Author Archive | RuralGP.com

Event: Safety & Sustainability in Rural Surgery

The Royal College of Physicians and Surgeons of Glasgow is pleased to announce a provisional programme for the Safety and Sustainability in Rural General Surgery Conference on 30 November and the morning of 1 December 2017. This conference will bring together many of Scotland’s current surgical trainees with a long-established network of remote and rural surgeons, the Viking Surgeons’ Club, in an exciting and unique event.

The conference will explore the current reality of Scottish rural surgical service provision, discuss the international remote healthcare experience, and offer updates into the management of surgical subspecialty emergencies in a rural context. We welcome delegates from around the world who have an interest in rural healthcare and the challenges therein.

Title: Safety and Sustainability in Rural General Surgery: The Viking Surgeons’ Conference 2017

Date: November 30 and December 1 2017

Venue: The Royal College of Physicians and Surgeons of Glasgow, 232 – 242 St Vincent Street, Glasgow, G2 5RJ

Book online: https://rcpsg.ac.uk/events/vikings

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The Belford: an example of great quality rural healthcare

Dr Patrick Byrne, consultant at the Belford Hospital in Fort William, was involved in hosting a visit from a delegation from the Philipines.  This article featured in Lochaber Life Magazine earlier this month.  It has been reproduced here with the kind permission of Iain Ferguson of the Write Image (picture credits to Iain too).

PHILIPPINE VISITORS TO BELFORD

Dr Patrick Byrne

The Belford Hospital continues to punch above its weight on the national and international stage, welcoming a delegation from the Philippines a few weeks ago.  The visit was part of a week-long study tour to the UK by Presidents and delegates from the Philippine Royal Colleges of Physicians, Surgeons, Paediatricians and Obstetricians and Gynaecologists, alongside officials from the Philippine Ministry of Health.

Teaching & training for most healthcare providers in the Philippines tends to be concentrated in the largest hospitals in cities, ignoring the district and rural locations.  This is in contrast to the UK where every hospital has a role to play and sometimes the best experiences and training is to be found in the smallest facilities, where one-to-one supervision from consultant teachers is often the norm, not the exception.  The purpose of their study tour was to learn from UK practices, specifically how supporting and investing in rural hospitals leads to a more efficient healthcare system across the region, and the country.

Led by the immediate Past President of the Royal College of Surgeons, Mr Ian Ritchie (who has family ties to Corpach), the delegates specifically requested to see an example of good training in a small hospital of approximately 100 beds.  Mr Ritchie replied, “I can bring you to a 34-bed hospital where training and patient care is not just good, but excellent”.  The importance of this visit, was underlined by the presence of the most senior NHSH personnel – Prof Elaine Mead (Chief Executive Officer), Mrs Gill McVicar MBE (Director of Operations) and Dr Emma Watson (Director of Medical Education).

Each, in turn, reiterated the importance of consultant-led services and training at Belford Hospital, both now and going forward. However, it was Miss Alison Bradley, a former Belford trainee, now a senior surgical registrar in Glasgow, who captivated and inspired everybody, proving that rurality is no impediment to ambition; quite the opposite, in fact, as she explained the details of her PhD research into pancreatic cancer.

Mr Ritchie said, “It was very clear to all who visited that numbers of beds is not an indicator of good training, it is that key relationship between a trainer and a trainee which, in Fort William, you all demonstrate to a very high degree.  The high point was certainly the Belford.”  In her letter of thanks, on behalf of the College of Paediatrics, Dr Cynthia Daniel echoed this, adding “I am certain with you and the rest who share the same passion for training and service, Belford Hospital should be safe for the next 150 years and beyond”.

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Reflections on an LIC in Lochaber

Lewis Mundell, student of Dundee University, recently completed a Longitudinal Integrated Clerkship in Fort William as part of his medical school training.  This article featured in Lochaber Life Magazine earlier this month.  It has been reproduced here with the kind permission of Iain Ferguson of the Write Image (picture credits to Iain too).

Training to be a Doctor in Lochaber

Lewis Mundell, LIC Student

I have spent almost a year in the Lochaber community, training as part of a project undertaken in partnership between the University of Dundee and Tweeddale Medical Practice. This is a trial project and a first in the UK. The purpose: to improve the teaching of medical students.

Other Medical Students in Dundee mainly spend their time in hospital in the form of four-week placements in different medical wards. The project I have been doing under the supervision and guidance of Dr Jim Douglas is focused on learning in the community where 90% of healthcare takes place. A focus is spent on patients, to learn from them rather than tutorials or textbooks.

