Author Archive | Rural GP Association of Scotland

Latest survey of Scotland’s rural GPs

Two weeks ago we asked our RGPAS (Rural GP Association of Scotland) members to provide feedback to the Committee in order to identify the latest views, opportunities and concerns about the new GP contract in Scotland.

Our members responded positively and rapidly.  66 responses were obtained over the week (over 50% response rate), the majority of which included considerably constructive comments.  Members were aware from the outset that all responses would be anonymised and published, and we are pleased to make this version available for download today.

Download the RGPAS March 2018 Members’ Survey on the new GP contract (PDF)

We believe that this represents an accurate snapshot of the current views about the contract and its anticipated impact on Scotland’s rural communities.   Chair of RGPAS, Dr David Hogg, wrote this blog a few weeks ago outlining why our Scottish Government needs to pay more attention to these concerns.

The RGPAS Committee and its members stand ready to engage positively with the Scottish Government to help provide the perspective that seems to have been sorely lacking in the negotiations leading up to the new contract being agreed by our leaders in the central belt of Scotland.

We have summarised some of the outcomes below.

 

 

 

 

 

 

 

Here’s some quotes from the survey…

Uncertainty

Our cluster lead has essentially hoovered up all our services to the central area where he and the other big practice are based. We no longer have physios and they tried to remove our health visitor. They are currently attempting to remove our vaccine service. The contract and the health board are a disgrace.

There is an overall sense of planning blight making it difficult to prepare for the upcoming retiral of 4 out of 10 partners by 2021 , after 3 years of waiting for a new contract to see no additional investment is having a negative impact on the practice.

Just the sense that the future is uncertain. Our practice nurse who runs an asthma clinic for us was really worried that some mainland based service would render her redundant.

It has indirectly contributed to my decision to leave my current role as a Salaried Rural GP

Yes, practices feeling unsettled, people thinking about retiring, Health Board getting even more anxious about resources, and threatening non core contracts

Impact on service planning

I am already aware that at least one IJB with a significant rural component has openly come out and stated that it feels that it will be unable financially to support/enact the changes proposed by the new contract. Although there is recognition that the stated goals of shifting work to the rest of the MDT to enable the GP to deal with complex generalism are unlikely to happen in the same way in rural practices as in suburban and urban practices there is still no clear communication about how funding for any work that is retained by such rural GPs (by necessity) may be obtained. There is no confidence that existing or proposed future enhanced services will be supported or financed.

No. In fact despite the future promises of that HB will provide all these new services, they are busy slashing things like smoking cessation.

No further cuts to date but cuts to our practice have already taken place over the last 3 years

Helping to define priorities for the rural SLWG

We used the opportunity to ask our members what they saw as the priorities for the Short Life Working Group to focus on, and there is a considerable range of constructive answers to this question.  These comments will be summarised by the RGPAS Committee and we will seek to do what we can to listen to these concerns and represent them to Scottish Government.  You can read all of the responses in the full copy of the survey.

Download the RGPAS March 2018 Members’ Survey on the new GP contract (PDF)
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Waiting for news about the #gpcontract rural SLWG

Members of the Rural GP Association of Scotland (RGPAS) are waiting patiently for news about the rural Short Life Working Group – the much-promised mechanism by which the Scottish Government has sought to reassure that implementation of the new GP contract to rural communities will be overseen.

RGPAS wrote to Cabinet Secretary for Health, Shona Robison MSP on 14th March, and yet to date we have had no response other than to confirm that our letter is ‘being considered’.  No formal announcement has been made as yet, despite early reassurances being offered that the SLWG would address concerns raised by rural GPs prior to the contract’s agreement.

What do Scotland’s rural GPs think?

Today we will be publishing the results of our latest members’ survey, which continues to demonstrate concern, disappointment and anxiety about how the new contract threatens to make rural practice in Scotland unsustainable.

  • Nearly 70% of respondents say they are less confident that the contract changes will be beneficial to Scottish rural practices
  • Nearly 70% of respondents say they are less confident about their rural practice’s sustainability due to the new contract
  • 97% of respondents believe that RGPAS should be represented on the rural Short Life Working Group
  • 97% of respondents have been happy with the RGPAS efforts to raise our members’ concerns about the new contract

What has been said so far about the SLWG?

