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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 & Dr Angus MacTaggart (Chair & Vice-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 Laura Ryan (Associate Medical Director, NHS 24)

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: Tips for Juggling Family Life and Rural GPing – with discussion :: 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

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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/

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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

 

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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.

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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…

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RRH Guide to Getting your work Published

One of the sessions at #ruralwonca was delivered by some of the team at the Journal for Remote & Rural Health.  I was really sorry to miss it, due to presenting in another session, but my tweeted request to make the advice available online was answered quickly and the presentation is now available – see below.

The journal team are keen to encourage and motivate rural healthcare professionals to share their research, and seem genuinely interested in helping budding writers to put pen-to-paper or finger-to-keyboard.

There is a lot of great innovation and problem-solving going on in rural practice.  Rural healthcare professionals tend to know their communities well, are used to dealing with limited resources, and some of the best examples of teamwork are to be found in rural settings.  However ‘being academic does not come easy to everyone, and the process of writing up evaluation and research can sometimes feel tedious and time-consuming.

However, it is now easier than ever to find interested journals, and there seems to be a drive to make the steps to getting work published more accessible.

Watch the presentation below for the RRH team’s top tips on getting your research out to a wider audience.  You can find the guidelines for authors available here.

Also, on the theme of research, here’s a great project that aims to enable rural doctors to develop their research activity through pragmatic and direct support.  Delivered by the Faculty of Medicine at Memorial University in Newfoundland, it’s called the ‘6 for 6’ programme.  Click here for more details or watch the video below.

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What happens when Deep End goes Rural?!

Many readers will be familiar with the Deep End project, originating in Glasgow but which has spread far and wide in describing the work of GPs working in areas of urban deprivation.  The original project brought together 100 general practices serving the most socio-economically deprived populations in Scotland.  The project team has carried out a fantastic amount of work to highlight the impact of inequalities on prevalence of medical conditions and access to healthcare.

So what happens when a Deep End GP (or a GP and GP trainee, to be precise!) travel out for some time in a remote island practice?  Dr Maria Duffy and Dr Elizabeth Dryden did exactly that, when they travelled to Benbecula to spend a week with rural GP Dr Kate Dawson… and produced this short video of their experience…

 

You can follow the Deep End project on Twitter – see below.

We look forward to the sequel!

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Setting the right path for Canadian rural practice

Thanks to Dr Douglas Deans for highlighting this recently-published report from a collaborative taskforce in Canada, which has been set up to identify positive actions that are likely to result in a more robust, sustainable and supported rural health service in Canada.  The collaboration comprises the Society of Rural Physicians of Canada (SRPC) and the College of Family Physicians of Canada (CFPC).

The report is refreshingly succinct, relevant and pragmatic, and likely to be of interest to anyone who is trying to work out how to articulate the balance between effective action and strategic direction to influence national policies, in the context of conflicting and difficult policy decision-making.  Many rural GPs and educators will be familiar with the challenge of identifying realistic interventions which can translate into more sustainable recruitment and retention to rural communities, so this road map from Canada is likely to be a welcome read.

Recruiting and retaining family physicians in rural areas through financial incentives alone is not enough.  We need a coordinated and thoughtful alignment of education, practice policies, community involvement, and government support.  Family medicine residents who are educated in rural training sites, who immerse themselves in the communities and who see themselves supported by peers, specialists, health care providers, and evolving distance technologies, are more likely to choose rural and stay rural.

Dr Trina Larsen Soles – SRPC Co-Chair of Taskforce

News Release   Download the Report

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#RuralGPframed – bringing rural healthcare into focus

Check the end of this article for tweets and images that have been posted online since the hashtag went live…

Image from W Eugene Smith’s “A Country Doctor”.  LIFE Magazine, 1948.

the best camera is the one you have with you

1948 saw the beginning of the National Health Service in the UK.  Many of its principles were based on the development of the Highlands & Islands (Scotland) Medical Service which was launched in 1913 following the publication of the Dewar Report into the challenges of rural healthcare in Scotland – and many consider the Dewar Report to be the blueprint of today’s NHS.

