Archive | Rural-Proofing

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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Mapping out the proposed Scottish #gpcontract allocation formula

Effects of the proposed workload allocation formula: red practices (n=354) require ‘income protection’ of up to 85% due to the negative effect of the WAF. Green practices either stay the same (n=4) or will see an increase in their funding (n=602).

Last night’s BMA Scotland webchat with the Scottish GP Committee (SGPC) about the new GP contract was an opportunity for GPs across Scotland to engage with our negotiating team to find clarity, response and reassurance (where possible) about the new contract.

We appreciate the time that our SGPC colleagues took out of their evenings in order to provide this session, which you can view here

RGPAS wishes to respond to an SGPC comment last night in relation to the map that has been published in the last few weeks showing which practices stand to gain from the proposed workload allocation formula. Concern was expressed that the originally published map was incorrect, as red dots had been used to indicate practices who will see no difference and no additional funding compared with their 2017 funding.

And so we are very happy to issue a revised map which makes this correction – see the map above.

The green dots indicate GP practices that will gain additional funding – or maintain current funding – and the red dots indicate practices which will see a fall in their allocated income as a result of the proposed formula.  These red practices will – in Phase One of the proposals – require ‘protected income’ to keep their funding in line with 2017 funding as otherwise they would see drops of up to 85% in funding for patient care.

You can view an interactive version of the map here.

Spot the difference?

Old and new maps compared. Spot the difference?

We’re surprised that this clarification is required, not least as we see very little difference between the maps.

There are significant concerns about the way in which the workload allocation formula has been devised, and from the graph below it can be seen that there is an obvious skew against rural practices.

Not just rural

This, however does not tell the whole story – our Deep End GP practice confreres – who represent the GP practices serving the most deprived communities in Glasgow – have expressed their own concerns and surprise that health inequalities do not seem to be adequately addressed by the proposed contract.

Going forward

Click to download the report (2.6MB, PDF)

Meantime, RGPAS remains committed to representing the needs of its members, and the wider needs of rural GP practices in Scotland and their communities.  Several weeks ago we published our official response to the new contract, including positive ways that we firmly believe RGPAS can assist with the process of further negotiation and shaping the future of Scottish primary care.  You can download the report ‘Looking at the Right Map’ by clicking the image on the right.

Rural GPs can join RGPAS here: (£20 per annum membership).

You can view our letter to Cabinet Secretary Shona Robison (response awaited).

Here’s some recent news coverage regarding RGPAS concerns:

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RGPAS response to the Scottish GP contract proposals

The Rural GP Association of Scotland (RGPAS) today publishes its response to the Scottish GP contract proposals.  Following much discussion on our members’ email discussion group, RGPAS videoconferences and wider engagement on social media and contract roadshows, we have collated the opportunities and challenges that we believe to exist in the proposals.

We recognise that a new vision for the future of Scottish primary care is vital.  We are keen to collaborate and inform the development of these plans in order that Scotland’s rural communities (at least 18% of the Scottish population) are represented appropriately.

You can read the GP contract proposal at the BMA Scotland website.

You can find out more about RGPAS at

Click to download the report (2.6MB, PDF)

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Event: Safety & Sustainability in Rural Surgery

The Royal College of Physicians and Surgeons of Glasgow is pleased to announce a provisional programme for the Safety and Sustainability in Rural General Surgery Conference on 30 November and the morning of 1 December 2017. This conference will bring together many of Scotland’s current surgical trainees with a long-established network of remote and rural surgeons, the Viking Surgeons’ Club, in an exciting and unique event.

The conference will explore the current reality of Scottish rural surgical service provision, discuss the international remote healthcare experience, and offer updates into the management of surgical subspecialty emergencies in a rural context. We welcome delegates from around the world who have an interest in rural healthcare and the challenges therein.

Title: Safety and Sustainability in Rural General Surgery: The Viking Surgeons’ Conference 2017

Date: November 30 and December 1 2017

Venue: The Royal College of Physicians and Surgeons of Glasgow, 232 – 242 St Vincent Street, Glasgow, G2 5RJ

Book online:

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The Belford: an example of great quality rural healthcare

Dr Patrick Byrne, consultant at the Belford Hospital in Fort William, was involved in hosting a visit from a delegation from the Philipines.  This article featured in Lochaber Life Magazine earlier this month.  It has been reproduced here with the kind permission of Iain Ferguson of the Write Image (picture credits to Iain too).


