After nearly 24 years as a rural GP in the Highlands, Dr Andreas Herfurt has finally had enough.
Three years later than planned, he is retiring on June 30 from the Armadale Practice in Sutherland with concerns about the health of the organisation he served.
Dr Herfurt, who leaves the practice at the same time as Dr Ceri Le-Mar, is critical of the NHS’s ability to recruit and retrain medical staff in rural areas.
He also rails against centralised decision-making and a ‘one-size-fits-all’ attitude to health care.
Dr Herfurt, who turns 59 this summer, has just one definite plan for retirement: “I don’t want to work for the NHS any more. I’ve had enough of that.”
Rural GP vacancies
NHS Highland is currently advertising for GPs to take over at Armadale as well as the practice in Tongue.
There are also vacancies at the Scourie, Durness and Kinlochbervie practice where long-term locums are in place.
The health board took over Alness and Invergordon Medical Practice last year due to staffing shortages.
Dr Herfurt has previously spoken of his fears about falling numbers of GPs in the Highlands.
He said he raised concerns about recruiting and retaining staff 15 years ago, but the NHS has been “reactive rather than proactive”.
He said he has for many years been training and mentoring advanced nurse practitioners (ANPs) who have increasingly taken on some of the GP’s workload.
“However, unfortunately, the NHS – and NHS Highland is no different – has one of the worst track records when it comes to managing their resources and looking after their troops.
“Recruitment might work, but the track record when it comes to retention is abysmal.
“Staff that do not have appropriate support and leadership look elsewhere and find more secure posts.
“That’s what happened with the majority of ANPs that came through here.”
The track record when it comes to retention is abysmal.
Dr Andreas Herfurt
Dr Herfurt said staff can find themselves “pushed from one post to the next” to fill vacancies in different locations.
“You don’t retain staff that way. It’s always the knee-jerk reaction ‘there is a lack of staff, we need to put somebody there’.
“We’re then surprised when all our staff run away. It’s not the fault of any individual, it’s a systematic fault.”
He outlined a typical scenario facing ANPs working for NHS Highland: “You could start off in Caithness as there’s a problem there for two nights.
“The following week you could be in Kinlochbervie for three days.
“The week after that, you may not know where you’re going, it might be the area you’re contracted to, it might be somewhere else.
Loyalty and pay ‘not related’
“If you have family, and have the audacity to think you have a life outside the NHS, how do you mix those two together?
“If someone else comes along and offers a job five days a week based in a single practice where do you go? It’s a no brainer.”
He said it’s nothing do to with finance: “There’s a perception that if you pay people enough they will stay loyal.
“That’s something organisations never quite understand. Staff loyalty and payment are not necessary related. Loyalty is based on lots of factors and payment is secondary.”
Dr Herfurt says for the most part he enjoyed working in the practice which cares for 950 patients over 400 square miles.
“I felt what I was doing was worthwhile. However, more and more decisions are now made elsewhere on the basis of one-size-fits-all with absolutely no clinical input.
“I wouldn’t be able to tell you where the decisions come from these days, but half of them are utter tripe.”
He cites the decision which means GPs no longer provide vaccinations.
“That might be useful in the city practices and ease the workload for my Inverness colleagues.
“There were no consideration or rurality. There were no rural clinicians around this area involved in the decision or even asked about it beforehand.”
Having administered thousands of Covid jags, his practice was then unable to give a fourth dose and could not even order vaccines for the practice staff.
“These are a couple of examples, but there are two or three examples every week. Eventually I said ‘enough is enough’.
NHS supports retiring GPs
As he leaves, does he have advice for a successor?
“Good luck.
“I would love to see a successor, particularly as I intend remaining in the area for some time and will be a registered patient.
“I like to think there will be some kind of continuity, not least because I’ve spent nearly 24 years getting the practice to the level it’s at now.
“I’d hate to see it fall apart, but that’s the risk.”
NHS Highland said GP practices are mostly independent businesses holding contracts with the NHS which supports retiring partners seeking new GPs to take over.
When no one takes on the contract, health boards have a responsibility to patients to ensure continuity of service.
A spokeswoman said: “Recruitment of GPs is a national issue at the moment and, particularly in remote and rural areas, it can often take a few rounds of advertising to yield results.”
She said the GP rural fellow programme supports newly-qualified GPs in remote and rural areas and many started their careers as rural fellows.
The Rediscover the Joy programme has also seen experienced GPs take short-term placements in remote areas.
“We are looking at several different ways of promoting the beautiful area we live in; our aim is to strengthen care provision for all patients in the Highlands.”
GP workloads higher than ever
The health board said the new national GP contract introduced a range of staff to work with GP practices to ease workload.
In relation to the transfer of vaccines she said: “GP workloads are stated by the BMA (British Medical Association) as being higher than ever before.
“The 2018 contract and associated changes were put in place to reduce the workload and improve patient quality.
“We hope that any additional capacity released through not having to deliver vaccinations can be focussed on the more complex end of health and care and managing this ever increasing demand.”
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