Archive | Recruitment & Retention

Mayara Floss: the challenges for women working in rural health

Mayara Floss

This video of Dr Mayara Floss – rural doctor in Brazil and passionate advocate for international rural health – has recently been publicised via the Rural WONCA email list by Dr John Wynn Jones, chair of the WONCA Working Party on Rural Health.

Mayara was invited to give her perspective on the issue of “Investing in rural health workers for the economic participation and empowerment of rural women and girls” at a meeting of the joint Commission on the Status of Women: a side-event of the World Health Organisation, International Labour Organisation, Permanent Mission of Ireland to the United Nations and Women in Global Health.

John introduced the video more eloquently than I could, and so with his permission, here’s what he said:

Dear All

I want to congratulate Mayara and thank her on behalf of Rural Wonca and all the rural health workers around the world for her presentation and wise words at the United Nations Commission on the Status of Women. Mayara is an exceptional person. I can’t even call her a future leader because despite the fact that this is her first year as a doctor she is already a world leader and an example to us all. It will be the Mayara’s of this world who will take up the mantle for the next generation and its our duty to support them.

Please look at the video of her session. She describes how medical schools in the largely rural country of Brazil do little to promote and teach rural health care. She eloquently describes her own journey against the odds and her quest to work among rural communities and the barriers that she encountered. Everyone needs to watch her presentation! 

During the panel session she implores us first to listen to our patients and are communities before coming up with ” so called helpfull solutions”.

She also asks us to think about the political tragedy that is happening in Brazil and the dismantling of one of the most enlightened primary care systems in the world and its replacement with private health.

We are all very proud of her and the many other members of Rural Seeds who are working so hard around the world to build their careers and make a difference for rural communities.

Kind regards


Mayara speaks in the video below for 20 minutes, at 30 minutes in, and there are subsequent (excellent!) contributions to the discussion thereafter.

Continue Reading · 0

Applications invited now for Scottish Rural GP Fellowships 2018

NES Logo 2005Applications are now being invited for the GP Rural Fellowship Scheme, overseen by NHS Education for Scotland.

The Fellowships offer a fantastic opportunity to build skills and experience in rural general practice, whilst experiencing the challenges and opportunities first-hand – during a well-supported year which includes nine weeks of study leave and a generous study budget.

The Fellowships are located across rural Scotland, from Dumfries & Galloway, to the Shetland Isles, including islands such as Islay, Arran, Skye and the Uists.

Many previous rural fellows have stayed in rural practice, and this article published in the Journal of Rural & Remote Health highlights the strengths and successes of the programme which has been running for over ten years.

Rural Fellowship Facebook Page     Rural Fellowship – Official Information

Closing date for applications: Wednesday 11th April 2018

Fellowships (one year) commence in August 2018.

Watch the latest video about the Fellowships…

Former Rural Fellow Gemma Munro explains more about her time as a Rural Fellow.

Why be a rural GP?

This video, as part of the RCGP #ThinkGP project, featured the range of rural GP duties on the Isle of Arran.


… and here’s a video from 2016 featuring some of the Fellows and others involved with the scheme…

Interested?  We want to hear from you…

All the Rural Fellowship sites will welcome you to chat on the phone or visit and tour round what’s on offer.  We can fix up a chat with current or previous rural fellows, and you can ask questions on the Fellowship Facebook page.  There is a lot of information available from the websites mentioned already, but sometimes it’s easier to arrange a chat on the phone or Skype… all descriptors of the Fellowships (on the official fellowships page) have contact details where you can find out more.

A couple of years ago we interviewed some of those involved in running the Rural Fellowships.  Hear more from them about what they think the fellowships can offer recently qualified GPs…

Gill Clarke – Fellowships Co-ordinator

gillGill has been running the fellowship scheme now for several years.  I asked her about the opportunities available, and why she thinks the fellowship scheme is a good way to enable recently-qualified GPs to experience rural practice.

Gill is very happy to be contacted about any of the fellowship options.

Angus MacTaggart – Islay Rural GP

angusAngus is one of two principals of Islay Medical Services, which now delivers primary health care across the island, as well as out of hours and hospital services.  He describes the attractions and challenges that he identifies with rural practice.

You can contact Angus at:


Continue Reading · 0

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:

Continue Reading ·

Our Scottish Government needs to recognise the potential of Scottish rural practice

The agreement of the new Scottish GP contract has triggered real concerns about just how seriously the challenges facing Scotland’s rural communities are being considered by our professional and political leaders – and how rural NHS services are being considered in the context of the overall NHS Scotland team.  In RGPAS (the Rural GP Association of Scotland) we believe that there has been little attempt to rural-proof the contract, and any plans to do so have been sidelined until ‘Phase 2’ which, of course, might never happen.