Dr Patrick Byrne

The Belford Hospital continues to punch above its weight on the national and international stage, welcoming a delegation from the Philippines a few weeks ago.  The visit was part of a week-long study tour to the UK by Presidents and delegates from the Philippine Royal Colleges of Physicians, Surgeons, Paediatricians and Obstetricians and Gynaecologists, alongside officials from the Philippine Ministry of Health.

Teaching & training for most healthcare providers in the Philippines tends to be concentrated in the largest hospitals in cities, ignoring the district and rural locations.  This is in contrast to the UK where every hospital has a role to play and sometimes the best experiences and training is to be found in the smallest facilities, where one-to-one supervision from consultant teachers is often the norm, not the exception.  The purpose of their study tour was to learn from UK practices, specifically how supporting and investing in rural hospitals leads to a more efficient healthcare system across the region, and the country.

Led by the immediate Past President of the Royal College of Surgeons, Mr Ian Ritchie (who has family ties to Corpach), the delegates specifically requested to see an example of good training in a small hospital of approximately 100 beds.  Mr Ritchie replied, “I can bring you to a 34-bed hospital where training and patient care is not just good, but excellent”.  The importance of this visit, was underlined by the presence of the most senior NHSH personnel – Prof Elaine Mead (Chief Executive Officer), Mrs Gill McVicar MBE (Director of Operations) and Dr Emma Watson (Director of Medical Education).

Each, in turn, reiterated the importance of consultant-led services and training at Belford Hospital, both now and going forward. However, it was Miss Alison Bradley, a former Belford trainee, now a senior surgical registrar in Glasgow, who captivated and inspired everybody, proving that rurality is no impediment to ambition; quite the opposite, in fact, as she explained the details of her PhD research into pancreatic cancer.

Mr Ritchie said, “It was very clear to all who visited that numbers of beds is not an indicator of good training, it is that key relationship between a trainer and a trainee which, in Fort William, you all demonstrate to a very high degree.  The high point was certainly the Belford.”  In her letter of thanks, on behalf of the College of Paediatrics, Dr Cynthia Daniel echoed this, adding “I am certain with you and the rest who share the same passion for training and service, Belford Hospital should be safe for the next 150 years and beyond”.

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Prof Paul Worley – Rural Health Commissioner for Australia

In a really interesting development for rural health internationally, Australia has appointed its first Rural Health Commissioner.

Charged with the responsibility of overseeing and driving a wide range of activities around supporting ‘rural generalism’ the post offers a chance to provide more co-ordinated leadership across domains, regions and disciplines to make rural health strategy more cohesive in Australia.

Professor Paul Worley has been appointed as the first Rural Health Commissioner and this move has been widely welcomed across the rural health community.  He brings an impressive portfolio of experience to the post, including in clinical, academic, educational and strategic development aspects of rural health.  You can watch Dr David Gillespie MP announce the post, and Prof Worley outline some of his visions for the future (at 5min 55s), in the video below.

Twitter and other social networks – including the WONCA Working Party on Rural Health international email list – have been buzzing with positivity about the new post, and it is likely that this approach might pave the way for similar developments in other countries.

In Scotland, we are watching developments with interest.  Rural medicine and health services are of significant importance in Scotland’s National Health Service – 98% of Scotland’s land mass is rural, and 18% of Scotland’s population live in a rural area, with many more flocking to rural areas during holidays.  And yet despite considerable aspects of medical care being delivered by GPs and primary care teams, within community hospitals, A&E units and facilities outwith the usual remit of GPs, there continues to be relatively little in the way of co-ordinated clinical governance and strategic unity to link rural and isolated practitioners together.  These services provided by rural GPs remain considered to be on the ‘fringes’ of general medical practice.  Therefore the opportunities created by appointing an experienced individual to provide leadership, stimulate innovation and inspire positive approaches, are sorely needed in areas other than Australia.

Having met Paul at the WONCA World Rural Health conference in Cairns this year, I’m delighted to hear this news and inspired to think that this is a situation to watch closely.  I have little doubt that we will be reflecting that Scotland could benefit from a similar approach in the near future.

Well done Australia, and all the folks involved in making this happen.  These are exciting times.

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