Education And Debate

The NHS in Dumfries and Galloway: straining but optimistic

BMJ 1999; 319 doi: https://doi.org/10.1136/bmj.319.7217.1123 (Published 23 October 1999) Cite this as: BMJ 1999;319:1123
  1. Richard Smith, editor (rsmith@bmj.com)
  1. BMJ, London WC1H 9TD

    Nineteen years ago Richard Smith looked at the NHS in Dumfries and Galloway, in Scotland, and concluded that it worked well.1 Ten years ago things weren't so good.2 And now …

    The long view of the NHS in Dumfries and Galloway, in Scotland, might be summarised as more staff, bigger and better buildings, more technology, and more activity but failure to keep up with rising demand and expectations from both patients and politicians. The result is a sense of strain and even disappointment. The unwritten contract, whereby doctors and other clinicians work long hours and take great responsibility in a perhaps patrician way in return for respect and considerable freedom, seems to be changing to one in which they are more tightly managed and less respected, and, as a result, they may be less willing to give their all. As one retired consultant put it: “The doctors no longer own the system.”

    Summary points

    Compared with 20 years ago, the NHS in Dumfries and Galloway has more staff, better buildings, and uses new technology, but staff feel they can never keep up with the expectations of patients and politicians.

    Initiatives from on high, such as the internal market, may come and go without making much difference on the ground.

    A new maternity hospital is about to be built through the private finance initiative.

    Telemedicine may have an essential role in such a large but sparsely populated district.

    Information technology is way behind the times.

    Nurses are fed up, doctors much less so.

    Patients are steadily becoming much more influential.

    The battle over how best to organise surgical services in Stranraer, which is two hours by road from Dumfries, continues and preoccupies many in the health service.

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