Rural GPs tend to be a robust lot.  We have to be, particularly with the professional isolation and sometimes downright scary clinical presentations to manage, with distance and geography providing an ever-dynamic challenge. Much of our professional resilience and stamina is generated by the support and trust that is handed over to us by the patients we work for, and the teams we work with, in ways that spark professional satisfaction greater than any other career imaginable to us.  And it is that privilege, responsibility to advocate and sense of duty, that has driven our concerns about the future of Scottish general practice as defined by the new contract.

Articulating our concerns has, at times, been difficult: we lack the political vocabulary, media experience and strategic confidence to communicate these concerns as effectively as we might if we didn’t have a significant day and night job to do.  Challenge has also presented in terms of time; returning home after a busy day in the surgery and a night oncall, to find 20 messages from journalists seeking an informed and on-record representative view is, I suspect, a world away from the luxury of a media team and press officers.  But surely we shouldn’t have to employ a media team to represent rural communities in a GP contract?

We have, however, had extraordinary encouragement, including from some who have been able to offer expertise in the areas of media and strategic engagement.  Throughout, we have been determined to maintain a respectful tone with our colleagues, confreres and appointed representatives.  Despite the shortcomings of the contract, I really believe that those involved all aim to act as professionally and ambitiously as any of us.  However we suspect they just don’t understand rural practice enough to see the opportunities that many of us saw for a new contract to sustain healthcare to rural communities in Scotland.  Throughout, it has been stimulating to work with bright, impassioned and committed colleagues.  And whilst journalists might collectively get a bad name, we have been fortunate to engage with ones who have respected our need to continue the day job, and put up with our own limitations of returning calls and emails between otherwise busy days.

It is clear that the new contract has failed to take into account the challenges and opportunities of providing healthcare in rural Scotland.  The honest admission from one of the SGPC Senior Negotiators during a roadshow that rural practice has been “parked” until a Phase 2 of the contract that might not even happen, was a bombshell moment for many of us listening in Inverness.  It appears that rural practice has been put on the ‘too difficult’ pile for the time being.  And there is ongoing confusion around the much-promised Short Life Working Group for rural practice.  Our First Minister advises that it has been set up.  Government tells us that it hasn’t, and won’t be for another few months.  RGPAS members are ideally placed to offer much-needed perspective, ideas and innovative ways forward, but we understand that because we raised concerns about the proposals, our invite to the group may not be forthcoming.

At this point I should make clear that I have no political affiliations. Personally, I used to think that SNP was doing a good job of managing NHS services in Scotland, however it has been extremely disappointing that the needs of rural communities have not been better reflected in the GP contract. I am keen to see that reversed, and believe there is the potential for that to happen.  It is surely incumbent on any party in power to reflect the needs of Scotland’s rural communities in its policies.

Click to download the report (2.6MB)

In November last year, I worked with our vice-chair Alida MacGregor and the rest of our committee to rapidly write a response document that provided positive solutions for the key issues that were identified in the proposed contract.  Informal feedback was complimentary about the realistic and constructive tone struck.  We realise that coming up with a Scotland-wide contract is difficult.  There are huge challenges across the primary care landscape of Scotland.  The efforts to identify some effective and realistic ways forward were recognised in our response.  Unfortunately, however, we have yet to receive any formal recognition or reply to the suggestions made in this document – from our negotiators or Scottish Government.  The document includes an executive summary, which summarises our key areas of concern.

We wanted early on to avoid creating too much division between urban and rural effects of the proposed contract.  General practice across Scotland is in need of increased resource.  The system has been in a state of crisis for some time, and there is no prospect of improvement unless big changes and more funding is provided.  Collapsing practices are becoming too common an occurrence across Scotland, and – particularly as a small country – we would like to see #RealisticMedicine recognised in a #RealisticContract: to work together as GPs to boost the sustainability of primary care across the country.  Workload is the rising tide that needs to be addressed, along with tackling the premises issue also seems to be a major stress-point for our urban colleagues.

And yet, as we learned more about the process, intentions and impact of the new contract, it became evident that the challenges of rural practice have been sidelined and placed on hold for a number of years yet.  Even more surprisingly, we learned that inner-city deprivation and health inequalities have been apparently forgotten in the new contract too.  It is widely accepted that measuring rural deprivation is difficult, and scores such as SIMD (Scottish Index of Multiple Deprivation) still do this poorly.  SIMD is far more robust for detecting and measuring urban deprivation.  However even despite the excellent work of the Deep End Project to focus on ways of alleviating urban health inequalities, it seems that an opportunity has been missed to address urban health poverty and deprivation.

