The NHS in Dumfries and Galloway: straining but optimistic

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.”