1948 was also a key moment in photojournalism, when LIFE Magazine featured the photography of W Eugene Smith. His photoessay of the work of Colorado country doctor Ernest Ceriani became a benchmark for photojournalism, and remains an iconic reference in the power of photography to provide perspective and insight. A YouTube presentation of the article is available too.

Since then, photography and photojournalism has evolved significantly.   Nearly everyone now has a quality camera-phone in their pocket.  The development of digital photography has resulted in the limits of photography being confined only to battery power, memory card space, and creativity.

Dr Greg Hamill (Arran GP) and Dr Stephen Hearns (Consultant, Emergency Medical Retrieval Service) work together using ultrasound-guided vascular access in an acutely unwell patient. (Patient consent obtained).  iPhone; 2017.

And yet, some would argue that this has had the effect of devaluing the art of good photography.  Paradoxically, because photography is within such easy reach, we sometimes fail to document episodes of experience – either as we assume someone else will be, or the immediacy of image capture devalues the art of composition, style and creative depiction.  And because so many images are produced (Facebook estimates that over 300 million photos are uploaded to its website every day), it is likely that great images fail to get the recognition and prominence that they deserve.

In just over a month’s time, I will be running a ‘Practical Tips’ session at the Rural WONCA conference in Cairns, Australia – on The Visible Rural GP: developing an image bank for modern rural practice.  The idea for this evolved through a personal interest in photography and its journalistic role, an interest in ‘how do we represent rural practice to potential rural GPs’ and awareness of projects such as  Document Scotland – just one inspirational project that aims to “photograph the important and diverse stories within Scotland at one of the most important times in our nation’s history”.

A tick that I removed from a patient who presented to our Arran War Memorial Hospital one summer weekend oncall. (Assumed consent from tick).  Canon 60D, with reversed 50mm; August 2016.

Perhaps we should be considering the need for presenting inspiring, accurate visual representations of rural practice today.

And so today, in the run-up to Rural WONCA 2017, I am committing to share (via Twitter, using the hashtag #RuralGPframed) at least one photo per day, from my own images, that depicts an aspect of rural practice.

I would be delighted for others to join me.  The more images that we can collect and share, to represent the stimulation, challenge and professional satisfaction of rural practice, the more insight that others – including potential rural GPs – will have into the opportunities that rural practice can offer.

Dr Kate Dawson (GP, Benbecula) and Dr Charlie Siderfin (GP, Orkney) during a valuable opportunity to get together and discuss research opportunities in rural practice.  Fujifilm XT1; January 2017.

What about video?

‘A picture is worth a thousand words’ but video often allows a narrative and mood to be more easily captured.  Video is important, and submissions of video are welcomed to this project.

Please remember, explicit consent is required for any footage featuring patients or anything related to them. Creativity  is welcomed!

#RuralGPframed

(search Twitter)

4/4/17 Update

Within 24 hours of this post going live, we’ve had an amazing amount of coverage across the world, particularly our Australian confreres.  Keep them coming!  Here’s just a few of the tweets that we’ve picked up on the hashtag…

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New Report: Health & Wellbeing in Rural England

Thanks to David Syme for highlighting this report which was published on 11th March 2017.

It offers a comprehensive view of the challenges and positive aspects of accessing and providing rural healthcare in England.

The report mentions eight key ‘health risks’ of rural areas:

  • Changing population patterns
  • Infrastructure
  • Digital access and exclusion
  • Air quality
  • Access to health and related services
  • Community support, isolation and social exclusion
  • Housing and fuel poverty
  • Employment and under-employment

There will of course be similarities between the issues raised in this report, and communities elsewhere in the UK and beyond.

You can download the report from this link.

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