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RGPAS18 Conference Programme announced

Click to visit www.RuralGP.scot

The Rural GP Association of Scotland (RGPAS) is pleased to issue the confirmed programme for its annual conference, due to take place on 8-10 November 2018, once again at our preferred venue of The Craigmonie Hotel in Inverness.  As ever, there may be some last-minute changes, but the following schedule looks set to go ahead.

Sandpiper Bag Checks – BASICS Scotland will be providing Sandpiper Bag equipment checks throughout the conference on Thursday and Friday – bring yours along for an easy way to find out what you’re missing and how to obtain supplies!

Revaluing Scottish Rural Practice

Thursday 8th November 2018

1330 Registration

1400 Main Conference Welcome:: Dr David Hogg & Dr Alida MacGregor

1430: Workshops 1st round

  • 1: Easing the Pain: Opportunities for regional blocks, ketamine and intranasal diamorphine (Dr Luke Regan)
  • 2: Blood Borne Viruses Workshop (Dr Lindsey Ross & colleagues)

1510: Coffee

1530: Workshops 2nd round

1615: Option 1: Planning for retirement, identifying your options– David Henderson, Medical+Dental Financial Planning Services

Option 2: Keeping a Healthy Balance in Work, Life and Play (Dr Alida MacGregor, RGPAS Vice-Chair)

1700-1800: SRMC Update (SRMC team)

1800-1900: Bar

1900 Conference Dinner

Friday 9th November

0900: A Spark of Positivity: Interface Working for Better Patient Care :: Dr Barba Chandler, Consultant Rehabilitation Medicine, Raigmore Hospital and Dr Richard Weekes, GP, Ullapool

0945: Down to Business – Where next for the contract in rural areas?

  • RGPAS AGM

1115: Coffee

1145: General Practice and Primary Care in Remote and Rural Scotland – Reflecting Back and Looking Forward :: Lewis Ritchie, Chair of the Rural Short Life Working Group

1230: Lunch

1330: How the contract will help rural practice – Andrew Buist, SGPC Chair

1400: Finding positive ways forward for rural & single-handed practice in Scotland – Group Discussion

1500: The Scottish Rural Medicine Collaborative (SRMC) Bureau Concept – How Can it Help You  (SRMC Team)

1530: Coffee

1600: Remote Educational Development at BASICS Scotland (Al MacLean, BASICS Scotland)

1630: BASICS Scotland and Responders – Update (Dr Ben Price, BASICS Scotland) – including Discussion/Questions

1730: Hotel Bar

1900 Dinner – Shapla, 2 Castle Road, Inverness, IV2 3AA (tbc)

Saturday 10th November

0930: Where next for RGPAS? Where next for rural practice?Supporting members, sustaining rural practice in Scotland (Group discussion and breakout group sessions)

1100: Walking Conversations: Making Links, Identifying Peers, Finding Momentum (A suitable walk around the hotel area will be identified, depending on weather etc.)

1230: Conference Close

 

If you wish to book lunch directly with the hotel, please contact reception staff.

As with previous years, there will be a strong focus on the conference being welcoming and convivial.  Many of our members (and non-members) come from remote and isolated practices, and RGPAS conferences place a strong emphasis on fostering informal peer support opportunities.

Unfortunately, this year we have had to curtail our usual undergraduate activity, as already highlighted in this article.  We very much regret that we cannot run the scholarships this year, but we’ve been so busy working out how to represent the concerns of our members and rural communities in relation to the new contract, that the committee don’t have the capacity this year to organise this aspect.  We very much hope that it will return in future years.

The cost of the conference is £130, and this includes a 3-course conference dinner with wine on the Thursday evening.  Accommodation can be booked directly with the Craigmonie Hotel.

We hope that the conference will showcase the ongoing innovation and potential that exists across rural Scotland, and the need for national health policy to be appropriately rural-proofed to ensure sustainability for the future of Scottish rural healthcare.

Register for RGPAS18
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RGPAS18 Conference Registration now open

Click to visit www.RuralGP.scot

The Rural GP Association of Scotland (RGPAS) is pleased to announce that registration for its annual conference is now open, following a period of priority booking for its members.

This year’s conference will take place on 8-10 November 2018, once again at our preferred venue of The Craigmonie Hotel in Inverness.

The programme will commence at 1pm on Thursday 8th November, and finish at lunchtime on Saturday 10th November.  This year will feature discussion, presentations and debate about the impact of the new Scottish GP contract on rural healthcare, as well as a number of clinical updates and opportunities for participants to catch up and relax.

As with previous years, there will be a strong focus on the conference being welcoming and convivial.  Many of our members (and non-members) come from remote and isolated practices, and RGPAS conferences place a strong emphasis on fostering informal peer support opportunities.

Unfortunately, this year we have had to curtail our usual undergraduate activity, as already highlighted in this article.  We very much regret that we cannot run the scholarships this year, but we’ve been so busy working out how to represent the concerns of our members and rural communities in relation to the new contract, that the committee don’t have the capacity this year to organise this aspect.  We very much hope that it will return in future years.

The cost of the conference is £130, and this includes a 3-course conference dinner with wine on the Thursday evening.  Accommodation can be booked directly with the Craigmonie Hotel.

What’s in the programme?

