Archive | GP Contract

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…

Uncertainty

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 theyworkforyou.com website)

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

https://youtu.be/8-QQgHLKRT0?t=31m23s

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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Spotlight: Primary Care on Skye – Quintessential Healthcare

Over the next few months we will be featuring a number of spotlights on current rural GPs across Scotland.  Dr Steve McCabe works at the Portree Medical Practice on the Isle of Skye and has written the following to give his perspective on rural healthcare…

Portree Harbour

Who am I?

My name is Steve McCabe. I have been involved in rural health for nearly 30 years. But I grew up in Airdrie, a town in Scotland’s industrial heartland and as a child I had no real connections to rural Scotland. The house I lived in stood on a hill. My bedroom was on the southwest corner of the house and it had two windows – one looking south, the other looking west. From the south window at night I could see the sky being “set alight” when the giant steel works at Ravenscraig opened their furnace doors. But from the west window on a clear day I could see the mountains of Arran.

Where am I?

I work as part of a group practice in Portree, the largest settlement on Scotland’s second largest island, Skye. Skye is widely regarded as one of the most beautiful islands in the world. It is one of the few Scottish islands with a growing population and Portree is the hub of island life, a busy wee place.

We also look after the islands of Raasay (pop. 192) and Rona (pop. 2).

The Wednesday commute to Raasay

Why am I here?

I was brought up on the stories of James Herriot (and his idyllic life as a rural vet) and A. J. Cronin’s heroic rural doctor, Dr Finlay. During school holidays my parents took me to rural areas – the East neuk of Fife, the Galloway hills, the Yorkshire dales. I knew from when I was 14 years old that I wanted to be a rural doctor. It is for this reason I went to medical school and nothing there changed my mind. While all my colleagues were jetting off to California or Queensland or Fiji for their electives I was living in an old dairy in the Scottish Borders experiencing rural GP life first hand. As a result I did my GP training in the Borders and subsequently worked as an Associate GP on Islay and Jura during 1995/96 before taking up my current partnership in Portree in May 1996.

Who is our population?

The island has three other practices but ours is by far the largest with 5500 patients – about half the island’s population. On top of that we are currently also dealing with about 1000 visitors each year but these are only a tiny fraction of Skye’s total number of visitors each year which now exceeds three quarters of a million people.

Who do I work with locally?

We have a full complement of primary care staff on the island (and a separate out-of-hours service) and we work very closely with all of them. Of course, just as with rural doctors, there is a fairly constant pressure on the recruitment and retention of community nurses, midwives and allied health professionals.

The Cuillin of Skye

What impact has the new GP contract negotiations had on me?

In its 2004 iteration the GP contract, negotiated at a UK level, had a very negative impact on rural practice in Scotland. It withdrew at a stroke many of the had-fought concessions rural practice had achieved. So, no more distant island allowances, no more rural mileage payments, no more notional lists, etc. Literally overnight we saw our income fall by more than 20% and we have never recovered that deficit.

I worked hard for nearly 17 years on BMA Scotland’s Scottish Council trying to highlight rural concerns and to rural proof BMA Scotland policy. I had hoped that, as a result, a new Scottish GP contract, negotiated in Scotland, would have had rural issues at its forefront. But instead we are told by BMA Scotland that rural is “too difficult to sort” and we have been kicked into a patch of long grass called phase 2.

RGPAS have been excellent at highlighting this iniquitous situation and we must give strength to their arm by supporting them as much and as often as we can.

What challenges do I face engaging in the political process?

None really – it is something I have always done throughout my professional life, driven as I am by a core belief that as GPs we have a fundamental role in local and national social activism. I have even managed to go so far as to have a debate on rural health issues held in the Scottish Parliament. I have over the years widely discussed rural health issues and concerns in national newspapers and on national radio and television. I continue to write a monthly article for a current affairs magazine in which I refuse to pull any punches.

What are my thoughts regarding the future?

I try to live in the moment as much as I can. I absolutely love my job and look forward to going to work every day. I miss it when I am on holiday. For me it has always been a vocational thing and that remains so now more than ever.

