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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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Students present Bright Ideas for Rural Practice

This year, the Rural GP Association of Scotland has once again run its student conference scholarship programme.  This is a significant investment for RGPAS, which uses money raised into its Educational Trust fund to support these scholarships.  The scholarships offer heavily-subsidised tickets to enable undergraduate students in the UK to attend and participate in the annual RGPAS conference.

To apply, students were asked to submit a 60 second sound or video clip explaining their Bright Idea for Rural Practice.  We are delighted to feature the winning entries below.

A number of these will be selected for PechaKucha-style presentation at our conference in November.  You can read more about the scholarships here, and also a great write-up of last year’s conference by one of the scholarship holders then, Catherine Lawrence from Hull & York Medical School.

There is still time to sign up to the conference, which takes place from 2-4 November 2017 in Inverness.  £130 for GPs or £65 for trainees gets you two-and-a-half days of quality CPD, along with a conference dinner (and wine).  It’s a great way to catch up with like-minded colleagues, and hear updates on clinical and non-clinical topics that are relevant to rural practice in Scotland.

Well done to all our scholarship winners.  We look forward to meeting you in Inverness!

Rohan Bald (Glasgow): Tackling Loneliness

Emma Bean (Glasgow 5th Year): Drones

Josephine Bellhouse (Glasgow): Improving Use of Communication Technology

Katherine Cox (Glasgow 4th Year): Developing Videoconferencing Peer Support

David Gibson (Glasgow): Awareness of Rural Medicine as a Career

Haiyang Hu (Glasgow): Access to Mental Health Services

Saskia Loysen (Glasgow): Increasing the use of Telemedicine (and pyjama bottoms)

Eloise Miller (Glasgow): Develop Rural Medicine Intercalated Degrees

Danielle Parsons (Aberdeen 4th Year): a Rural Medical School for Scotland

Gregor Stark (Glasgow 5th Year): Rural Research Consortium

Rosslyn Waite (Dundee): Improving Connectivity

Hannah Webb (Glasgow 2nd Year): Access to Sexual Health Services

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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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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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Rural Medicine Café discusses Rural Health Research

Mayara Floss, founder of the Café

Readers might be familiar with the Rural Medicine Café, set up by budding rural GP Mayara Floss who is a medical student in Brazil.

Following the 2015 Rural WONCA Conference in Dubrovnik, she set up the virtual Café to create a relatively informal space in which rural medics from all over the world could come together for some conversation to discuss hot topics, and develop collaboration.  Mayara runs these sessions on Google Hangouts, which offers easy access and is fairly successful on most broadband connections.

So far an impressive range of topics have been discussed.  The most recent event took place on Saturday, and involved doctors and students from Brazil, the Caribbean, Halifax in Canada, Scotland and Kenya discussing ways in which research in rural health could be improved and facilitated.

An important outcome of each virtual Café is that the content can be watched later, on YouTube.  The relaxed nature of these sessions means that they can take a fair chunk of time to watch, but for rural health enthusiasts who want to catch up on the conversations, it represents an interesting resource from which to learn from practices across the world.  Where else can you engage so easily in sharing and discussing rural health issues with worldwide conferes?

For future events, take a look at the Café Facebook page.  The most recent Café (running to just over an hour) can be accessed at the following link:

https://youtu.be/SdP53qewijU?t=1s

Well done to Mayara for an impressive result to her initial ambitions to develop this project.  Do contact her via the Facebook page if would like to watch or take part in a future Café.  The next Café will discuss the WONCA Rural Medical Education Handbook on Saturday 4th February.

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#RGPAS16 brimming with student ideas for #ruralGP

newlogosquaretextToday over 80 students, trainees and rural GPs will meet up in Inverness, for the annual conference of the Rural GP Association of Scotland.

This year’s event has attracted record numbers of attendees, and a stimulating programme of events is in store, along with lots of opportunities to chat, network and seek new ideas for rural practice.

As part of the RGPAS student scholarship programme, we have encouraged student delegates to submit video or audio clips of around 60 seconds, outlining their visions of the future of rural practice.

Not all clips are available as yet, and we will develop this page over the next week to include more clips, as well as add the photos of RGPAS students on this page too.  In the meantime, take a listen to the diverse and innovative ideas being put forward by the students below, all of whom will be joining us in Inverness.  Great to hear such an inspired group of students!

The conference will run from 2pm today – Thursday 3rd November – to Friday 4th November.  You can follow events on twitter using the hashtag #RGPAS16 – we hope to share reports and presentations from the conference on RuralGP.com soon after the conference too.

