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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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What are green lights all about?

Flashing green lights are rarely seen in cities, but they are part of an important emergency response to rural areas.  In this article we highlight the use of green lights in the provision of prehospital and other health care in Scotland.

Please help us by sharing this article with others who may be visiting rural Scotland this summer.

You’re enjoying the amazing scenery to be found on the North Coast 500 route around northern Scotland.  Behind you, you notice a car with a flashing green light.  What does this mean?…

  1. it’s a funeral director attending a sudden death
  2. it’s a vet attending an emergency
  3. it’s a doctor attending a medical emergency
  4. it’s a fashion statement

The answer is 3.

We’ve written this article as a number of our members have highlighted increasing difficulties getting to emergency calls as other road users can seem unaware of the meaning of green lights.  As we head into another busy summer to welcome tourists and visitors to Scotland’s rural countryside and islands, we thought we might provide some information about the meaning of green lights.

The NC500 (North Coast 500) seems to have particular issues – perhaps as it has experienced a significant increase in the number of people travelling along its roads, who aren’t used to driving in rural/remote Scotland.  Here’s what one of our members recently described…

The NC500 is becoming a significant concern, in particular with groups of cars travelling nose to tail in convoy and not appreciating that they will not all fit into one passing place. This as I’m sure you can imagine causes complete gridlock. Thankfully we have very few emergency calls ourselves but both of us have experienced difficulty getting past slow traffic in recent weeks despite using green lights.

My particular one was a very urgent call to **** (young man, cardiac arrest, we were told, so you can imagine how keen I was to get there safely but as soon as possible). I found myself behind a group of 3 open top sports cars. On open road they were going fast enough for me not to need past but I could see that as soon as we reached a narrow section there would be a problem. Indeed at the first passing place they couldn’t all get in, and ended up with a prolonged negotiation with a large campervan not wanting to reverse.

I had green dashboard lights on and also tooted and flashed my lights, hoping they would stay where they were and let me pass once the campervan was away, but all I got was rude gestures in the air, and they moved off very slowly, continuing in very close convoy. I assume (hope?) that they did not notice the green lights or did not know what they meant but there are other similar tales which I’m afraid make me wonder.

Spot the Sandpiper responder? They work with all other emergency personnel, including ambulance, fire, police, lifeboat and mountain rescue teams. (Staged simulation – pic by Chris Hogge).

Across Scotland’s rural landscape, the Scottish Ambulance Service rely on over 500 volunteers (probably a lot more) to augment its emergency service.  As well as First Responders (local community members trained up to use a defib, oxygen, administer CPR and deliver vital emergency care to heart attack and other seriously ill patients), there are Sandpiper BASICS doctors, nurses and paramedics who make themselves available – including in their own time – to attend road accidents, cardiac arrests, seizures and lots of other medical emergencies.  Sometimes they will be requested to attend by the ambulance service directly, or they decide to attend a patient after a phone assessment or having been informed by another community member.  We work closely with our local ambulance crews, and national services such as Helimed, the Emergency Medical Retrieval Service and Coastguard helicopters.

Green flashing lights are permitted in law – The Road Vehicles Lighting Regulations 1989 s 11 (2)(m) – to be used as “a warning beacon fitted to a vehicle used by a medical practitioner registered by the General Medical Council (whether with full, provisional or limited registration)”.  They do not permit drivers to be exempt from any road traffic laws, but serve as an important means of making other drivers aware that a doctor is on their way to an emergency call.  In rural areas – where traffic lights, 30mph speed limits and other restrictions are less frequent – it can make a significant difference if a clear passage can be enabled for doctors to attend emergencies as soon as possible.

Lights are usually only used in life-or-limb threatening situations – when time is of the essence.  Rural areas normally experience longer ambulance response times.  This is partly due to longer distances being travelled due to geography.  However many islands in Scotland have only one or two ambulances (which are normally also used for patient transport too) – so if they are unavailable, or if there are multiple casualties at an incident, a local GP, nurse or off-duty paramedic is often asked to assist.

So what should I do?

As with assisting any emergency vehicle with their progress, there is no need for erratic action.  However, it makes a significant difference to pull over safely, and allow a car behind you to get through.  If you see a doctor’s car approaching, plan ahead where possible to ‘create space’ in the road for them to pass other users, and use passing places on single track roads.  Please don’t stop on corners however, as this is a dangerous place to overtake, unless there is a clear view of the road ahead.

If it’s not safe to allow the car to pass, then don’t worry – just wait until the next suitable opportunity to pull over and let the vehicle past.

What about other responders?

The law allows only registered medical practitioners (doctors) to use green lights.  However rural areas rely on lots of voluntary responders – including lifeboat crews, mountain rescue teams and coastguard teams.  Team vehicles are often permitted to use blue lights and sirens.  Some volunteers will make themselves more visible by wearing emergency clothing en route, or by using sun-visor signs that should be visible in your rear-view mirror.

Often, they will be the first responder on scene for some time, particularly if the nearby ambulance is already busy.  Please do what you can to allow these essential services to make good progress through traffic – it could be you or your family who need their assistance the next time!

Where can I learn more?

