You can download the RGPAS response here.
More comment to follow.
You can download the RGPAS response here.
More comment to follow.
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.
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…
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.
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.
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.
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:
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.
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
This year, the Rural GP Association of Scotland has once again run its student conference scholarship programme. This is a significant investment for RGPAS, which uses money raised into its Educational Trust fund to support these scholarships. The scholarships offer heavily-subsidised tickets to enable undergraduate students in the UK to attend and participate in the annual RGPAS conference.
To apply, students were asked to submit a 60 second sound or video clip explaining their Bright Idea for Rural Practice. We are delighted to feature the winning entries below.
A number of these will be selected for PechaKucha-style presentation at our conference in November. You can read more about the scholarships here, and also a great write-up of last year’s conference by one of the scholarship holders then, Catherine Lawrence from Hull & York Medical School.
There is still time to sign up to the conference, which takes place from 2-4 November 2017 in Inverness. £130 for GPs or £65 for trainees gets you two-and-a-half days of quality CPD, along with a conference dinner (and wine). It’s a great way to catch up with like-minded colleagues, and hear updates on clinical and non-clinical topics that are relevant to rural practice in Scotland.
Well done to all our scholarship winners. We look forward to meeting you in Inverness!
Things are heating up for this year’s RGPAS 2017 conference, to be held in Inverness on 2-4 November. A full programme is planned, spanning a range of topics relevant to rural general practice. Click here for the latest conference programme.
We are pleased to announce that following the success of student scholarships being offered for the last 3 years, we will once again be offering RGPAS Conference Student Scholarships.
Year on year we aim to build on feedback, including a session specifically for students and trainees which is being led by the current NES GP Rural Fellows – should be a great session.
Never have I been to a conference so friendly, so relaxed, and so full of life.
Read more in student Catherine Lawrence’s conference review…
Student scholarships are available for a greatly reduced rate: £10 (reduced from £130) for the full programme – including the conference dinner with wine too! We will also provide accommodation (bed & breakfast) for Thursday and Friday nights – shared twin room, same gender – of up to ten students who register for the event.
The cost of this is being funded from the RGPAS Educational Fund. Income for this fund includes the proceeds of the donations made for advertising on RuralGP.com, our conference sponsors and other activities that RGPAS carries out to fundraise over the year.
You must be an undergraduate medical student at a UK university (intercalated, international and mature students welcome to apply). We are keen to hear from any students who have an interest in general or rural practice.
We want to hear your ideas! We ask all scholarship applicants to record 60 seconds of audio or video, outlining your bright idea for the future of rural practice. Is there a technological innovation that you think is untapped? How do we use new clinical approaches to improve the care of our patients? How do we improve the working lives of rural GPs and their colleagues?
Email us at firstname.lastname@example.org with the subject “Students #RGPAS17” along with your submission (a file, or even better a link to a Dropbox/YouTube/Vimeo movie, or Soundcloud audio) and the following details about yourself:
Closing date for applications is 15th September. Successful applicants will be notified by the end of September at latest. Those successful applicants will then be invited to register and make £10 payment using our online booking facility to secure their place.
We will be featuring a special session on the Friday afternoon of the conference, aimed to bring together students’ visions for the future of rural practice. From those students who have received a scholarship, we will select several to present a short powerpoint presentation – of 20 slides each advancing after 20 seconds. This format is often called ‘Pecha Kucha’ and there is a wealth of advice and tips on the internet about how to make a good Pecha Kucha presentation.
The format allows us to feature a number of short, snappy presentations of just over 6 minutes each, and give students and trainees a podium to share their views on the future of rural practice. Slides can include text, but the more photos the better! We will let you know if your ideas have been selected for presentation very soon after the deadline, and you can download a template powerpoint file here.
Any questions? Email email@example.com
Once again, we hope to welcome both new and experienced rural health professionals, and we have a stimulating programme lined up to cover a wide spectrum of topics which are relevant to rural general practice in Scotland. You can view information, statistics and feedback from previous conferences here.
This year, conference registrations should be made online. Until September 1st, registration will be restricted for current RGPAS members. After September 1st, registration will be open to all.
The cost of conference registration is £130, which includes catering (including Thursday lunch for RGPAS members attending the morning event), the conference dinner and wine on the Thursday evening. There are no single-day tickets and we hope that this is seen as excellent value for a 2.5-3 day conference.
Trainees can register for £65 (half price), and students who are successful in achieving a student scholarship will be asked to pay a nominal £10 registration fee.
Accommodation should be booked directly with the Craigmonie Hotel (01463 231 649) – unless you wish to stay elsewhere – and special rates are available on mentioning that you are attending the RGPAS conference.
Never have I been to a conference so friendly, so relaxed, and so full of life.
Read more in student Catherine Lawrence’s conference review…
More details about our 2017 Student Conference Scholarships are available here.
