Archive | Rural-Proofing

RGPAS18 Conference Programme announced

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The Rural GP Association of Scotland (RGPAS) is pleased to issue the confirmed programme for its annual conference, due to take place on 8-10 November 2018, once again at our preferred venue of The Craigmonie Hotel in Inverness.  As ever, there may be some last-minute changes, but the following schedule looks set to go ahead.

Sandpiper Bag Checks – BASICS Scotland will be providing Sandpiper Bag equipment checks throughout the conference on Thursday and Friday – bring yours along for an easy way to find out what you’re missing and how to obtain supplies!

Revaluing Scottish Rural Practice

Thursday 8th November 2018

1330 Registration

1400 Main Conference Welcome:: Dr David Hogg & Dr Alida MacGregor

1430: Workshops 1st round

  • 1: Easing the Pain: Opportunities for regional blocks, ketamine and intranasal diamorphine (Dr Luke Regan)
  • 2: Blood Borne Viruses Workshop (Dr Lindsey Ross & colleagues)

1510: Coffee

1530: Workshops 2nd round

1615: Option 1: Planning for retirement, identifying your options– David Henderson, Medical+Dental Financial Planning Services

Option 2: Keeping a Healthy Balance in Work, Life and Play (Dr Alida MacGregor, RGPAS Vice-Chair)

1700-1800: SRMC Update (SRMC team)

1800-1900: Bar

1900 Conference Dinner

Friday 9th November

0900: A Spark of Positivity: Interface Working for Better Patient Care :: Dr Barba Chandler, Consultant Rehabilitation Medicine, Raigmore Hospital and Dr Richard Weekes, GP, Ullapool

0945: Down to Business – Where next for the contract in rural areas?


1115: Coffee

1145: General Practice and Primary Care in Remote and Rural Scotland – Reflecting Back and Looking Forward :: Lewis Ritchie, Chair of the Rural Short Life Working Group

1230: Lunch

1330: How the contract will help rural practice – Andrew Buist, SGPC Chair

1400: Finding positive ways forward for rural & single-handed practice in Scotland – Group Discussion

1500: The Scottish Rural Medicine Collaborative (SRMC) Bureau Concept – How Can it Help You  (SRMC Team)

1530: Coffee

1600: Remote Educational Development at BASICS Scotland (Al MacLean, BASICS Scotland)

1630: BASICS Scotland and Responders – Update (Dr Ben Price, BASICS Scotland) – including Discussion/Questions

1730: Hotel Bar

1900 Dinner – Shapla, 2 Castle Road, Inverness, IV2 3AA (tbc)

Saturday 10th November

0930: Where next for RGPAS? Where next for rural practice?Supporting members, sustaining rural practice in Scotland (Group discussion and breakout group sessions)

1100: Walking Conversations: Making Links, Identifying Peers, Finding Momentum (A suitable walk around the hotel area will be identified, depending on weather etc.)

1230: Conference Close


If you wish to book lunch directly with the hotel, please contact reception staff.

As with previous years, there will be a strong focus on the conference being welcoming and convivial.  Many of our members (and non-members) come from remote and isolated practices, and RGPAS conferences place a strong emphasis on fostering informal peer support opportunities.

Unfortunately, this year we have had to curtail our usual undergraduate activity, as already highlighted in this article.  We very much regret that we cannot run the scholarships this year, but we’ve been so busy working out how to represent the concerns of our members and rural communities in relation to the new contract, that the committee don’t have the capacity this year to organise this aspect.  We very much hope that it will return in future years.

The cost of the conference is £130, and this includes a 3-course conference dinner with wine on the Thursday evening.  Accommodation can be booked directly with the Craigmonie Hotel.

We hope that the conference will showcase the ongoing innovation and potential that exists across rural Scotland, and the need for national health policy to be appropriately rural-proofed to ensure sustainability for the future of Scottish rural healthcare.

Register for RGPAS18
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RGPAS18 Conference Registration now open

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The Rural GP Association of Scotland (RGPAS) is pleased to announce that registration for its annual conference is now open, following a period of priority booking for its members.