On 25th January 2018, First Minister Nicola Sturgeon apparently advised that the SLWG had been set up.

Of course we must listen to the issues for rural GPs, which is why a short-life working group has been established to look specifically at those issues. Members do not simply have to listen to the Scottish Government on this; it is the British Medical Association’s position that the concerns that are being expressed by rural GPs are unfounded and that no GP will lose funding as a result of the new contract. That is the reality of the situation, but I accept that we have to convince rural GPs that that is the case, and we will continue to work collaboratively with them to seek to do exactly that.

First Minister for Scotland, Nicola Sturgeon, speaking at First Minister’s Questions on 25.1.18

(Quote from theyworkforyou.com website)

You can watch the above announcement being made in the video clip below.

https://youtu.be/8-QQgHLKRT0?t=31m23s

Since then we have heard very little, and we remain in the dark about how the SLWG will function, how it will represent rural GPs in Scotland and how key stakeholders like RGPAS and LMCs will be able to contribute to this forum.

RGPAS call for action from the Scottish Government

We call on the Scottish Government to understand the level of concern expressed, and to respond to it in a transparent, co-operative and effective manner.   RGPAS is ready to contribute constructively to the rural SLWG.  Inclusion in the Short Life Working Group should be forthcoming for both RGPAS and relevant LMC representatives, including Highland LMC which we suspect represents the majority of Scotland’s rural GPs.

Inevitably, the schedules of Scotland’s rural GPs are busy and require advance planning, and therefore we request adequate notice and arrangements to ensure effective representation.  We also hope to see adequate patient representation given that the new contract paves the way to redesigning primary care services for all of Scotland’s communities.

The issues facing rural Scottish General Practice are complex, this has been acknowledged by SG and SGPC. Phase one of the new GP contract did not adequately address these issues.  We believe that the solutions can be found to deliver a fit for purpose, rural-proofed contract. The answers lie in the rural workforce and as such we are very keen to represent remote and rural GPs on the SLWG.

Dr Alida MacGregor (GP Principal, Cowal Peninsula), RGPAS Vice-Chair

We would like clarification regarding the timing and make-up of the ‘Short Life Working Group’.  As representatives of many rural GPs in Scotland who will be affected by the contract, we believe that it is essential to  have the opportunity to represent our members’ views . We are ready to contribute to this important opportunity to develop local primary care services – particularly as GPs are often in the best position of understanding the needs of their communities and the ways in which services can be most effectively delivered.

Dr Susan Bowie (GP Principal, Shetland), RGPAS Secretary

It has been widely acknowledged that the 2018 GP contract almost completely ignored the potential opportunities for developing rural general practice and also failed to address the problems facing us.  I welcome the setting up of a SLWG to address these deficiencies and see it as an opportunity for SGPC to regain some credibility with rural doctors. In order to do so it is essential that grass roots remote and rural doctors are strongly represented on the group. In my opinion this would best be done by including Highland LMC and the Rural GP Association of Scotland. Failure to do so will miss an opportunity to strengthen rural practice, and further reinforce the perception that rural medicine is undervalued by the centre.

Dr Richard Weekes (GP Principal, Ullapool), RGPAS Committee Additional Member

The new contract for Scottish GPs received virtually no support among rural doctors, and Scottish Government sought to reassure them by announcing a Rural Short Life Working Group. It is vital to ensure that the two organisations representing the majority of rural GPs – RGPAS and Highland LMC – will be included in the working group. Rural GPs across Scotland, particularly the majority who fear that the contract will make their practices unsustainable, will see effective representation of their concerns as being a vital to implement the new contract successfully.

Prof Phil Wilson (GP Inverness & Director of the Centre for Rural Health), RGPAS Research Lead

RGPAS have consistently put forward constructive ideas to solve the serious lack of an effective rural element in new contract.  RGPAS and the Highland LMC are able to offer considerable insight, expertise and credible representation on rural issues to the Short Life Working Group.   The new contract can still be rural-proofed, but only if those with a deep practical knowledge of rural health are at the heart of the SLWG.

