The islands

Shetland is a remote sub-arctic archipelago situated some 70 miles north-east of Caithness in Scotland and lies between the Atlantic Ocean and the North Sea. The population is around 23,000 who live spread across 14 (or so) islands but there are numerous uninhabited islands. The dental needs of the majority of the population are met by the Salaried NHS Dental Service which, despite the remoteness, strives to deliver a service that surpasses many expectations.

The service has for some time struggled to reach its full complement of dental officers and support staff; it is not hard to understand this as the remoteness of the islands is often seen as a barrier for many. However, once here, many find that the trappings of modern society are very much present yet everything is smaller and takes a little longer to get here.

The Salaried Service currently has 14 dental chairs spread across seven clinics of various sizes. The most northerly clinic is based in Yell and serves the population of Yell (one chair), Fetlar and the most northerly island in the UK, Unst. There is another clinic on the island of Whalsay (one chair). The remainder are based on Mainland (the largest island) – with a three-surgery clinic in the village of Brae and the rest in Lerwick, which is the island's capital and has a population of over 9,000.

The islands have historically had travelling dental caravans but these are now a thing of the past: one caravan remains but it can no longer be moved. I get to work in this when clinic space is at a premium; some bemoan working in the caravan it but personally I love it as it suits dental hygiene perfectly.

My first year

I've had a brilliant first year; I was warmly welcomed by all the staff and made to feel part of the team immediately. Dentistry in Shetland is like dentistry anywhere but we have to make certain considerations when doing laboratory work; there are no on-site labs and work has to be sent to mainland UK. This presents a problem as any breakages require work to be sent away by post, but also any adjustments to work yet to be fitted have to go away in the post, meaning long waits for the patients to have work completed. We are served by a daily ferry from Aberdeen as well as cargo boats; there are numerous flights each day to and from airports in Scotland but these can be cancelled at very short notice due to extreme weather conditions. Occasionally, the boats may be delayed (more so in winter) which can (rarely) lead to shortages in consumables that may require some rationing to ensure essential and urgent needs are met.

The relocation

So why make the big move? I suppose it was driven by many factors but the need for a change was certainly in there. We used to live in Derbyshire and I worked in Nottingham and had been in that area since leaving the army in 1999. My wife Kerry has had many jobs over the years but eventually settled as a dental receptionist, a role she really enjoys, and has been lucky enough to gain a dental receptionist position in NHS Shetland. We have two kids, Danielle (19) and Harry (17). When we made the big decision to move Danielle was already 18 and decided that she did not want to go all that way and currently lives and works in Manchester. Harry has found work in Shetland; he started working in Frankie's, an award-winning fish and chip shop and the UK's most northerly, but has now moved on and works as a receptionist in a hotel.

Do I miss my old job? For sure; I worked there for ten years and miss the staff and patients terribly. I have been back a few times and have got a night out arranged in September with as many as turn up. I am regularly in contact with my old practice manager as she still wants to tap my knowledge of certain things and I am more than willing to oblige.

Training dental nurses

A highlight for me over the last year was being invited to take on the training of student dental nurses. I had to dive into the NEBDN Diploma with some gusto as the students had received very few tutorials for the preceding year. I had no knowledge of the systems of teaching involved; it became a steep learning curve but we soon settled into a programme of teaching. I would like to thank all my friends and colleagues in England and Wales that helped me out. The service chooses to train its own dental nurses as recruiting trained individuals is understandably difficult, but like many dental services, retention is also tricky.

I would like to point out that unemployment in Shetland is rare. This is due to an increasing service sector serving tourism but also Shetland has the largest oil terminal in Europe, the largest gas terminal currently being constructed and soon will have a large wind farm that will provide electricity to 350,000 homes on mainland UK, and these all require huge manpower. For now, the mainstay of income remains the fishing industry supplemented by income from crofting and farming.

Remote CPD

Our CPD needs are met by the North of Scotland Postgraduate Dental Dean who provides speakers to visit the islands to deliver our training. Being such a small team, we can approach the dean and request the training that will serve our learning needs: an advantage I am sure that many readers would cherish! The deanery has asked me to deliver a presentation to my clinical colleagues here in Shetland and this will be repeated to hygienists, therapists and dentists in Inverness in February 2015. On the same day I will present an ‘update on periodontology’ for dental nurses, something I have never done before, but now relish the challenge of pitching the science of perio to my dental nurse colleagues.

We never get representatives of the large dental companies visiting us (hint hint) but we direct our patients to local shops (Tesco, Boots, The Co-op) or pharmacies to purchase oral hygiene aids. We are fortunate to have several oral health education-trained dental nurses that help support and reinforce the message we deliver.

Scotland's Childsmile programme is an integral part of NHS Shetland's long term plan to prevent dental disease in children and in later life; find out more about this ongoing programme at http://www.child-smile.org.uk/.

Northern highlights

As well as being privileged to work with the great team here in Shetland, those of us that live here are lucky enough to experience the northern lights (Aurora Borealis) in winter.

Additionally, in the summer we experience ‘Simmer Dim’, the longest day of the year, where the sun is above the horizon for 19 hours and the northern sky never darkens during sunset. The wildlife is also worth a mention as we get many migratory birds as well as perennial visitors such as puffins.

Whilst the dentistry remains the same, our lifestyle has changed. I live in a remote part of Shetland. We are 34 miles north of Lerwick with the nearest shop two miles away and the nearest takeaway and pub 11 miles away, yet we have adjusted well and got used to the very long days in summer and the very short days in winter. As you can imagine, living in such a remote area means that all the neighbours get to know each other and will look after each other's interests. We have not locked our front door in over a year and we can certainly call on neighbours if we need something. Most communities have a communal hall that is used for social events and a common feature are Sunday Teas where the community contribute cakes, sandwhiches and fancies to be bought by those that go along; not necessarily good for teeth but given that they are usually for charity, all is forgiven.

If you ever need an epiphany, moving to a remote place may help you. It has me.