 

Innovation ideas

Sally Andrews (Aberdeen University): On the role of telemedicine to improve patient care and good housing availability to improve recruitment to rural areas…


Joe Daley (Glasgow University): Improving the interface between rural primary care and secondary care input…


Rhys Hall (Glasgow University):  The use of drones to overcome geographical barriers of rural practice…


Catherine Lawrence (Hull & York Medical School): Reflects on her experience of a Scottish rural GP elective…


Scott MacDonald (Glasgow University): Using technology to allow patients to take more responsibility for monitoring their health…


Lean-Lik Ng (Dundee University): How to engage with medical students of today to pave the way for future rural general practice…


Iona Robertson (Dundee University): Describes the increasing role of telemedicine in reducing the need to travel longer distances to secondary care…


Keenan Smith (Glasgow University): Reflecting on infrastructural revolution to provide better access to rural healthcare…


Blair Wallace (Dundee University): On the role of point-of-care investigations in improving efficiencies and quality of care offered to rural patients…

 

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Our experience of simulation training on Arran

splogoIn September 2014 we took delivery of three Laerdal mannequins to support the work of emergency responder groups on the Isle of Arran.  These were funded by the kind support of the Sandpiper Trust.  Spurred on by the work of the TOPCAT study – identifying that quality early CPR, along with effective clinical teamwork and leadership results in considerable improvement in survival from cardiac arrest – we sought to provide an island based resource to allow professionals and the public to improve their resuscitation skills.

This project was named ‘caiRRn’ – the Cardiac Arrest Integrated Rural Responder Network.  You can read more about the project at http://www.cairrn.org.uk.

Or watch this presentation from Richard Lyon, one of the stalwart researchers at the Resuscitation Research Group in Edinburgh.  If you need any convincing that this is worthwhile work, just watch this.

Earlier this year, the Scottish Government published the document ‘Out of Hospital Cardiac Arrest – A Strategy for Scotland‘.  We are particularly enthused that it gives several specific consideration to the challenges and opportunities of improving cardiac arrest survival in rural areas.

Community

After discussing our caiRRn project proposal with the Sandpiper Trust, we received two Laerdal QCPR mannequins for focussed CPR practice with our First Responder groups, emergency teams and the wider public.  To date they have been used to help train over 100 members of the public on Arran, and feature regularly in the training of our three First Responder Groups.

We will report on our experience of these mannequins in a separate article.

Professionals

We were also delighted to take delivery of a Resusci Anne Simulator for use with more qualified responders, particularly those who manage more complex arrest and peri-arrest scenarios as part of their voluntary or professional duties.  Over the last year, we have integrated its features into increasingly regular training – including GPs, hospital nurses, practice staff of Arran Medical Group and paramedics & technicians of the Scottish Ambulance Service.

It has been a steep learning curve, and after a year, we feel that it is now an integral part of regular training.  We have built simulation sessions into our weekly GP meetings; and we use the simulator on an ad-hoc basis when the hospital workload allows.  Our ambulance colleagues have found it particularly useful to practice scenarios as well as a teaching aid for trainee paramedics learning about patient assessment: breath sounds, heart sounds, advanced airway management and more.

We are grateful to the Sandpiper Trust for their considerable generosity in facilitating these resources to be available locally to Arran teams.  Already there are patients who have benefited from the training allowed – including some who have experienced and survived cardiac arrest on Arran.  We are keen to share the lessons learned, and have produced the following video clips as a way of doing this.

If you have any questions about our experience of the simulators, please contact us.  Dr David Hogg (GP) has been leading this project, and you can contact him at: david.hogg@nhs.net .

Conflicts of Interest: I am one of the Clinical Governance Leads at BASICS Scotland, which receives lots of support from the Sandpiper Trust.  I do not have any links with Laerdal, and I’m not on any commission! 

Introduction

Why Simulation?

Tour of Features

What about defibrillation?

Tour continued…

Any tips?

A brief demonstration

Acknowledgements

 

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Must-watch video from @KangarooBeach

When was the last time you watched something that you felt simply had to have a wider audience?

For me that was last night.  Tim Leeuwenburg of Kangaroo Island, Australia had already presented this talk to the wide community of SMACC in Chicago, but by sharing his story and reflections on video, it makes for compulsive viewing by all clinicians, from those about to hit the wards and experience ‘grown up’ clinical responsibility, to those who are approaching burnout – or who are keen to identify burnout in others.

As a rural GP I found Tim’s story compelling and relevant, and I think others will too.  If you can tolerate the graphic nudity (it’s worth it), take or make 30 minutes in your life to watch this.  And share.

 

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