Archive | Hot Topics

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

Continue Reading ·

Rural GPs Scotland (RGPAS) Conference 2017 – registration open

Realising Realistic Rural Medicine

Twitter hashtag: #RGPAS17

Click to visit www.RuralGP.scot

The annual RGPAS (Rural GP’s Association of Scotland) conference will be held on Thursday 2nd to Saturday 4th November 2017, at the Craigmonie Hotel in Inverness.

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.

Click here for RGPAS 2017 Online Registration

Never have I been to a conference so friendly, so relaxed, and so full of life.


Programme

Thursday 2nd November 2017

This year, an RGPAS Members-Only meeting will be held on Thursday morning, to which all RGPAS members are invited.  Lunch will be served to attending members after this session, following which the main conference will open.

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)

Lunch for non-members can be organised with the Craigmonie Hotel by prior arrangement – please contact them directly.

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 Cases Presentation :: Susan Bowie (Rural GP, Hillswick, Shetland)… and others TBC

1415 NHS24: Challenges and Opportunities :: Dr Anna Lamont (Associate Medical Director, NHS 24) and Billy Togneri (Clinical Service Manager, NHS24)

1445 ScotSTAR: Update on Service Development :: Dr Drew Inglis (Associate Medical Director, ScotSTAR)

1515 The SAR helicopter service in Scotland: what has changed? :: Duncan Tripp (Winchman Paramedic, Bristow Search & Rescue)

1545 Open Discussion

1615 Coffee Break

1630 Rural LGBTQ+ :: Dr Thom O’Neill (Paediatric Clinical Research Fellow, Edinburgh) including update on latest RGPAS work

1710 The Echo Project :: Dr Catherine Todd (GP, The Highland Hospice)

1730 Finish

Dinner is included in the registration fee for all delegates. Dress is smart casual. Some limited tickets are available for partners or colleagues who wish to join us. Details soon.

1930 Conference Dinner at the Craigmonie Hotel

After Dinner Speaker: Tom Morton “The Rural Doctor’s Wife (!)”


Friday 3rd November

0815 Breakfast Mentoring Session (Students/New Doctors)

0900 Rural Emergency Medicine Update :: Dr Luke Regan (Emergency Physician, Raigmore Hospital)

0930 Can I Really Be Sued for This? :: Dr Gordon McDavid (Medicolegal Adviser, Medical Protection Society)

Realistic Medicine Workshops

1000 Realising Rural Realistic Medicine in Remote Practice :: Dr Kath Jones (Clinical Director, NHS Highland North & West)

1030 Coffee

1100 Breakout Session 1 (40 minutes)

  • Realistic Research:Why Every Rural GP Should Consider Research :: Prof Phil Wilson (Director, Centre for Rural Health, Inverness)
  • Realistic Work/Life: Managing the chaos of family life and Rural GPing- finding your village :: Dr Alida MacGregor (Rural GP, Kyles Medical Centre, Tighnabruaich)
  • Realistic Resuscitation: Simulation Session  (EMRS & Mobile Skills Unit)

1150 Breakout Session 2 (40 minutes)

  • Realistic Dispensing ::Dr Hal Maxwell (Scottish Representative, Dispensing Doctors Association)
  • Realistic Collaboration: The Echo Project :: Dr Catherine Todd (GP, The Highland Hospice)
  • Realistic Resuscitation: Simulation Session  (EMRS & Mobile Skills Unit)

1230 Lunch

1330 Pecha Kucha Sessions

  • The PILL project :: Dr Richard Weekes (Rural GP, Ullapool & Additional Member, RGPAS Committee)
  • Scholarship Presentation: Rural WONCA Conference & Clinical Courage :: Dr David Hogg (Rural GP, Isle of Arran)
  • GURRMS Annual Student Conference :: Josephine Bellhouse (Medical Student & Secretary, Glasgow University Remote & Rural Medicine Society)
  • Scholarship Presentation: Journey to Mexico :: Dr Mark Aquilina (Rural GP, Lochgoilhead & Shetland)
  • Selected Student Scholarship presentations

1430 Coffee

1500 AGM – all welcome – agenda items to Dr Susan Bowie (Secretary) by 24th October

(Parallel Emergency Medicine simulation session will be run  for students and trainees)

1730 Finish

1930 Dinner in Inverness (Shapla Restaurant – TBC)


Saturday 4th November

0900 EMRS Clinical Update morning with Clinical Skills Unit

Clinical update sessions including hands-on clinical skills, simulation sessions in the mobile skills unit and general updates about the ScotSTAR retrieval service.