Although the majority of my time has been spent in Tweeddale, 40% of my time has been spent in Raigmore and the Belford Hospital as well as working with Physiotherapists, District Nurses and Pharmacists. By being in the community, I have gained a better perspective of health care, understanding the challenges patients face when the GP simply says ‘visit the Physiotherapist’.

The most unique part of this year has been the ‘Patient Journey’. This has allowed me to follow people through their health care experience from ‘cradle to grave’. I have followed mothers through pregnancy; seen children cope with infections; learned from teens struggling with depression; saw life-saving surgery; watched a patient fight cancer and the hardest part – the privilege of being present at the end of life. Each of these experiences has been humbling and I will never forget the people involved.

Many medical ‘experts’ have said ‘how can a student learn everything he needs to know without being trained in a city, in a ‘centre of excellence’? I would argue that a community like Lochaber is a centre of excellence as it is a centre of people, all actively engaged in training a medical student. In comparison to cities, where community is reduced, Lochaber can recognise its own need for doctors and other health care professionals and therefore its need to train these professionals locally.

Once again I would like to thank you all for allowing me to join your community. I have learned so much! I will definitely consider returning to this area for future training and possibly long-term employment when I’m qualified. It is impossible to list the many people who have helped me, but a special thanks goes to Dr Jim Douglas and all the staff at Tweeddale, Dr Amy Macaskill and the CMHT, Theresa Mackay and the Midwifery Team, Belford Staff, Jaquai Parfitt, Staff at Raigmore, Fleming & Fleming, Lloyds Pharmacy, Macmillan Cancer team and not least the Scottish Ambulance Service.

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RCGP set to hold #RuralGPchat on Wed 26th July 8-9pm

The Royal College of General Practitioners (RCGP) is set to hold a ‘Twitter chat’ about rural general practice – aimed to highlight and discuss the key issues regarding rural general practice in the UK.

You can join the discussion on Twitter on Wednesday 26th July at 8-9pm.

#RuralGPchat

Calling all rural GPs and HCPs, plus patients who receive care through rural general practice – join our #RuralGPchat on…

Posted by Royal College of General Practitioners on Monday, 24 July 2017

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Aberdeen Uni showcases pilot Rural GP exposure for first year students

Aberdeen University Medical School have just released this video to report on a project which enabled first year medical students to experience rural general practice.  A new initiative by the University, made possible by a donation from Mr Joe Officer, saw 14 first year medical students taken on a two day adventure to Cairngorm national park and the surrounding area, to speak to those working in rural practices and to see first-hand the benefits of living and working in the countryside.

It’s increasingly recognised that career advice is essential for the earlier stages of medical school.  Role modelling and creating career aspirations early on can be hugely helpful to students who are thinking about their future career options.  As exposure to rural general practice tends only to be available in the later stages of medical school, this project highlights some of the reactions of students who were given the opportunity to learn more about Rural GP earlier on in their careers.

It’s pretty eye opening just how much can be done in a rural setting when you have a purpose built GP hospital

Kudos to Aberdeen University for recording the experience in such a vibrant and professional manner, and to the students for giving such articulated reflections and comments through the video too.  Maybe this is something that could be rolled out on a wider level?

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Elective Report: Isle of Arran 2017

Hannah & Louise

Hannah Kennedy and Louise Black are two third year medical students at Glasgow University, who have just completed a 4 week elective in rural GP on the Isle of Arran.  They kindly agreed to have their elective report published on RuralGP.com…

Our time was split between the five practices that make up the Arran Medical Group, as well as the small community hospital in Lamlash. This allowed us to experience a wide range of rural clinical practice in both primary and secondary care settings. We attended GP surgeries led by various doctors, many of whom also have interests in other specialties, including dermatology and gynaecology. We also had the opportunity to sit in on nurse-led clinics. This meant that we were able to see a range of clinical presentations, as well as practice history taking and clinical examinations. Going on home visits also allowed us to get a flavour of the island community.

Time spent at the Arran War Memorial Hospital was divided between the A&E, the four inpatient wards and outpatient clinics. Taking part in daily ward rounds and seeing patients on the ward provided an opportunity to practice clinical skills and examinations. The size of the hospital also meant that we could get to know patients and follow their care journeys through from admission to discharge. Attending a discharge planning meeting gave us a useful insight into the challenges involved with discharge and social care in a rural setting.