This year’s conference will take place on 8-10 November 2018, once again at our preferred venue of The Craigmonie Hotel in Inverness.

The programme will commence at 1pm on Thursday 8th November, and finish at lunchtime on Saturday 10th November.  This year will feature discussion, presentations and debate about the impact of the new Scottish GP contract on rural healthcare, as well as a number of clinical updates and opportunities for participants to catch up and relax.

As with previous years, there will be a strong focus on the conference being welcoming and convivial.  Many of our members (and non-members) come from remote and isolated practices, and RGPAS conferences place a strong emphasis on fostering informal peer support opportunities.

Unfortunately, this year we have had to curtail our usual undergraduate activity, as already highlighted in this article.  We very much regret that we cannot run the scholarships this year, but we’ve been so busy working out how to represent the concerns of our members and rural communities in relation to the new contract, that the committee don’t have the capacity this year to organise this aspect.  We very much hope that it will return in future years.

The cost of the conference is £130, and this includes a 3-course conference dinner with wine on the Thursday evening.  Accommodation can be booked directly with the Craigmonie Hotel.

What’s in the programme?

Programme details are still to be confirmed.  We are in the process of finalising speakers and the schedule, and this will be published here and notified to our members.  We are aiming for a relevant and useful mix of topics and speakers, to inform and re-energise participants – but also to reflect the anxieties and concerns of RGPAS members about the impact of the new GP Contract on rural communities, and consider effective ways forward.  We’re pleased to confirm that Prof Sir Lewis Ritchie (Chair of the Rural Short Life Working Group formed by the Scottish Government to consider implementation of the GP contract) and Dr Andrew Buist (Chair, Scottish GP Committee) will be attending.  We will also have updates from the Scottish Rural Medicine Collaborative, management of blood-borne viruses and consideration of how to recognise and maximise the delivery of Realistic Medicine in rural settings.

We hope that the conference will showcase the ongoing innovation and potential that exists across rural Scotland, and the need for national health policy to be appropriately rural-proofed to ensure sustainability for the future of Scottish rural healthcare.

Register for RGPAS18
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Last chance to take part in the Rural Youth Project survey

Last chance to take part in the Rural Youth Project survey (and win festival tickets)

Nearly 40% of young people living rurally plan to move to urban centres, according to the interim results from the Rural Youth Project survey. 92% say broadband is essential to their future, and 50% don’t feel they have a say in what happens in their local community. In its last week, the organisers of the RYP survey are calling on all young people aged 18-28, living rurally, in any occupation from agriculture to health, retail or education, to complete its online survey before it closes on 31st May.

“Not only can you win tickets to some great events, but by spending a few minutes responding to the Rural Youth survey you can help make a real difference,” says Jane Craigie, co-founder of the Rural Youth Project which launched in January with the support of rural industry partners. “The more people who take part, the more voices will be heard, and the more weight we have to convince those who have the ability to make a difference that it is worth the investment.”

The Rural Youth Project includes an online survey, vlogging series and Rural Youth Festival which will be held in Scotland in August featuring live music, international speakers and leadership workshops. Survey responses have been collected from as far as Angola, Canada, Iceland and Australia as well as from all around the UK from Orkney to Oxford.

“So far transport and broadband are being highlighted as the main issues for young people living rurally, closely followed by access to social life,” says co-founder Rebecca Dawes, who works for rural and agricultural communications specialists, Jane Craigie Marketing. “These are not unexpected, but what it does show is that infrastructure is central to keeping young people in rural communities, and this could be the step change that ensures rural areas continue to be thriving, self-sufficient economies filled with people of all ages.”

As well as challenges, the survey has highlighted the opportunities rural living offers young people. 75% said that youth groups had given them confidence, resilience and a positive outlook on the future, which illustrates the continuing importance of investment in these organisations, and others have cited the space and beauty of living outside urban centres.

The data, which looks at housing, transport, connectivity, healthcare, employment, skills and training, income and social wellbeing, will be professionally analysed with support from Scottish Enterprise to illustrate what barriers and opportunities are influencing young people’s choices, with a view to helping decision-makers at local, industry and policy level support this and future generations to thrive in both business and personal life.

