“Today’s recommendations aim to enhance primary care across remote, rural and island communities by ensuring stability for rural GP incomes alongside other measures that support innovative approaches to the use of IT and physical infrastructure, as well as recruitment and retention practices.” Jeane Freeman, Health Secretary in the Scottish Government

It is part of official Scottish and UK Government, big organisations and major funding bodies ‘speak’, that where we live, Orkney, is labelled as ‘remote’ (and often ‘very remote’). In fact anywhere outside the central belt of Scotland and any major town is also described as ‘remote’. It is of course completely inaccurate and it perpetuates the negative idea that most of Scotland is somehow that little bit ‘backward’and devoid of modern facilities.

Stornoway

Whilst it is welcome to see Jeane Freeman, Health Secretary in the Scottish Government accept the recommendations for improving health care in rural and island communities these places continue to be labelled as ‘remote’.

One of the recommendations is to develop a National Centre for Remote, Rural and Island Care. This is part of a range of measures to support GPs in these areas. [ Report of the first year of work of the Remote and Rural General Practice Working Group.]

There are challenges being faced by GPs across Scotland and indeed there are specific ones to rural and island communities – as there are specific ones for urban areas.

The area labelled as ‘remote’ and rural stretches over 70% of Scotland. In this map it is the green and blue bits.

The recommendations in the report are made to support GP services and make sure that they are suitable for the 21st century. Interestingly the most ‘remote’areas ( and those are the green areas on the map)  have the best GP to patient ratio. I’m sure something most people in urban areas are envious of when they often have to wait a considerable time to get an appointment with their local surgery.

Deep End Practices working in urban areas of high deprivation expressed similar concerns about facing distinct challenges. While Deep End practices are outwith the scope of this report, we recognise that there is a shared issue here. Rural practices and those in the areas of highest deprivation face not only national challenges, but also ones that are distinct to the realities of delivering general practice in a unique setting. [Shaping the Future Together Report]

There are significant issues for ‘remote’ and rural areas centering around poor transport and digital connectivity – these are problems of inadequate infrastructure unable to support 70% of Scotland. Whilst there is to be improvement in digital connectivity in Scotland the North will lag behind in this due to the ongoing legal challenge holding up the R100 roll out. Legal Challenge Delays R100 Broadband to the North

GP practices today involve a team of skilled professionals. They face staffing issues as has been seen with the rise in the expensive use of locums to provide cover. Filling vacancies across the service is not unique to island and rural areas, especially with the ending of free movement as the UK leaves the EU in less than 2 weeks. It does, however, become more difficult to recruit staff to an area when the description used is that it is ‘remote’ or in the case of Orkney ‘very remote’.

The expert medical generalist role set out in the new GP Contract describes an approach that has been in place in rural communities since the Highlands and Islands Medical Service was established following the 1912 Dewar Report. This model contributed to the development of the UK National Health Service. [Shaping the Future Together]

Key Recommendations from the Report

1. The Scottish Government and British Medical Association must continue to state their unequivocal commitment to maintaining the Income & Expenses Guarantee under current contractual and funding arrangements.
2. New terms and conditions arrangements, developed as part of Phase 2 or any further iteration of the GP Contract, should clearly recognise the diversity of remote and rural general practice.
3. A set of criteria for the use of the Rural Fund should be developed, recognising and supporting the distinct role of rural GPs and multidisciplinary teams.
4. A package of support for dispensing practices, should continue to be developed through the Dispensing Working Group that will protect and enhance the sustainability of Scotland’s dispensing practices.
5. A National Centre for Remote and Rural Health and Social Care should be established to foster and promote innovation and excellence in Scotland and internationally.
6. Efforts should be renewed to make maximum use of information technology and digital connectivity in the provision of remote and rural primary care.
7. More effective collaboration with Health Boards and HSCPs is necessary to improve pressing physical infrastructure issues across remote, rural and island general practice, to better support multidisciplinary working, training and education.
8. Closer working with HSCPs (Health and Social Care Partnerships), territorial and national (special) Health Boards and Bodies is required to establish change management support and capacity for remote, rural and island communities. In turn, these endeavours should also help non-rural areas across Scotland.
9. The Scottish Rural Medicine Collaborative should continue to develop innovative solutions to support recruitment and retention of remote and rural GPs and the broadening multi-disciplinary team workforce, at all career stages.
10. Further promotion of the recruitment of medical, nursing, pharmacy and allied health professional (AHP) students is required. This includes more opportunities for student rural replacements and support for the expansion of training practices and training opportunities in remote, rural and island areas.
11. The method of funding allocations to territorial Boards with significant remote and rural areas, including Island Boards, should be reviewed, in light of changing demographics and evolving models of care provision.
12. Proportionate mechanisms should be in place to assess and evaluate new models of care provision in remote and rural areas and to assimilate and disseminate best practice.

Jeane Freeman said:

“Much of Scotland is rural and those who live in remote or rural communities have a right to expect access to the highest quality medical care.

“The new GP contract is bringing improvements and the Working Group was established to help ensure that the challenges specific to rural areas were addressed.

“Today’s recommendations aim to enhance primary care across remote, rural and island communities by ensuring stability for rural GP incomes alongside other measures that support innovative approaches to the use of IT and physical infrastructure, as well as recruitment and retention practices.

“I thank Sir Lewis and his colleagues for all the work involved in developing this important report and I look forward to continuing to work with them and others to continually improve the GP contract.”

Whilst this labelling as remote for 70% of Scotland continues so does the negative mindset.  It will continue to be difficult to recruit and retain skilled medical professionals and  increasingly difficult to attract and retain young families to rural and island communities.

Support for GP services by the Scottish Government and BMA is welcome but until there is a change in how governments and organisations view rural and island communities, getting rid of the ‘remote’ terminology and the image it projects then 70% of Scotland will continue to struggle to maintain and sustain viable populations.

View over Kirkwall from St Magnus Cathedral

Reporter: Fiona Grahame