Dr Douglas Deans, RGPAS Committee Co-opted Member (Rural Faculty)

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Spotlight: Primary Care on Skye – Quintessential Healthcare

Over the next few months we will be featuring a number of spotlights on current rural GPs across Scotland.  Dr Steve McCabe works at the Portree Medical Practice on the Isle of Skye and has written the following to give his perspective on rural healthcare…

Portree Harbour

Who am I?

My name is Steve McCabe. I have been involved in rural health for nearly 30 years. But I grew up in Airdrie, a town in Scotland’s industrial heartland and as a child I had no real connections to rural Scotland. The house I lived in stood on a hill. My bedroom was on the southwest corner of the house and it had two windows – one looking south, the other looking west. From the south window at night I could see the sky being “set alight” when the giant steel works at Ravenscraig opened their furnace doors. But from the west window on a clear day I could see the mountains of Arran.

Where am I?

I work as part of a group practice in Portree, the largest settlement on Scotland’s second largest island, Skye. Skye is widely regarded as one of the most beautiful islands in the world. It is one of the few Scottish islands with a growing population and Portree is the hub of island life, a busy wee place.

We also look after the islands of Raasay (pop. 192) and Rona (pop. 2).

The Wednesday commute to Raasay

Why am I here?

I was brought up on the stories of James Herriot (and his idyllic life as a rural vet) and A. J. Cronin’s heroic rural doctor, Dr Finlay. During school holidays my parents took me to rural areas – the East neuk of Fife, the Galloway hills, the Yorkshire dales. I knew from when I was 14 years old that I wanted to be a rural doctor. It is for this reason I went to medical school and nothing there changed my mind. While all my colleagues were jetting off to California or Queensland or Fiji for their electives I was living in an old dairy in the Scottish Borders experiencing rural GP life first hand. As a result I did my GP training in the Borders and subsequently worked as an Associate GP on Islay and Jura during 1995/96 before taking up my current partnership in Portree in May 1996.

Who is our population?

The island has three other practices but ours is by far the largest with 5500 patients – about half the island’s population. On top of that we are currently also dealing with about 1000 visitors each year but these are only a tiny fraction of Skye’s total number of visitors each year which now exceeds three quarters of a million people.

Who do I work with locally?

We have a full complement of primary care staff on the island (and a separate out-of-hours service) and we work very closely with all of them. Of course, just as with rural doctors, there is a fairly constant pressure on the recruitment and retention of community nurses, midwives and allied health professionals.

The Cuillin of Skye

What impact has the new GP contract negotiations had on me?

In its 2004 iteration the GP contract, negotiated at a UK level, had a very negative impact on rural practice in Scotland. It withdrew at a stroke many of the had-fought concessions rural practice had achieved. So, no more distant island allowances, no more rural mileage payments, no more notional lists, etc. Literally overnight we saw our income fall by more than 20% and we have never recovered that deficit.

I worked hard for nearly 17 years on BMA Scotland’s Scottish Council trying to highlight rural concerns and to rural proof BMA Scotland policy. I had hoped that, as a result, a new Scottish GP contract, negotiated in Scotland, would have had rural issues at its forefront. But instead we are told by BMA Scotland that rural is “too difficult to sort” and we have been kicked into a patch of long grass called phase 2.

RGPAS have been excellent at highlighting this iniquitous situation and we must give strength to their arm by supporting them as much and as often as we can.

What challenges do I face engaging in the political process?

None really – it is something I have always done throughout my professional life, driven as I am by a core belief that as GPs we have a fundamental role in local and national social activism. I have even managed to go so far as to have a debate on rural health issues held in the Scottish Parliament. I have over the years widely discussed rural health issues and concerns in national newspapers and on national radio and television. I continue to write a monthly article for a current affairs magazine in which I refuse to pull any punches.

What are my thoughts regarding the future?

I try to live in the moment as much as I can. I absolutely love my job and look forward to going to work every day. I miss it when I am on holiday. For me it has always been a vocational thing and that remains so now more than ever.