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

Continue Reading ·

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?

Continue Reading ·

STI Management: Syndromic vs. Laboratory-based Approach

Clinical considerations and ethical deliberations from a rural Caribbean clinic

Dr Josie Reynolds recently contacted RuralGP.com to offer to write about her experiences and observations from rural Jamaica.  We’re delighted to feature the first of these articles here…

As doctors, we are most comfortable with our diagnoses when we have investigative results to confirm them. This is especially true for those trained in high-income countries, as more and more sophisticated laboratory tests and imaging have become part of everyday practice.

But in rural, remote settings, particularly those of low and middle income countries, the practicality and cost of diagnostic testing can become a barrier to treatment. This barrier is intensified in the management of sexually transmitted infections by the taboo and stigma that surround these conditions.

Because of this it has been argued that a syndromic approach to STI management can be more appropriate to tackle the burden of disease. Syndromic management of STIs works by grouping symptoms and signs of disease into syndromes and treating based on the most common causative pathogen(s), e.g. vaginal discharge syndrome, lower abdominal pain and male urethritis syndrome.

This practical approach in the most resource poor environments can help to tackle high burden of disease, therefore reducing significant morbidity, infertility and increasing spread of infection. In these settings there is a strong argument for forgoing the lab tests and treating empirically.

But what about those settings that fall somewhere in the middle?

At what point is it more appropriate to treat following laboratory testing?

Are there any markers that indicate the tip of balance in favour of a laboratory-based approach?

 

Picture a rural Caribbean health clinic. The mountainous community can seem remote based on the terrible conditions of the roads, but in fact as the crow flies there is only 10 miles to the capital city. There is also fairly regular transport by bus to the city Mon – Sat, and a public run clinic in town which provides free STI testing and treatment (all be it slow).

Community members, however, have very little disposable income and primarily lead subsistence lifestyles. With this in mind, working as a primary care physician at the clinic, I was not keen to send people away without treatment in case they did not go to get testing & treatment and the infection continued to spread. Syndromic management, therefore, seemed the way to go…

But the more I thought about syndromic management – STI management without any laboratory testing – the more negative implications I could think of:

  • Contact tracing – this is still possible, but do you treat all sexual contacts even if symptom free? This could expose numerous people to the risk of unnecessary medications when there is no guarantee that they have the disease.
  • Missing concomitant STIs e.g. HIV – it’s not uncommon for STIs to come in pairs and symptoms are frequently vague or non-existent. Treating syndromically without testing misses the opportunity to pick up some of the more serious infections that may be present simultaneously.
  • Contributing to antibiotic resistance – as one of the biggest threats to modern medicine, antibiotic resistance cannot be ignored. Whilst syndromic management may be the pragmatic approach, the greater picture needs to be considered.
  • Relaxed approach – could syndromic management give patients the impression that STIs are not very serious as no testing is required? Could this apparently relaxed approach translate into less incentive to prevent reinfection?
  • The subtle symptoms – for the barn-door cases, where signs & symptoms are clear and fit neatly into the box, this approach is straight-forward. But what about the grey areas? Or the patients which don’t follow the usual pattern?
  • Impact on doctor-patient relationship – with a less evidence-based approach and therefore greater risk of treatment failure, is there a danger of loss of trust or breakdown of relationship between the healthcare provider and patient?
  • Reliable statistics – guidelines for syndromic management often mention adding in treatment for certain infections, e.g. gonorrhoea, if there are high levels in the region. However, in low-middle income settings, the epidemiological data is less likely to be complete and therefore recorded levels may be misleading.

 

I found myself in a struggling health system, but provisions were not non-existent – should I accept the flaws of the approach and treat syndromically or encourage patients to overcome the barriers and receive a better standard of care overall?

I realised too that part of my reserve for syndromic management linked into a deeper notion: by accepting syndromic management as routine are we reinforcing the idea that disadvantaged people deserve second rate healthcare?