Emergency care on Arran was a highlight of the elective. Accident and Emergency consisted of one bed – a lot different to what we are used to! We got the chance to see patients as they arrived at A&E and fill out casualty cards, which was a first for both of us. This allowed us to practice presenting patient cases and form a list of differential diagnoses, which we found very useful. We also got to experience evenings and weekends on-call. During this time, we witnessed our first emergency helicopter transfer, which was very exciting. It was interesting to learn about the factors that contribute to the decision on whether or not to transfer a patient to the mainland, including weather and availability of transport.

Other things that were useful to observe were consultations at care homes, social work meetings and AMG team meetings, where topical issues were discussed in the group.

As well as experiencing a variety of clinical practice, we also had plenty of time to explore what the island has to offer. On our first day we were sent round the island on a treasure hunt, to get our bearings and see some of sights such as Brodick Castle and the ruins at Lochranza. Arran is a beautiful place with an endless number of walks; a few of which we enjoyed were the Machrie Moor Standing Stones, North Glen Sannox and Goatfell, the highest point on Arran! We also enjoyed spending sunny days at the beaches around the island and eating a lot of tasty Arran Dairies ice cream!

 

 

Doing our elective on Arran has given us a great insight into what rural medicine is like. The small, close-knit island community was something neither of us had experienced before. We noticed that this raises issues in medical practice, for example in terms of confidentiality, however, it means that doctors know their patients well and so there is a greater level of patient trust and care provision. Something that stood out for us was the enthusiasm of the AMG team to improve the healthcare for the people on Arran, despite the limited availability of resources on the island. We felt really welcomed by all members of the team during our time, which has added to our positive experience. Overall, an enjoyable and educational elective and an experience both of us have benefitted from.

For future students looking to organise a placement on the Isle of Arran, we have created a “Pros and Cons” list of the elective and “Top Tips” to help you prepare:

Pros Cons
Made to feel part of the AMG team Hospital can be quiet at times – but this can give you more time to explore or catch up on work in the library
Flexible timetable – have the opportunity to see and do things you want to Expense of travel and accommodation
Variety of experiences available within placement – from lifeboat and mountain rescue training to GP surgeries to specialist clinics Poor weather can sometimes limit outdoor activities
The opportunity to get involved with practical skills

 

Transport around the island can be tricky without a car – as buses don’t come frequently and practices are quite spread out
A lot of outdoor activities on offer on the island
The island is busy during the summer with many events held in each village – something else you could get involved in

Top Tips

  • Organise accommodation well in advance.
  • Be prepared for a more relaxed style of placement.
  • Grab the opportunity to get involved in placement as the AMG team are keen for you to make the most of it.
  • Walking boots, suncream and midge spray are essential!
  • If someone tells you a walk will be leisurely, do not believe them, you are in for a trek.
  • Try Arran Dairies ice cream.
  • Make the most of sunny days and time off by exploring.

We’d like to thank David Hogg for organising our elective and making it possible and the whole of the AMG team for looking after us.

All photos by Hannah & Louise.
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What matters in remote & rural practice? Your input requested…

RuralGP.com has just received this request from Elizabeth, who is seeking contributions to research that she is carrying out into the needs of remote & rural practice in Scotland.  If you are able to assist, please contact Elizabeth directly…

My name is Elizabeth Lemmon, I am a PhD student based at the University of Stirling and currently undertaking an internship at the Scottish Government within the Health and Social Care Analysis Team. The aim of the internship is to carry out some research into remote and rural general practice in Scotland in an attempt to better characterise them in terms of their activities and the challenges they face. I’m currently pulling together data which are publicly available on general practices to improve the evidence base and identify where further data analysis are needed.

I am contacting you to ask if anyone would be interested in sharing their experiences within remote and rural general practice and highlight any areas which you feel are priorities or which need further research?

I understand that there is currently work taking place within the Scottish Government on the Primary Care Evidence Collaborative which is developing a 10-year evaluation framework for primary care transformation. The work I will be doing during my internship on remote and rural practices will help to identify priorities for data, research and analysis and ensure that rural issues are included.

Any feedback is much appreciated!

Elizabeth Lemmon
Scottish Graduate School of Social Science Intern
Health and Social Care Analysis
Scottish Government
Email: Elizabeth.Lemmon@gov.scot
T: 0131 244 3469

 

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Highland innovations in eHealth

Thanks to RGPAS member Dr Richard Weekes for highlighting some fantastic work going on in NHS Highland to innovate eHealth applications aimed at improving access to healthcare in rural settings.

Here’s an introductory video showcasing some of the projects…

…an STV news item about the PILLCAM project in Ullapool to provide easy access to endoscopy facilities – using some very novel technology…

… and more about bringing endoscopy to rural communities…

… and the RAPID project to overcome connectivity challenges in rural Scotland…

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