The funding allocation has not produced the consistent increase in funding to Deep End practices that would allow unmet need and the inverse care law to be addressed. In reality this means that funding streams for patients in the most deprived third of Scotland are not at parity with the rest of the population. This situation will continue to impact on A&E departments, hospital use and premature mortality and morbidity, as documented in many Deep End reports. That is an unfortunate consequence of the inaccuracy of the weighting formula.

Dr Anne Mullin, Chair of the Deep End GP Project (December 2018)

Returning to rural, our negotiating colleagues will highlight the steps forward with golden hellos and relocation packages.  We note them but are not very convinced – they haven’t worked so far.  They will also highlight that ‘no practice will lose out’, and that our practice funding is protected for the foreseeable future.  However being placed on ‘income support’, whilst discovering that the official workload estimation formula greatly underestimates the true workload in rural GP practices, is not the strategy that we see fit for a country where 20% of the population lives rurally, and many more visit for their holidays.  The many additional services that are currently provided for our rural patients have gone completely unrecognised.

Prof Phil Wilson, Professor of Rural Health & Primary Care at the Centre for Rural Health in Inverness, and RGPAS Committee member has commented:

Prof Phil Wilson

The new workload allocation formula is based on an outdated and unrepresentative sample of practices (the PTI dataset was abandoned as worthless by SGHD in 2013), and relies simply on consultation numbers (or Read codes) per patient as the driver for allocation of funds to practices.

Funding allocations are now simply calculated on the basis of patient numbers, age and SIMD scores, and the cost of supply of medical services (higher in rural areas) is now excluded from the formula for reasons that have not been made clear.

Arguably it is patients in rural and remote areas that are most reliant on their practices to deliver health care. They have no option to register with a nearby practice or attend an A&E department if their practice collapses. Over 90% of practices in the northern Health Boards will be in the income support category. It is rural practices that have the biggest problems recruiting GPs and there are already large swathes of Caithness, Sutherland and the Isles where patients cannot access a doctor without travelling huge distances.

Yes, we are protected from the considerable cuts that would otherwise occur (up to 85% for some practices!), but there is an absence of any additional resource which is so greatly needed in some areas.  In addition, it seems that it was left to us to work out the impact for ourselves – using carefully mapped ISD data and some helpfully released contract impact data, to visualise the impact.  If the impact of the new contract was sufficiently scrutinised from the outset, why not address the rural/urban issue from the outset, instead of relying on others to process the figures?  As a result of this, some of us found the contract proposals to be a ‘scratch and sniff’ document, and unfortunately many times we found ourselves scratching through rhetoric and aspiration, to find a smell that was not particularly rosy.  Expert academics have lambasted the interpretation of econometric analysis provided by Deloitte: they were particularly surprised as Scottish Government have a reputation for normally doing workload allocation formulae rather well.

Fundamentally, the approval and implementation of a resource allocation formula that so drastically works against rural areas is surprising from a Government that should be reflecting the demographics of a country that is proud of its rural landscape.  We explained this in our letter in December to Shona Robison, our Cabinet Secretary for Health.  The question that our leaders in education, social work and other public services have been asking: ‘is this the precedent for future funding to rural areas?’.  For easy reference, here’s that map again:

Turning to the recruitment elements of the contract: we need to recognise that a strong driver for recruitment is retention.  Students and trainees who see fulfilled, fairly-treated and adequately resourced GP teams are more likely to go into general practice.  Golden handshakes, relocation allowances and bonded undergraduate education can all be implemented with some effect.  However, we need to embrace the pipeline model of recruitment & retention.  We need to recognise that leaks further downstream (particularly if for negative reasons) can be hugely detrimental to recruitment.  We need an integrated, positive, pragmatic and holistic approach to why folk come to and go from work in rural communities.

The internationally regarded Prof Roger Strasser, Professor of Rural Health & Dean/CEO of the Northern Ontario School of Medicine in Canada, is considered an expert in rural health recruitment, retention and delivery.  He has been moved to comment:

Prof Roger Strasser

This situation seems paradoxical. On the one hand, the Scottish government is investing in education, training and service initiatives to improve health in rural and remote areas, and on the other hand the government is undermining these initiatives by undervaluing and demoralising the rural practitioners who are the cornerstone of care.

It appears to be a classic example of decisions being made to address issues/concerns in the cities/dense population areas that have unintended negative consequences for people in rural and remote communities.

Unfortunately rural practitioners and their communities are left questioning whether these consequences are truly ‘unintended’.

The ball is now in the Scottish Government’s court.  Rural GPs in Scotland are as ready as we ever have been to continue innovative, realistic and community-focussed healthcare design, and we hope to see our involvement invited in the near future.  We need to see the work of rural GP teams recognised more accurately, supportively and fairly if we are to find a positive way forward from the difficult months that have resulted from a contract that has been inadequately rural-proofed.

