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Tiree farmhouse

Animal Care Tiree photo

During their rotating one-week shifts, locums serving the community-owned practice in Tiree stay in a leased farmhouse out front.

When the sole veterinarian on Tiree retired last year, no practice buyer stepped in, leaving inhabitants of the remote Scottish island without a replacement.

Boasting pristine beaches of fine, white sand and clear turquoise water, and enjoying relatively abundant sunshine for a place in the United Kingdom, Tiree is nicknamed, only half jokingly, as "the Hawaii of the north." It's also isolated. The 30-square-mile island, population around 700, is a four-hour ferry trip from the port town of Oban, on Scotland's west coast.

The difficulty of luring a new practitioner to settle in the tiny, distant community has led Tiree to implement a plan B, which, although still in its early days, is working out so promisingly that it has become their preferred option. And they hope it can provide an innovative model of care for other remote communities that are struggling to find veterinarians.

Animal Care Tiree, which opened its doors on Feb. 16, is unique in numerous ways. It is understood to be the U.K.'s first veterinary practice owned by the local community. It applies an unconventional business model in which the clinic is staffed for 32 weeks of the year by locums, each staying on the island in rotating one-week shifts. For the remaining 20 weeks, care is provided through telemedicine only.

"At first, the locals thought, 'We'll just have to try this,' " said Dr. Tom Wallbank, the clinic's senior veterinarian and coordinator of its locum rota. "But now, we're like, 'Hey, this is a bloody good idea.' "

Part of the model's appeal is its promise of long-term stability, Wallbank explained, reasoning that another buyer could struggle to sell the practice when they retired, too. "The community doesn't want to find itself in this position again," he said. "Ten years may be a long time for a new owner, but to our farms, 10 years is nothing."

Thousands of animals

Although Tiree is small, its need for veterinary care is big.

The island is divided into more than 200 crofts, a type of farm unique to the Scottish highlands and islands. Crofting is a form of land tenure for small-scale farms, which are governed by strict laws, including that tenants or owners must reside on the croft. They also must cultivate the land or engage in another "purposeful use," such as producing crafts using crofting products like wool or hosting renewable energy assets like wind turbines and solar panels.

Home to around 1,500 cattle and 4,500 sheep, Tiree supplies livestock for beef and lamb production on the British mainland. Its approximately 700 human residents own more than 500 companion animals, to boot, according to Rhoda Meek, a local crofter and the clinic's head director.

"Our crofts tend to raise young animals until they're about 5 months old for lambs and 9 months old for calves, and then they're exported off the island — nine times out of 10, to somewhere like the Scottish Borders region, where they've got more grass for more of the year, and they're finished there," Meek said. "We're quite early in the production chain, and the margins are tight, so you want to try and keep as many animals alive as possible."

Meek, a digital consultant with a dog and four cats, is one of the clinic's nine local leaders, who comprise its board of directors. The clinic is constituted as a nonprofit financed purely from revenue raised from charging its customers. Some £70,000 (US$92,390) in establishment costs were provided by two community development funds, which are partly backed by money raised from the local livestock market and a wind turbine that provides energy to the island.

As under the previous owner, the practice serves Tiree and the neighboring island of Coll, which has around 200 permanent residents.

Rough seas and other trials

The practice has secured the services of six locums, including Wallbank — a number that he maintains is just about right to provide reliable cover and offer continuity to the crofters. "That's enough for a rotation but a small enough team for collegiality," he said. "If we had 10 to 15 locums coming in each year, you can imagine it would be chaos."

Wallbank, who resides just outside the northern Scottish city of Inverness and provides a locum service to practices in the highlands, said he's attracted to shift work because it allows him to allocate time for his family. He's also fascinated by farming methods on Scotland's islands.

The Tiree clinic is staffed continuously for 12 weeks during the critical spring calving season. For the remaining 40 weeks of the year, it is staffed one week on, one week off, with telemedicine offered during the 20 unstaffed weeks. Telemedicine services are provided by the locums, predominantly by Wallbank, to save money and provide a more consistent service.

Crucially, the clinic has employed a practice manager, Hannah MacKechnie, a local crofter and nonveterinarian, who will manage appointments and the clinic's pharmacy. "She is basically the lynchpin of this whole thing," Meek said.

