Rural connectivity in Scotland – a step forward?

phoneOn Wednesday 10th September, I attended a meeting in Edinburgh about connectivity in rural Scotland.  Following the report ‘Being Rural’, launched a few weeks ago by the RCGP Scotland Rural Strategy Group, the meeting was organised to discuss our concerns with the relevant departments of the Scottish Government.

Is this important?

Connectivity has become a crucial issue for the sustainability of rural areas – and not just for healthcare.  The digital divide is now more evident than ever, and the gap continues to drive inequalities of access to healthcare.  With integration of health and social services due to commence in April 2015, there will be an inevitable requirement for greater sharing of data and collaboration.  It will be vital that adequate connectivity is in place – in terms of reliable landline, mobile and broadband networks.  It is clear that connectivity needs to be placed high up the agenda if integration – as well as the wider sustainability of public services in rural areas – is to succeed.

Of course, focus should not rest exclusively with health services.  Access to broadband is a strong determinant of social functioning, as well as professional collaboration.  For rural areas to remain attractive to tourists, new business and to maintain a vibrancy of community, this will depend on improving equity of access to decent network capacity.

What’s RCGP Scotland doing about this?

So through the RCGP Scotland Rural Strategy Group, last week’s meeting followed from one held a few months earlier, and this time it was clear that we were speaking to the decision-makers at the core of Scotland’s broadband and mobile network strategy.  Representatives from Community Broadband Scotland, the Digital Directorate of the Scottish Government and the Digital team of the Scottish Futures Trust met with us to get a better insight into the problems we are facing… and it was useful for us to get an insight into the scale of the challenges that they face too.  ‘Backhaul’ – or the data capacity required to connect exchanges, as well as subsea and cross-country fibre cabling – is a major issue.  There seemed to be a commitment to get this right the first time, not least as this will determine how future-proofed the longer term strategy will be.  Aside from the copper cabling connecting your surgery to the exchange, every mobile phone mast and exchange needs to plug into larger data ‘pipes’ to keep the information flowing.  This can be complex, costly and time consuming – and yet is an essential component to achieving better connectivity.

What is clear is that there are a number of high-level organisations working on the issues.  It is therefore important that we ensure that health care (specifically general practice) connectivity needs are well represented.  There is over £300 million of public money, being used to attract around £3 billion of investment into Scotland’s digital infrastructure over the next 5 years.  This is all designed to tie into the Scottish Government’s ‘World Class 2020 vision‘ to be a world class digital nation.

On the one hand, I do take the view that development of local connectivity infrastructure is outwith the remit of a rural GP/practice team, especially with so much other clinical/non-clinical work going on.  However, it is clear that engagement with communities to consider their options, and represent their difficulties effectively, is necessary for this investment to be spent appropriately.  At the very least, we need to help RCGP members to navigate the complex state of multiple organisations being involved with superfast broadband rollout, to ensure that any engagement is as relevant and fruitful as possible.

All very good, what does this mean for me?

For rural GPs and healthcare teams across Scotland, we’ve been keen to give decision-makers a pragmatic view of the challenges faced at present.  These include:

  • branch surgeries being unable to operate properly as remote access to computer records (such as EMIS/Vision notes, Docman’d ECGs/discharge letters and other medical information) being reliant on broadband speeds above 2Mb/s
  • difficulties in setting up group/federated/branch practices – particularly at a time when increasing numbers of surgeries are considering this option for recruitment/retention reasons
  • isolation faced by rural GPs by not being able to connect to webinars, online video and other CPD material
  • difficulties faced by BASICS GPs and First Responders in being available on-call (or more frequently, being tethered to the home phoneline – which makes for a poor level of work/life balance)
  • dangers faced of lone working without mobile phone coverage, sometimes taken for granted in less rural areas

Site visits have already been undertaken by some of the organisation mentioned, in some areas, and there are local examples of excellent progress – for instance the Isle of Coll, and Applecross.  An invitation to Arran has been taken up by the Scottish Futures Trust, and this will be arranged in the near future.

What can I do?

Over the next few months, we hope to report frequently on engagement between RCGP Scotland and the organisations mentioned above.  Much of this work has been building on the ton of work done already by Dr Drew Inglis from the Emergency Medical Retrieval Service – you can read more about this work at – and you may already be receiving Drew’s regular email updates.

In short, keep your ear to the ground, and ensure that your wider advocates – not least your MSP – are aware of connectivity issues in your area.  The next few years look set to stage some fervent action to get Scotland’s connectivity up to decent standard including in rural areas.  We need to ensure that the needs of rural healthcare teams are placed high up the agenda.

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