Rural practice in Scotland has always been fertile ground to serve up great solutions for the challenges of modern healthcare.  This new contract has delivered a body-blow to rural GPs and their teams.  Give us respect, recognition and realistic resource and we will deliver.

Find out more about RGPAS concerns regarding the new contract at our #RememberRural information page:

Continue Reading · 1

Latest news from the SRMC

THE Scottish Rural Medicine Collaborative (SRMC) has been set up with Scottish Government funding to look at ways of improving the recruitment and retention of remote and rural general practice in Scotland.

The SRMC works across 10 health board areas – Grampian, Highland, Orkney, Shetland, Western Isles, Dumfries & Galloway, Ayrshire & Arran, Fife, Tayside and Borders, all of whom are represented on the programme board, as are NHS Education for Scotland, RCGP Scotland, and the Rural GP Association Scotland. It is also working with the INTERREG:making it work (MiW) programme.

Six closely linked rural GP projects with distinct objectives have been set out for the two-year programme.

These are:

  • Recruitment strategy/good practice guidelines. This is aimed at improving the consistency and effectiveness of recruitment.
  • Recruitment yearly wheel. This will identify and help promote appropriate recruitment events.
  • Marketing resources. This will explore look at developing a rural GP recruitment website.
  • Community of practice. This will provide an online forum to share knowledge and experience.
  • Recruitment and retention toolkit. This will consider how po- tential or new employees in remote and rural general practice can have a structured approach to activities and plans to integrate them into their communities. It will cover community recruitment, community integration and employers’ recruitment support.
  • Recruitment support. This will look at ways of providing specific sup- port for employers of rural GPs.

The SRMC team have just published their latest newsletter – download it by clicking the button below.

Download the SRMC Newsletter March 2018
Continue Reading ·

Dumfries & Galloway GP event – invitation to come visit!

Calling all GPs with itchy feet…

We invite you to come and spend a night in the lovely Creebridge House Hotel in Newton Stewart on
Saturday 28 April 2018.

Dinner, bed and breakfast for you and a partner will all be paid for.

All we ask is that you share dinner on the Saturday evening with a few local GPs.  We would also like to treat you to lunch at the Crown Hotel in Portpatrick on the Sunday.

How you spend the rest of your weekend is up to you…

For more information, please contact Lucy Gurling (GP Liaison Officer) at

There is no cost to you for this event. We want to make it easy for you to come and experience the beauty and feel-good nature of Wigtownshire. Our hope is that, once you have had a taste of the place, you may consider coming to live and work here.

To register for this event, we need an assurance from you that you are a fully qualified GP who is actively considering a move within the next year, and that you are open minded about moving to rural Wigtownshire.

Anyone interested should contact Lucy Gurling by emailing describing in a couple of paragraphs a little about you and why you would like to come to this event.

In terms of plans for the weekend, we would be more than happy to point you in the direction of places of interest in the area, and also happy to organise informal tours of GP premises if requested.

Please come armed with questions about living and working here, and also about family life – we will do our best to answer you. But if, having visited, you decide this area is not for you, we will respect that and will be pleased that you came to explore what Wigtownshire has to offer.

For more information you can view this PDF or watch the clip below…

Banner image above courtesy of JMiall
Continue Reading ·

@GURRMS 2018 Conference: Skye, 23-25 March

Tickets for the 2018 GURRMS (Glasgow University Remote & Rural Medicine Society) are set to go on sale for students tomorrow evening.  Following on from the highly successful GURRMS 2017 conference that was held on Islay last year, GURRMS 2018 is set to take place in Portree on the Isle of Skye, at the Aros Centre from 23-25 March, and another action-packed and stimulating programme is taking shape.

James whilst on an Isle of Arran Medical elective.

I caught up with the chair of GURRMS, James McHugh, this afternoon to find out more about how plans are coming together.  Once again a full range of speakers has been organised, and the committee are busy sorting out finances and logistics to ensure that this year’s event runs smoothly.  Kudos to them given that these guys are also coming up to their final exams, with the stresses and time involved with that.

Full details will be announced over the next while on the GURRMS Facebook page, and tickets are due to become available in the next day or so.  Last year’s event sold out within hours and so be sure to keep an eye out for the tickets being launched.

GURRMS 2018 is receiving financial support from RGPAS (the Rural GP Association of Scotland) along with a number of other funding streams, and RGPAS has been keen to support and encourage student activities like this, so we’re delighted to see plans take shape so promisingly.

We wish the best of luck to GURRMS in running their second conference, and we’re looking forward to meeting students who are keen to find out more about rural practice – see you in Skye!

Continue Reading · 0

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:

Continue Reading ·

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)

Continue Reading · 2