Locums live during their visits in a farmhouse leased by the practice from a local crofter. They typically travel to the isle by ferry, which can accommodate cars and pets. Tiree also is accessible by air through a fleet of small, Twin Otter aircraft that service Scotland's islands. ("Take your noise-canceling headphones," Wallbank advises.)

Where's Tiree - final

Although things have gone well so far, running the practice has presented myriad challenges. While Wallbank was speaking to the VIN News Service, for instance, high seas had sparked ferry cancellations, stranding one of the locums on Tiree — and her replacement in Oban — for two days past their scheduled crossover time. Wallbank also was in the midst of trying to set up the clinic's invoicing system.

"We had certain priorities, which was just having somebody there with some gear. Initially, we hardly had any drugs. We were kind of using farmers' drugs. And then the next priority was, 'Right, we need sterilized surgical instruments.' Now we've got all that in place and were considering taking a breather, and then we're like, 'Oh, we need to charge people.' "

The clinic bases its prices on the average of what animal owners are charged on the mainland, based on annual fee data compiled by the Society of Practising Veterinary Surgeons, a U.K. professional association. Compensating locums, who usually are paid a higher hourly rate than permanent employees, comprises a large share of the clinic's overhead and is the reason that it can't afford to service the practice every day of the year.

On the plus side of the ledger, clinic leaders anticipate the operation's income will be supported by supplying veterinary drugs. "People can still buy their drugs on [or from] the mainland but I think proportionally, per client, we'll sell at least as much but probably a larger volume of medication than your average mainland practice," Wallbank said.

A model for others?

Overcoming regulatory challenges was pivotal to demonstrating the feasibility of such an unusual model of care. For example, the Royal College of Veterinary Surgeons, the U.K.'s regulator for the profession, stipulates that all veterinarians must take steps to ensure their patients have access to 24-hour emergency care, either at their own practice or a partnering practice. Although the Tiree clinic is equipped to perform some surgery, patients may be ferried or flown to the mainland for emergency and specialist care at a partnering referral practice in Oban. The Tiree clinic also has established a relationship with the University of Glasgow's veterinary school, which has a large teaching hospital.

"We've had a lot of conversations with the Royal College to make sure that what we're doing actually complies with the requirements of vets," Meek said. "There's also, I think in the U.K., a growing realization that if you want some veterinary services in places like ours, it's not going to be perfect. And the conclusion that has been reached in this case by the Royal College is that some provision is hugely better than none."

Dr. Tom Wallbank

Animal Care Tiree photo

Dr. Tom Wallbank is the Tiree clinic's senior veterinarian and locum team coordinator.

Wallbank said one hurdle facing the practice will be offering a 24-hour euthanasia service for companion animals. MacKechnie, the practice manager, can administer pain relief as prescribed by a veterinarian but can't access controlled substances.

Potential workarounds could include allowing any veterinarians who happen to be vacationing in Tiree to access the practice's euthanasia drugs, Wallbank said, or perhaps MacKechnie could become qualified to administer euthanasia drugs in emergencies.

"We're doing our best," he said. "It comes back to the reality that it's either this or nothing."

Despite the challenges, Wallbank is confident the model he's helping to apply in Tiree could work elsewhere in the U.K. and beyond. That's partly because a similar model has existed for decades in New Zealand, where Wallbank spent seven years practicing veterinary medicine for that country's large dairy industry. Nonprofit "club" practices commonly are established in New Zealand by dairy farmers because they have such a high volume of livestock and can struggle to find consistent care. "We're helping Tiree for different reasons, but the principle is the same, and the structure is similar," Wallbank said.

Looking to the future, Meek is open to the possibility of a veterinarian moving to Tiree and taking the reins. Still, she'd prefer them to become an employee of the community-owned practice rather than the owner.

"We may well find a locum who falls in love with the place," she said. "By looking to employ the vet, whatever ends up happening, we'd have a model in place that means we shouldn't be back in the same difficult situation five or 10 years down the line."

Although Wallbank sees value in having a resident veterinarian on Tiree, he believes the current system may have an edge.

"The massive advantage I can see is that instead of having one vet on the island, the farmers are getting six vets with a wealth of combined experience," he said. "So it's a one-doctor clinic with access to six different opinions and skill sets."