To learn more about the role of Sandpiper BASICS responders, and of Community First Responders, watch the videos below.  Here are some links to the organisations mentioned above:

Finally, here’s two stories about where a fast local voluntary response made a significant difference…

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BASICS Scotland Adult Tele-education Course Starts 28th August 2017

BASICS Scotland would like to announce the dates for the next Adult Tele-education Course, presented by Karyn Webster. This 10 week course will start on Monday the 28th August and run for 10 weeks with a 2-week break in October.

Tele-education by BASICS Scotland is an online learning resource ideal for remote and rural practitioners eager to reinforce and develop their skills in pre-hospital emergency care. The benefit of Tele-education is that participants can take part without having to leave their home or place of work. The course is delivered entirely over the web, with weekly 1-hour live sessions in a video conferencing format which participants can attend or view the recordings later at a time more convenient for them!

Topics on this course include:

  • Allergy & Anaphylaxis
  • Asthma
  • LVF – Adult Pneumonia
  • Stroke & TIA
  • Chest Pain & Thrombolysis
  • Head Injury
  • ENT Emergencies
  • Wounds
  • Burns & Tetanus
  • Pain Relief
  • Seizures

If you are interested in taking part in this course or would like more information head over to the BASICS Scotland website and complete an application form today!

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New Edinburgh University Remote & Rural Medicine Society!

Kirsty Reid, who is a medical student in Edinburgh and newly-appointed President of EURRMS has written this to highlight the work being done at Edinburgh University to engage with RGPAS and other opportunities for undergrads in Scottish rural medicine…

It is my pleasure to introduce the first Edinburgh University Remote & Rural Medicine Society! We are a new student society here in Edinburgh with the aim to promote remote and rural medicine.

We hope to hold talks and workshops from remote and rural medics and surgeons, encourage Edinburgh students to attend next year’s undergraduate conference and help to promote medicine as a career option in remote and rural schools, among other goals. We have lots of ideas and are keen to hear any suggestions or advice!

If you would like to get in touch, please do not hesitate to contact myself or Iwan Williams via email. If you would like to hear about what we are getting up to, please visit our Facebook page which will be updated as we start back next term.

Kirsty Reid
EURRMS President
Email: s0700316@sms.ed.ac.uk

Iwan Williams
EURRMS Vice President
Email: s1206781@sms.ed.ac.uk

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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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Update from the Scottish Rural Medicine Collaborative

The Scottish Rural Medicine Collaborative (SRMC) is a programme funded by the Scottish Government’s GP Recruitment and Retention Fund. The programme – chaired by Ralph Roberts (Chief Executive of NHS Shetland) – is about developing ways to improve the recruitment and retention of GPs working in a rural setting across ten Health Board areas in Scotland – Grampian, Highland, Orkney, Shetland, Western Isles, Dumfries & Galloway, Ayrshire & Arran, Fife, Tayside and Borders. Also involved are NES, NHS HR Directors, RCGP Scotland and Rural GP Association. They are now looking for assistance from the rural health community in Scotland……

The SRMC Programme Board have agreed that the programme will work in the six project areas outlined above and are looking for the following people to support this work:

  • A Programme Clinical Lead which will be funded 2 PAs (0.2 WTE) per week towards backfill for the post holder and will work across the whole Programme.
  • Project Leads for Project 2* (Rural GP Recruitment Yearly Wheel), Project 3* (Rural GP Marketing Resources) and Project 6* (Rural GP Recruitment Support). More details about these individual projects are available in Appendix 1 in the linked document below. They would be particularly interested to hear from HR Managers or Practice Managers.
  • Project Team Members for all projects. They would be particularly interested to hear from HR Managers or Practice Managers.

Please note your interest by Monday 22nd May 2017.

To find out more about these opportunities please contact either:

Download more information here (PDF)
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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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AProf Bruce Chater on Dr MacLeod and #ruralwonca

Today RuralGP.com highlighted the tribute speech given by Associate Prof Bruce Chater to the life and work of Dr John MacLeod of Lochmaddy in Scotland.

I was delighted to catch up with Prof Chater after his speech, to ask him more about Dr MacLeod’s work with Rural WONCA, how the WONCA Working Party for Rural Practice is progressing, and also for some advice to younger rural doctors on how to effect change in their own communities.

You can listen to the recording below…

 

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The legend of Dr John MacLeod remembered at #ruralwonca

Today’s #ruralwonca programme includes a keynote delivered by Associate Professor Bruce Chater: the Dr John MacLeod Oration.

Dr MacLeod was a legend in the world of WONCA and an inspirational rural GP.  I regret that I never had the opportunity to meet him; my own career in rural practice was just starting when he died and whilst a student experience in the Hebrides (Stornoway) was an inspiring part of my own interest in rural practice,  my travels didn’t take me to Lochmaddy.  I was running the RuralGP.com site at the time of his death, however, and you can read more about Dr MacLeod in the obituary, eulogy and tribute that were published at the time by Dr James Douglas and Dr John Wynn-Jones.

His legacy in the WONCA World Working Party on Rural Practice is evident, and I’m looking forward to hearing more from Prof Chater’s perspective in his keynote today.

Dr Sarah Chalmers

In the last few days I also met Sarah Chalmers.  When Sarah was a medical student, she experienced an elective with Dr MacLeod and I was delighted to be able to ask her more about her experience in this podcast.  Coincidentally, she had arranged another elective which had fallen through, and it was a chance conversation at a student event with Prof Chater which led to him emailing Dr MacLeod and thus the elective was set up in Lochmaddy instead!

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