The Rural Youth Project presented its interim results earlier this month at the European Network for Rural Development with Scottish Rural Network, and have a parliamentary reception with Lantra Scotland, which represents this skills of land-based, aquaculture and environmental industries, at the Royal Highland Show in June.

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Latest survey of Scotland’s rural GPs

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

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

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

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

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

We have summarised some of the outcomes below.








Here’s some quotes from the survey…


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

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

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

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

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

Impact on service planning

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

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

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

Helping to define priorities for the rural SLWG

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

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

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

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

What do Scotland’s rural GPs think?

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

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

What has been said so far about the SLWG?

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

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

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

(Quote from website)

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

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

RGPAS call for action from the Scottish Government

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

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

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

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

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

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

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

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

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

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

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

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

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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.

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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:

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International research into rural young people’s views

Research into rural youth launched to coincide with the Year of Young People

An initiative designed to research and better understand rural young people, aged 18-28, has been launched. The Rural Youth Project coincides with the 2018 Year of Young People and will combine an online survey, year-long in-depth video logs (vlogs) of 15-20 rural young people and a Rural Youth Ideas Festival.

The target countries for the research are: England, Scotland, Wales and, internationally, Austria, Australia and the USA.


The initiative is a social enterprise venture and is the brainchild of Jane Craigie and Rebecca Dawes. The Rural Youth Project has the support of partners interested and engaged in the rural youth ‘space’, they are LANTRA Scotland, the Scottish Association of Young Farmers (SAYFC), Scottish Enterprise, Scottish Rural Action, Scottish Rural Network and YouthLink Scotland, and will be managed by Jane Craigie Marketing.

Inspired by their participation in leadership initiatives, including the Scottish Enterprise Rural Leadership Programme and the Windsor Leadership Programme, Jane and Rebecca aim to identify and engage young rural leaders to help them drive positive change within their local rural communities.

“Rural young people are fundamental to the vibrancy, energy and economic outlook of rural places,” explains Jane Craigie. “We wanted to better understand what young people perceive their challenges and opportunities to be, as well as gaining a better understanding of their degree of optimism for the future.”

Important to understand the needs of rural young people

Rebecca Dawes, with her background in the SAYFC, added that there is a real lack of insight into this important group within our rural communities, hence the decision to run this project.

She said: “the research to date amongst rural young people, both nationally and internationally, has been fragmented, but what we do know is that rural areas have a lower percentage of 16-34 year-olds and evidence suggests that migration of young people away from rural areas hinges on education, employment opportunities, housing and public transport availability – some of the many research areas that we are surveying.

“With so much emphasis on youth this year, we want to make sure that rural young people have a voice that will be heard, what better way is there to share their outlook?”

The project, which will be repeated annually, aims to research a wide range of rural young people including those working in education, farming, retail and hospitality, as well as those who are in full time education, or unemployed.

“The project, which will be repeated in 2019-22, has the bold ambition to better inform society and policy-makers about the vibrant talent that is held amongst our rural youth, and to compare our findings with those from other countries around the world.

James Rose explained why the Scottish Rural Network are supporting the project “The future of rural Scotland is in the hands of its young people. In 2018, the Year of Young People, The Scottish Rural Network (SRN) is supporting the Rural Youth Project to gain a vital insight into what matters to young people in rural areas and bring together the people who will define our rural communities in the years to come.”

Penny Montgomerie from SAYFC added “Young people need to have the confidence to drive policy and influence decision makers on matters that impact them rather than relying on older generations to make presumptions on their needs.”

Jane Craigie Marketing will use their wide-reaching networks within the international agricultural and rural leadership community and the International Federation of Agricultural Journalists to publicise the project and its outcomes.

The survey will open on 26 January and close on 30 April 2018. The incentive for completing the survey is a pair of tickets to the TRANSMT Festival in Glasgow on 8 July or a pair of tickets for ButeFest 2018.

The 2018 Project will culminate in a three-day Rural Youth Ideas Festival, run by Jane Craigie Marketing on 20-22 July in rural Scotland and an action plan developed by the Project partners.

The survey can be reached via the Project website

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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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