But the reality is I will be 53 later this year and I cannot go on for ever. I always said I would stop working as a doctor while I felt I was still at the top of my game rather than fizzle out and fade away. I can see already I don’t have the stamina I used to have and I am increasingly tired after busy days. My memory is also not as sharp as it was – the days of me never having a diary (which I didn’t until my mid-40s – I kept it all in my head and never missed anything) are now gone. So my plan is to retire at 58. One of the main driving forces behind that decision is that I will do my next revalidation at 54 and it will be my last. I regard revalidation as one of the worst things to happen to our profession and I am still sad to this day that we allowed it to be thrust upon us and that we let go of the wonderful model of appraisal we previously had.

And when I do retire I don’t know what I will do – but it will be something completely different…

Bluebell Wood, Portree

 

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Spotlight: Rural Practice on Jura

Over the next few months we hope to feature a number of spotlights on current rural GPs across Scotland.  Dr Martin Beastall works on Jura with his wife Dr Abby…

Life and Work on the Isles of Islay & Jura: Living the Remote and Rural Dream

Who are we?

Jura Medical Practice consists of a husband and wife GP team – myself (Dr Martin Beastall (42)) and Dr Abby Beastall (36). I am responsible for the running of the Surgery on Jura and Dr Abby works mainly at the Bowmore Surgery on Islay, and does one session per week on Jura. Between us, we are also responsible for out of hours care on Jura 24 hours per day, 7 days per week. We came to Jura just over 5 years ago having both worked in and around the Doncaster area in England for a similar length of time. We were both looking for a change, an adventure, and having both worked in large urban Practices, a chance to reconnect with our patients and make a real difference to their lives. We met on the Doncaster GP training scheme in 2005. I had changed from Surgical training, whereas Abby had always intended to train as a GP. Between us, we have a varied mix of skills, perfect for the challenges that Remote & Rural Medicine brings.

Where are we? 

Jura is a large island of approximately 400 square kilometres in the Southern Hebrides, situated to the north east of Islay. Jura has a tiny population (under 250), whereas Islay’s community numbers just over 3000. We are situated directly west of Glasgow as the crow flies. An ill patient can be transported by helicopter to Glasgow in under 30 minutes, whereas a journey by car requires two ferries and takes most of a day to complete.

Why are you there?

Rural General practice brings with it many challenges but also great rewards. We have the opportunity to genuinely provide ‘cradle to grave’ medical care and to be an integral part of our patients’ lives. We are a small but thriving community on Jura. We believe having medical services here is essential for the continued growth and stability of our community and that without continuity and stability, the future of the community overall would be threatened.

Who is our patient population?

The population of Jura matches the overall Scottish demographic, just in miniature. Every age group is represented and the care we provide ranges from baby vaccinations to very personal palliative care for those coming to the end of their lives.

Who do you work with locally?

Being the GP on Jura means being the Doctor, Practice Nurse, Phlebotomist, Health Care Assistant, Paramedic and Pre-Hospital Responder all in one. Flexibility and a willingness to attempt almost any task asked of you is key here. We are lucky to have a dedicated team of carers and District Nurses on the island, and are well supported by allied health professionals based on Islay also. Emergencies are dealt with locally when possible, but a comprehensive support structure exists regionally to provide help ranging from helicopter transport to full blown medical retrieval teams when required.

What is it like having 24 hour a day responsibility for your patients’ health and wellbeing?

Being ready and available 24/7 can be hard psychologically. Patients have direct access to their GP here (rather than using a service such as NHS24) which has its pros and cons. Being able to deal with things locally is very satisfying but it can be hard sometimes to demonstrate to the wider world the time and money saved by avoiding transferring patients elsewhere.

What impact have the new GP contract negotiations had on you?

We have both been very grateful for the efforts made by the RGPAS on our behalf. We feel that as rural GPs we are very much an afterthought. Issues such as the provision of out of hours cover after April 1st 2018 have been very unclear. This has had a destabilising effect on us, exactly the opposite of the stated intended effect of the new contract.

What challenges do you face engaging in the political process?

Being geographically remote and (due to childcare issues) essentially single handed means attending meetings is very difficult given the 24/7 responsibility for patient care. Video conferencing and webcasting still seems the exception rather than the norm. It is easy to feel out on a limb here.

What are your thoughts regarding your future? 

We both remain positive about our futures living on Islay and Jura. We cannot imagine a better community to live in and raise our daughter in, and are hopeful that the new GP contract will enable us to continue to provide the high level of medical care we have done for the last five years for the foreseeable future.

Photos by Martin and Abby.
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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: http://ruralgp.scot/rememberrural/

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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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