0930 Registration for RGPAS morning
1000 RGPAS members update :: Dr David Hogg (Chair, RGPAS)
1030 The Scottish Rural Medicine Collaborative :: Ralph Roberts (Chair, SRMC)
1100 The New GP Contract :: Dr Andrew Buist (Deputy Chair, BMA Scottish GP Committee)
1130 Open Discussion
1230 Lunch (provided to members attending above session)
1300 Main Conference Registration
1330 Main Conference Welcome & welcome to students :: Dr David Hogg & Dr Catherine Todd
GPs don’t do OOH any more do we? (Session Chair: Kate Dawson)
1345 BASICS Scotland Update :: Dr Ben Price (Assistant Medical Director, BASICS Scotland)
1415 NHS24: Challenges and Opportunities :: Dr Anna Lamont (Associate Medical Director, NHS 24) and Billy Togneri (Clinical Service Manager, NHS24)
1445 Sponsors’ Spot 10 mins each for Eden Medical, Head Medical and Novacor
1515 Coffee Break
1530 ScotSTAR: Update on Service Development :: Dr Drew Inglis (Associate Medical Director, ScotSTAR)
1600 The SAR helicopter service in Scotland: what has changed? :: Duncan Tripp (Winchman Paramedic, Bristow Search & Rescue)
1630 Open Discussion
1700 Rural LGBTQ+ :: Dr Thom O’Neill (Paediatric Clinical Research Fellow, Edinburgh) including update on latest RGPAS work
1740 The Echo Project :: Dr Jeremy Keen (Consultant in Palliative Medicine, The Highland Hospice)
1930 Conference Dinner at the Craigmonie Hotel
After Dinner Speaker: Tom Morton “The Rural Doctor’s Wife (!)”
0815 Breakfast Mentoring Session (Students/New Doctors)
0900 Rural Emergency Medicine Update :: Dr Luke Regan (Emergency Physician, Raigmore Hospital)
0930 Remote Practice: Is it really reward without risk? Do patients sue rural doctors? :: Dr Gordon McDavid (Medicolegal Adviser, Medical Protection Society)
1000 Realising Rural Realistic Medicine in Remote Practice :: Dr Kath Jones (Clinical Director, NHS Highland North & West)
1100 Realistic Research:Why Every Rural GP Should Consider Research :: Prof Phil Wilson (Director, Centre for Rural Health, Inverness)
1330 Pecha Kucha Sessions
1500 AGM – all welcome – agenda items to Dr Susan Bowie (Secretary) by 24th October
1930 Dinner in Inverness (Shapla Restaurant – TBC)
0930 Looking Forward
(Updated: 22/10/17) In replacement of the EMRS clinical update session, we are delighted to run a session dedicated to GP mentoring, dealing with the stresses of practice, and steps to developing a peer-support or co-mentoring network within RGPAS. We will also be exploring other ‘next steps’ for RGPAS too. Full details about this session will be released very soon.
0930 Visit to Bristow Search & Rescue Helicopter Base, Dalcross, Inverness Airport
Transport leaves Craigmonie Hotel sharp at 0930. This session is aimed at students and trainees, however if rural GPs wish to attend this, we will endeavour to meet demand for this.
1230 Conference Close
If you wish to book lunch directly with the hotel, please contact reception staff.
Flashing green lights are rarely seen in cities, but they are part of an important emergency response to rural areas. In this article we highlight the use of green lights in the provision of prehospital and other health care in Scotland.
Please help us by sharing this article with others who may be visiting rural Scotland this summer.
The answer is 3.
We’ve written this article as a number of our members have highlighted increasing difficulties getting to emergency calls as other road users can seem unaware of the meaning of green lights. As we head into another busy summer to welcome tourists and visitors to Scotland’s rural countryside and islands, we thought we might provide some information about the meaning of green lights.
The NC500 (North Coast 500) seems to have particular issues – perhaps as it has experienced a significant increase in the number of people travelling along its roads, who aren’t used to driving in rural/remote Scotland. Here’s what one of our members recently described…
The NC500 is becoming a significant concern, in particular with groups of cars travelling nose to tail in convoy and not appreciating that they will not all fit into one passing place. This as I’m sure you can imagine causes complete gridlock. Thankfully we have very few emergency calls ourselves but both of us have experienced difficulty getting past slow traffic in recent weeks despite using green lights.
My particular one was a very urgent call to **** (young man, cardiac arrest, we were told, so you can imagine how keen I was to get there safely but as soon as possible). I found myself behind a group of 3 open top sports cars. On open road they were going fast enough for me not to need past but I could see that as soon as we reached a narrow section there would be a problem. Indeed at the first passing place they couldn’t all get in, and ended up with a prolonged negotiation with a large campervan not wanting to reverse.
