Author Archive | Rural GP Association of Scotland

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:

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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

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: (£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

Click to download the report (2.6MB, PDF)

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Students present Bright Ideas for Rural Practice

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!

Rohan Bald (Glasgow): Tackling Loneliness

Emma Bean (Glasgow 5th Year): Drones

Josephine Bellhouse (Glasgow): Improving Use of Communication Technology

Katherine Cox (Glasgow 4th Year): Developing Videoconferencing Peer Support

David Gibson (Glasgow): Awareness of Rural Medicine as a Career

Haiyang Hu (Glasgow): Access to Mental Health Services

Saskia Loysen (Glasgow): Increasing the use of Telemedicine (and pyjama bottoms)

Eloise Miller (Glasgow): Develop Rural Medicine Intercalated Degrees

Danielle Parsons (Aberdeen 4th Year): a Rural Medical School for Scotland

Gregor Stark (Glasgow 5th Year): Rural Research Consortium

Rosslyn Waite (Dundee): Improving Connectivity

Hannah Webb (Glasgow 2nd Year): Access to Sexual Health Services

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RGPAS Conference Student Scholarships 2017


Twitter hashtag: #RGPAS17

Student workshop at RGPAS16

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

What’s on offer?

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, our conference sponsors and other activities that RGPAS carries out to fundraise over the year.

Who’s eligible to apply?

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.

How do I apply?

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 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:

  • Your name
  • Your university
  • Contact address & mobile
  • If you require accommodation, and confirmation of whether this is required for both nights
  • Confirmation that you intend to attend the conference from Thursday lunchtime to Saturday lunchtime
  • Title of your submission
  • “I consent to my presentation being made available on, and affiliated websites/social media”.

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.

Present your vision

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

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