But the reality is I will be 53 later this year and I cannot go on for ever. I always said I would stop working as a doctor while I felt I was still at the top of my game rather than fizzle out and fade away. I can see already I don’t have the stamina I used to have and I am increasingly tired after busy days. My memory is also not as sharp as it was – the days of me never having a diary (which I didn’t until my mid-40s – I kept it all in my head and never missed anything) are now gone. So my plan is to retire at 58. One of the main driving forces behind that decision is that I will do my next revalidation at 54 and it will be my last. I regard revalidation as one of the worst things to happen to our profession and I am still sad to this day that we allowed it to be thrust upon us and that we let go of the wonderful model of appraisal we previously had.

And when I do retire I don’t know what I will do – but it will be something completely different…

Bluebell Wood, Portree

 

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Spotlight: Rural Practice on Jura

Over the next few months we hope to feature a number of spotlights on current rural GPs across Scotland.  Dr Martin Beastall works on Jura with his wife Dr Abby…

Life and Work on the Isles of Islay & Jura: Living the Remote and Rural Dream

Who are we?

Jura Medical Practice consists of a husband and wife GP team – myself (Dr Martin Beastall (42)) and Dr Abby Beastall (36). I am responsible for the running of the Surgery on Jura and Dr Abby works mainly at the Bowmore Surgery on Islay, and does one session per week on Jura. Between us, we are also responsible for out of hours care on Jura 24 hours per day, 7 days per week. We came to Jura just over 5 years ago having both worked in and around the Doncaster area in England for a similar length of time. We were both looking for a change, an adventure, and having both worked in large urban Practices, a chance to reconnect with our patients and make a real difference to their lives. We met on the Doncaster GP training scheme in 2005. I had changed from Surgical training, whereas Abby had always intended to train as a GP. Between us, we have a varied mix of skills, perfect for the challenges that Remote & Rural Medicine brings.

Where are we? 

Jura is a large island of approximately 400 square kilometres in the Southern Hebrides, situated to the north east of Islay. Jura has a tiny population (under 250), whereas Islay’s community numbers just over 3000. We are situated directly west of Glasgow as the crow flies. An ill patient can be transported by helicopter to Glasgow in under 30 minutes, whereas a journey by car requires two ferries and takes most of a day to complete.

Why are you there?

Rural General practice brings with it many challenges but also great rewards. We have the opportunity to genuinely provide ‘cradle to grave’ medical care and to be an integral part of our patients’ lives. We are a small but thriving community on Jura. We believe having medical services here is essential for the continued growth and stability of our community and that without continuity and stability, the future of the community overall would be threatened.

Who is our patient population?

The population of Jura matches the overall Scottish demographic, just in miniature. Every age group is represented and the care we provide ranges from baby vaccinations to very personal palliative care for those coming to the end of their lives.

Who do you work with locally?

Being the GP on Jura means being the Doctor, Practice Nurse, Phlebotomist, Health Care Assistant, Paramedic and Pre-Hospital Responder all in one. Flexibility and a willingness to attempt almost any task asked of you is key here. We are lucky to have a dedicated team of carers and District Nurses on the island, and are well supported by allied health professionals based on Islay also. Emergencies are dealt with locally when possible, but a comprehensive support structure exists regionally to provide help ranging from helicopter transport to full blown medical retrieval teams when required.

What is it like having 24 hour a day responsibility for your patients’ health and wellbeing?

Being ready and available 24/7 can be hard psychologically. Patients have direct access to their GP here (rather than using a service such as NHS24) which has its pros and cons. Being able to deal with things locally is very satisfying but it can be hard sometimes to demonstrate to the wider world the time and money saved by avoiding transferring patients elsewhere.

What impact have the new GP contract negotiations had on you?

We have both been very grateful for the efforts made by the RGPAS on our behalf. We feel that as rural GPs we are very much an afterthought. Issues such as the provision of out of hours cover after April 1st 2018 have been very unclear. This has had a destabilising effect on us, exactly the opposite of the stated intended effect of the new contract.

What challenges do you face engaging in the political process?