I had green dashboard lights on and also tooted and flashed my lights, hoping they would stay where they were and let me pass once the campervan was away, but all I got was rude gestures in the air, and they moved off very slowly, continuing in very close convoy. I assume (hope?) that they did not notice the green lights or did not know what they meant but there are other similar tales which I’m afraid make me wonder.
Across Scotland’s rural landscape, the Scottish Ambulance Service rely on over 500 volunteers (probably a lot more) to augment its emergency service. As well as First Responders (local community members trained up to use a defib, oxygen, administer CPR and deliver vital emergency care to heart attack and other seriously ill patients), there are Sandpiper BASICS doctors, nurses and paramedics who make themselves available – including in their own time – to attend road accidents, cardiac arrests, seizures and lots of other medical emergencies. Sometimes they will be requested to attend by the ambulance service directly, or they decide to attend a patient after a phone assessment or having been informed by another community member. We work closely with our local ambulance crews, and national services such as Helimed, the Emergency Medical Retrieval Service and Coastguard helicopters.
Green flashing lights are permitted in law – The Road Vehicles Lighting Regulations 1989 s 11 (2)(m) – to be used as “a warning beacon fitted to a vehicle used by a medical practitioner registered by the General Medical Council (whether with full, provisional or limited registration)”. They do not permit drivers to be exempt from any road traffic laws, but serve as an important means of making other drivers aware that a doctor is on their way to an emergency call. In rural areas – where traffic lights, 30mph speed limits and other restrictions are less frequent – it can make a significant difference if a clear passage can be enabled for doctors to attend emergencies as soon as possible.
Lights are usually only used in life-or-limb threatening situations – when time is of the essence. Rural areas normally experience longer ambulance response times. This is partly due to longer distances being travelled due to geography. However many islands in Scotland have only one or two ambulances (which are normally also used for patient transport too) – so if they are unavailable, or if there are multiple casualties at an incident, a local GP, nurse or off-duty paramedic is often asked to assist.
As with assisting any emergency vehicle with their progress, there is no need for erratic action. However, it makes a significant difference to pull over safely, and allow a car behind you to get through. If you see a doctor’s car approaching, plan ahead where possible to ‘create space’ in the road for them to pass other users, and use passing places on single track roads. Please don’t stop on corners however, as this is a dangerous place to overtake, unless there is a clear view of the road ahead.
If it’s not safe to allow the car to pass, then don’t worry – just wait until the next suitable opportunity to pull over and let the vehicle past.
The law allows only registered medical practitioners (doctors) to use green lights. However rural areas rely on lots of voluntary responders – including lifeboat crews, mountain rescue teams and coastguard teams. Team vehicles are often permitted to use blue lights and sirens. Some volunteers will make themselves more visible by wearing emergency clothing en route, or by using sun-visor signs that should be visible in your rear-view mirror.
Often, they will be the first responder on scene for some time, particularly if the nearby ambulance is already busy. Please do what you can to allow these essential services to make good progress through traffic – it could be you or your family who need their assistance the next time!
To learn more about the role of Sandpiper BASICS responders, and of Community First Responders, watch the videos below. Here are some links to the organisations mentioned above:
Finally, here’s two stories about where a fast local voluntary response made a significant difference…
Back in March, the Rural GP Association of Scotland (RGPAS) launched a range of guidance designed to make rural practice in Scotland more accessible to lesbian, gay, bisexual, transgender (LGBTQ+) patients.
At the annual RGPAS Conference last year, held in Inverness, we were delighted to welcome Dr Thom O’Neill to talk about LGBTQ+ inequalities in rural areas, and some of the practical ways that as GPs we can reduce barriers to healthcare.
Thom’s presentation stimulated a lot of discussion, and led to a project whereby he worked with RGPAS to develop factsheets, posters and other materials to help rural GP practices ensure that their services are welcoming to LGBTQ+ patients – especially younger patients.
We are aware that since then a number of GP practices have had discussions in their teams about how to make their health services more LGBTQ+ accessible. We’ve also had a number of international enquiries about this work – including from Canada, New Zealand and Australia – who have been keen to use this work to increase awareness.
Thom has also been asked to adapt the factsheets for secondary care use in some parts of Scotland too. So, as expected, the theme seems to have resonated with a wide number of clinicians and service managers.
Thom and David recently caught up to discuss how these guidelines came about, and to explore some of the themes of why LGBTQ+ patients seem to face specific inequalities of access to health care – and how rural practice has some unique opportunities to improve this. We hope to have Thom back to this year’s RGPAS Conference (2-4 November, once again in Inverness – details soon) for an update on what how this work has been developing.
You can listen to the podcast here:
In the podcast above, we make reference to the work of Alex Bertie about recording his experience of seeking help and assistance with gender dysphoria. Alex’s videos make for some insightful and compelling viewing, but this one is specifically about his thoughts about the GP consultation – and the difference that a more supportive and informed consultation can make particularly at a challenging and difficult time.
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