Or perhaps my scientific-based training was blinding me to the benefits of syndromic management? Was my personal desire to get to the bottom of the cause preventing me from putting the important things first?

Either way, it appears to me that a more sophisticated set of guidelines is required from the Global Health Sector to reflect the variations in development of health systems worldwide, rather than a binary choice which may work for some, but not for all.

What do you think? What would you do in a similar situation? Which factors would tip the balance in your decision?

References:

http://apps.who.int/iris/bitstream/10665/82207/1/WHO_RHR_13.02_eng.pdf

http://www.phac-aspc.gc.ca/std-mts/sti-its/cgsti-ldcits/section-4-1-eng.php

http://sti.bmj.com/content/80/5/333

http://applications.emro.who.int/aiecf/web79.pdf

http://siteresources.worldbank.org/INTPRH/Resources/STINoteFINAL26Feb08.pdf

http://hetv.org/resources/reproductive-health/rtis_gep/syndromic_mngt.htm

https://www.idealclinic.org.za/docs/National-Priority-Health-Conditions/Sexually%20Transmitted%20Infections_%20Management%20Guidelines%202015.pdf

http://onlinelibrary.wiley.com/doi/10.1046/j.1365-3156.1999.00360.x/full

https://www.hindawi.com/journals/isrn/2014/103452/

Continue Reading ·

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

 

Continue Reading ·

Podcast from @fakethom and @RuralGPScot highlights #ruralLGBTQ work in #ruralGP

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.

You can find out more about these resources at: www.ruralgp.scot/lgbtq-plus.

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.

Continue Reading ·

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…

Continue Reading · 0

Next EMRS CG VC meeting on Friday

The next EMRS ScotSTAR Clinical Governance meeting is due to take place on Friday 12th May, at 1.30pm.

These meetings take place at the EMRS base next to Glasgow Aiport, and VC links are invited (via the NHS Scotland VC Network) from rural practitioners (GPs, nurses, paramedics) across Scotland.

The team values input and opinion at these meetings from rural practitioners. Combining the insight of both referring site clinicians and retrieval teams into the intricacies of missions audited creates a fantastic learning environment. Attendees come away from these meetings enthused and encouraged to provide the highest possible levels of care for our patients.

The meeting on Friday brings a few cases under the longitudinal audit microscope. The EMRS team have chosen two of the most challenging cases, one primary and one secondary retrieval and opinion will be welcomed in dissecting out the details so that we can learn from combined experience.

To join the meeting, contact Anne Cadman (details in agenda below) with your VC details.

Download the agenda for this meeting

The above text was modified from an email sent out recently by Dr Randal McRoberts, Consultant at EMRS and lead for the Clinical Governance meetings.

Continue Reading ·

Update from the Scottish Rural Medicine Collaborative

The Scottish Rural Medicine Collaborative (SRMC) is a programme funded by the Scottish Government’s GP Recruitment and Retention Fund. The programme – chaired by Ralph Roberts (Chief Executive of NHS Shetland) – is about developing ways to improve the recruitment and retention of GPs working in a rural setting across ten Health Board areas in Scotland – Grampian, Highland, Orkney, Shetland, Western Isles, Dumfries & Galloway, Ayrshire & Arran, Fife, Tayside and Borders. Also involved are NES, NHS HR Directors, RCGP Scotland and Rural GP Association. They are now looking for assistance from the rural health community in Scotland……

The SRMC Programme Board have agreed that the programme will work in the six project areas outlined above and are looking for the following people to support this work:

  • A Programme Clinical Lead which will be funded 2 PAs (0.2 WTE) per week towards backfill for the post holder and will work across the whole Programme.
  • Project Leads for Project 2* (Rural GP Recruitment Yearly Wheel), Project 3* (Rural GP Marketing Resources) and Project 6* (Rural GP Recruitment Support). More details about these individual projects are available in Appendix 1 in the linked document below. They would be particularly interested to hear from HR Managers or Practice Managers.
  • Project Team Members for all projects. They would be particularly interested to hear from HR Managers or Practice Managers.

Please note your interest by Monday 22nd May 2017.

To find out more about these opportunities please contact either:

Download more information here (PDF)
Continue Reading ·