Being geographically remote and (due to childcare issues) essentially single handed means attending meetings is very difficult given the 24/7 responsibility for patient care. Video conferencing and webcasting still seems the exception rather than the norm. It is easy to feel out on a limb here.

What are your thoughts regarding your future? 

We both remain positive about our futures living on Islay and Jura. We cannot imagine a better community to live in and raise our daughter in, and are hopeful that the new GP contract will enable us to continue to provide the high level of medical care we have done for the last five years for the foreseeable future.

Photos by Martin and Abby.
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Louise Polson publishes in RRH about student placement in Shetland

Louise Polson, medical student at Glasgow University, has written about her student rural medicine placement in Remote & Rural Health.

She writes…

This placement also provided the opportunity to research and write this essay, which gave me a much deeper understanding of how emergency care is provided in remote areas and allowed me to consider how care could be improved for future patients. I believe key areas for improvement include increasing links with medical schools to provide more student placements, possibly through publicising positive testimonies from students who have already been (such as myself), and also improving recruitment and retention of staff through increased access to further training opportunities.

Congratulations Louise!  We are particularly pleased to see this published, as Louise joined us in 2015 when she received an RGPAS Student Scholarship to attend our annual conference.

Read the full article here: https://www.rrh.org.au/journal/article/3824#cite_2

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RGPAS survey indicates extent of #gpcontract concern

A members’ survey carried out by the Rural GP Association of Scotland (RGPAS) has revealed a considerable level of concern across rural GPs in Scotland about the new GP contract proposals.  Of 115 members, 74 have responded (65% response rate).

One reason for conducting this survey, is the refusal to publish the geographical breakdown of the results of the national poll.  We understand that this may be due to a technicality of the voting process and therefore hope that this is useful information for SGPC and Scottish Government to view the perspectives of rural GPs in Scotland about the new contract.

Click to download the report (2.6MB, PDF)

In November last year, RGPAS published a constructive appraisal of the proposed new GP contract.  Since then we have attempted to engage with SGPC and Scottish Government to understand how appropriate steps can be taken to ensure that the very acute needs of Scottish rural general practice will be adequately addressed.  RGPAS wrote a letter to the Cabinet Secretary for Health, Shona Robison, and a phone call took place on Wednesday 13th December to discuss our concerns in more detail.  A formal response to this letter was promised, but as yet we have not received this.  Specific concerns highlighted at this time included whether the GP contract proposals were compatible with the Scottish Government’s ‘Realistic Medicine’ strategy, and the effects of the proposed Workload Allocation Formula (WAF) in delivering much-needed additional resource only to urban-based practices.  Notably, these specific concerns about the WAF are echoed by our ‘Deep End’ colleagues – GPs who work in some of the most deprived communities in Scotland.

In the last few days, further concerns have been raised by Prof Phil Wilson about the methodology behind the proposed new Workload Allocation Formula as well as the process of polling GPs across Scotland – from which the SGPC will decide whether to go ahead with the proposed ‘Phase One’ of the proposals.  [STOP PRESS: A further letter from Prof Wilson was sent on 8th January with additional concerns about the allocation formula].

RGPAS remains ready to work with SGPC and the Scottish Government to address the issues being raised by our members, whether the new contract goes ahead or not.  The survey results below indicate the strength of feeling, but moreso the passion that rural GPs – like many GPs across Scotland – have for advocating for their communities, and delivering quality primary care in some particularly challenging circumstances.

RGPAS believes these concerns need to be addressed with the utmost urgency, and not wait until or whether Phase Two of the proposed contract is enabled – if Phase Two happens, we understand that it won’t be for another 2-5 years.  We do understand the plans to form a ‘Short Life Working Group’ for rural practice.  However, the time for action is now, not least to address the constructive concerns raised already in this process about the proposals of Phase One.

This is critical for the future of Scottish rural primary care, and the RGPAS committee and membership is ready now to see more effective representation of the health needs of Scotland’s rural communities than what has been proposed.