Programme details are still to be confirmed.  We are in the process of finalising speakers and the schedule, and this will be published here and notified to our members.  We are aiming for a relevant and useful mix of topics and speakers, to inform and re-energise participants – but also to reflect the anxieties and concerns of RGPAS members about the impact of the new GP Contract on rural communities, and consider effective ways forward.  We’re pleased to confirm that Prof Sir Lewis Ritchie (Chair of the Rural Short Life Working Group formed by the Scottish Government to consider implementation of the GP contract) and Dr Andrew Buist (Chair, Scottish GP Committee) will be attending.  We will also have updates from the Scottish Rural Medicine Collaborative, management of blood-borne viruses and consideration of how to recognise and maximise the delivery of Realistic Medicine in rural settings.

We hope that the conference will showcase the ongoing innovation and potential that exists across rural Scotland, and the need for national health policy to be appropriately rural-proofed to ensure sustainability for the future of Scottish rural healthcare.

Register for RGPAS18
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RGPAS Conference 2018 update

Our conference is set to go ahead on the 8-10 November 2018, in Inverness at the Craigmonie Hotel.

HOWEVER, we have regretfully had to make changes to the usual format, and we are not able to run the student scholarship scheme that has been a successful and vibrant component of past RGPAS conferences.

The RGPAS Committee has reflected on the current challenges to rural practice in Scotland.  Implementation of the new GP contract has created much extra work, anxiety and uncertainty amongst our members.  As a result, we aim to offer a programme focussing on pragmatic support and guidance to our members.

Our members and committee are busy rural GPs, and we have been stretched further by the implementation of a non-rural-proofed GP contract.  We believe that this has devalued and threatened many of the existing services and skills provided to Scotland’s communities by GP-led practice teams.  We need to consider our strategic response as an organisation and as individual members.

Booking details will be provided as soon as possible.

Click to download the report (2.6MB)

We intend to provide more detail on our current concerns in the next few weeks, including our perspective on progress with initiatives such as the rural Short Life Working Group.  Our summary document ‘Looking at the Right Map?’ remains our reference point for our ongoing concerns about the new contract.  There have, however, been additional concerns raised since that publication including:

  • the feasibility of rural multidisciplinary teams and pharmacy support
  • recognition of the workload created by seasonal spikes of temporary residents
  • the sustainability of additional services offered by rural practices
  • the safety and efficacy of the proposed vaccinations programme, which is to be provided by health boards
  • the effect of the new contract on capacity for undergraduate teaching
  • the effect of the contract on GP recruitment and retention in rural areas

In the meantime, we apologise in particular to the many students who have already contacted us with an interest in rural practice, and hope that we can offer our student scholarships again next year.

Further reading…

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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.

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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BASICS Scotland Adult Tele-education Course Starts 16th April 2018

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 16th April and run for 10 weeks with a 1-week break in June.

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:

  • Assessment Airway & ENT
  • Asthma
  • Breathlessness (LRTI/LVF)
  • Chest Pain & Thrombolysis
  • Allergy & Anaphylaxis
  • Stroke & TIA
  • Head Injury
  • Seizures
  • Wounds, Burns & Tetanus
  • Pain Relief

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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GURRMS student conference in Portree this Friday

The Glasgow University Remote & Rural Medicine Society will hold their conference this Friday and Saturday in Portree, on the Isle of Skye.

This follows a highly successful conference held by GURRMS last year on the Isle of Islay, successfully bringing together a large number of medical students from Scotland and beyond, to hear about rural practice, share thoughts and experiences, and gain a better perspective of career options for the future.

Quite incredibly, tickets were sold out for GURRMS18 within 15 minutes of them becoming available online.  Perhaps it is not so surprising, given the varied and experienced line-up of speakers they have secured for the event, along with activities both medical and social.  The blend of social and educational activities provided at GURRMS17 has also established a positive and attractive precedent for GURRMS too.

You can read through the GURRMS conference programme – just released today – from this link.  Highlights include Dr Ben Price talking about BASICS Scotland activity, Dr Luke Regan discussing ‘Why I Love My Job and You Should Too’, and Prof Phil Wilson on ‘Why Rural Doctors Need to do Research’.  I am delighted to have been asked to speak too, and will be asking ‘Rural GP – Is it what it’s Cracked Up To Be?’.

The Keynote Talk is being delivered by Profs Roger and Sarah Strasser – who are travellig from Canada and Australia as I type, to inspire the GURRMS18 students with their advice and experience from developing innovative rural health education… and the international opportunities that come with rural practice.

The conference has been supported by a number of organisations, including RGPAS, but much of the credit must fall to James and his committee of Josie, Seb, Michael, Eloise and John for all their work to bring this together.

Many students in Scotland have very little exposure to rural medicine, despite almost half of the population living in such an area. The aim of this conference is to promote this career as a viable option and to encourage those interested to go and explore what there is to offer! Here on Skye, we hope you have an authentic experience and truly get to see what rural medicine is.

My own journey was started with an elective on Arran where I learned first-hand how this path is right for me, so we hope that we can give you a glimpse of that with what will be a stimulating programme. We encourage you to get involved in discussions and make the most of the experts here, who have a wealth of experience!

James McHugh, President of GURRMS

Well done to GURRMS for putting on this event, juggling all the logistics (whilst some were sitting final exams) and providing such a brilliant showcase for Scottish and international rural health.  We might even celebrate with a Skye dram or two!

You can follow the conference on Twitter using the #GURRMS18 and #thinkrural hashtags.

Download the #GURRMS18 programme

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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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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

John

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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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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