasing super-specialisation in training and healthcare provision has led to centralisation of services,
particularly in cancer care and, to a certain extent, the demise of the general surgeon. However, there has been a recognition that this shift has advanced too much or too far and that mechanisms are now needed to train more general surgeons.