 

 

 

 

 

Some of the comments at the end of the survey are particularly illuminating…

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Mapping out the proposed Scottish #gpcontract allocation formula

Effects of the proposed workload allocation formula: red practices (n=354) require ‘income protection’ of up to 85% due to the negative effect of the WAF. Green practices either stay the same (n=4) or will see an increase in their funding (n=602).

Last night’s BMA Scotland webchat with the Scottish GP Committee (SGPC) about the new GP contract was an opportunity for GPs across Scotland to engage with our negotiating team to find clarity, response and reassurance (where possible) about the new contract.

We appreciate the time that our SGPC colleagues took out of their evenings in order to provide this session, which you can view here https://www.bma.org.uk/connecting-doctors/my_working_life/p/gpcontractwebchat

RGPAS wishes to respond to an SGPC comment last night in relation to the map that has been published in the last few weeks showing which practices stand to gain from the proposed workload allocation formula. Concern was expressed that the originally published map was incorrect, as red dots had been used to indicate practices who will see no difference and no additional funding compared with their 2017 funding.

And so we are very happy to issue a revised map which makes this correction – see the map above.

The green dots indicate GP practices that will gain additional funding – or maintain current funding – and the red dots indicate practices which will see a fall in their allocated income as a result of the proposed formula.  These red practices will – in Phase One of the proposals – require ‘protected income’ to keep their funding in line with 2017 funding as otherwise they would see drops of up to 85% in funding for patient care.

You can view an interactive version of the map here.

Spot the difference?

Old and new maps compared. Spot the difference?

We’re surprised that this clarification is required, not least as we see very little difference between the maps.

There are significant concerns about the way in which the workload allocation formula has been devised, and from the graph below it can be seen that there is an obvious skew against rural practices.

Not just rural

This, however does not tell the whole story – our Deep End GP practice confreres – who represent the GP practices serving the most deprived communities in Glasgow – have expressed their own concerns and surprise that health inequalities do not seem to be adequately addressed by the proposed contract.

Going forward

Click to download the report (2.6MB, PDF)

Meantime, RGPAS remains committed to representing the needs of its members, and the wider needs of rural GP practices in Scotland and their communities.  Several weeks ago we published our official response to the new contract, including positive ways that we firmly believe RGPAS can assist with the process of further negotiation and shaping the future of Scottish primary care.  You can download the report ‘Looking at the Right Map’ by clicking the image on the right.

Rural GPs can join RGPAS here: http://www.ruralgp.scot/join (£20 per annum membership).

You can view our letter to Cabinet Secretary Shona Robison (response awaited).

Here’s some recent news coverage regarding RGPAS concerns:

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A guide to Scotland’s new helicopters

Many thanks to Bristow Helicopters (and Duncan Tripp, who is one of the Inverness crew and also a BASICS responder/instructor) for forwarding these information booklets about the new S92 and AW189 helicopters which have been providing the new Coastguard Search & Rescue helicopter service across Scotland and the rest of the UK since January.

We are now in the thick of winter, with challenging weather to match.  Those rural GPs on islands and more remote parts of Scotland will already be very familiar with the vital role that these aircraft provide in the emergency transfer of unwell and seriously injured patients.

Each booklet is easy-to-read and offers practical advice about things to consider when working with these aircraft.  Other responders, including mountain rescue and lifeboat volunteers, may also find these helpful to read.

Members of BASICS Scotland can also access the online ‘iSAR’ video and quiz-based learning about working safely with these helicopters.  Members can contact the BASICS Scotland office to access this resource.

 

          

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RGPAS response to the Scottish GP contract proposals

The Rural GP Association of Scotland (RGPAS) today publishes its response to the Scottish GP contract proposals.  Following much discussion on our members’ email discussion group, RGPAS videoconferences and wider engagement on social media and contract roadshows, we have collated the opportunities and challenges that we believe to exist in the proposals.

We recognise that a new vision for the future of Scottish primary care is vital.  We are keen to collaborate and inform the development of these plans in order that Scotland’s rural communities (at least 18% of the Scottish population) are represented appropriately.

You can read the GP contract proposal at the BMA Scotland website.

You can find out more about RGPAS at www.ruralgp.scot

Click to download the report (2.6MB, PDF)

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