Recruitment & retention of rural GPs is a hot topic in many countries, not least Scotland and the UK. Traditionally, much focus has been placed on encouraging and supporting newly-qualified doctors to ‘choose rural’ in the earlier parts of their career. Attracting younger doctors to rural areas remains a vital part of maintaining sustainable rural practice, however there is increasing attention to the opportunities of attracting more experienced GPs to rural practice.
It makes sense. Rural practice demands – arguably – the widest spectrum of generalism in medicine. Faced with everything from emergency medicine to complex palliative care, with complicating geographical considerations. There are times when access to secondary care is either delayed or not possible, due to the distance or mode of transport available. Practising medicine in this regard is particularly challenging, and requires good clinical judgement. It’s also what makes the job so stimulating as a career choice. So for GPs who want a career change, and yet stick within general practice, rural practice may well offer the change in circumstances that they want. And their well-honed clinical judgement and experience is highly valuable to rural communities.
Making the switch
So how can we make this an easier, a more viable choice for more experienced GPs to make? Aside from the logistical factors, it is recognised that solid provision of training and subsequent mentoring can be very effective in ensuring that GPs making this transition feel adequately supported. Experience from programmes such as the Scottish GP Rural Fellowship Scheme is rich in helping to pinpoint what skills and competencies are important in promoting professional resilience in rural GPs. Initiatives such as the EU/Northern Periphery Recruit & Retain project are providing networking possibilities to learn about good practice in Iceland, Scandinavia and Scotland amongst others.
First and foremost, rural GPs need to be good GPs, with a safe and competent approach to all the common/important general practice presentations – including those detailed in the RCGP Curriculum which can act as a good aide memoire to the scope of practice that GP involves.
A close second is confidence and competence in acute care. Organisations including BASICS Scotland are well established in running courses and refresher training in acute medical and trauma care, and are frequently cited as contributing essential skill acquisition to rural healthcare professionals across Scotland. There is continual development of the training that they offer, with effective feedback mechanisms to match course content with what’s important in practice.
Thirdly, it is recognised that professional-to-professional support, perhaps as far as ‘pastoral support’ is important. Mentoring is increasingly cited as an effective mechanism to support new and less experienced GPs, such that the Royal College of GPs in the UK has recently set up a nation-wide match-making facility (requires RCGP login) for mentees and mentors. It is clear that having a supportive colleague available by phone, Skype or email, can be hugely beneficial in reducing the isolation faced by many GPs working in rural practice.
So what’s the next step?
RCGP Scotland has recently set up a Rural Strategy Group, and input to this has included the RCGP (UK) Rural Forum and NHS Education for Scotland. The Rural Forum have been active in proposing a framework that could provide an integrated, pragmatic package of training and support for more experienced GPs wishing to switch to rural practice. The contents of this proposal are still being finalised, however this tenet of recruitment & retention in Scottish rural practice is now clearly an important one, and will likely see fruition in the next year or so. As ever, the funding streams need to be clarified, and ensuring quality training that is relevant to rural practice will come at a cost. However, with Scottish rural practice already at crisis point in terms of recruitment & retention of GPs, it is an investment that is sorely needed.
What are other countries doing?
It is always easy to look to Scandinavia, Australia and New Zealand, amongst others, for ideas. In this particular field, Australia offers some very helpful models, particularly from its Remote Vocational Training Scheme. In typically Australian innovative style, there are a number of videos available on Vimeo that explain their work further. You can view these here and a couple of them should appear below. RuralGP.com hopes to cover future developments in this area. You can leave comments below, or alternatively submit your own viewpoint article and we’ll publish it here.
Dumbledore image Creative Commons licence by Spielbrick Films