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Sustaining General Practice in Challenging Environments

Sustaining General Practice in Challenging Environments. Remote and Rural Perspective By Dr Susan Taylor. Remote and Rural General Practice is Different. Historical Background Innovative Solutions may help urban problems Remote and Rural Medicine is a speciality. Recent Publications.

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Sustaining General Practice in Challenging Environments

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  1. Sustaining General Practice in Challenging Environments Remote and Rural Perspective By Dr Susan Taylor

  2. Remote and Rural General Practice is Different • Historical Background • Innovative Solutions may help urban problems • Remote and Rural Medicine is a speciality

  3. Recent Publications • BMA – Healthcare in a Rural Setting • Building and Health Service Fit for the Future (Professor David Kerr) • Delivering for Health – Scottish Executive 2005

  4. Centre for Rural Health – www.abdn.ac.uk/crh • Clinical Peripherality Index – from 0-100 • Based on :- • Population Density • Something • Drive time to Consultant hospital • Drive time to Health Board Headquarters

  5. Geography • Population Density • Generalist Skills Required • Dispensing – new Pharmacy Contract with no clear plan for Dispensing Doctors

  6. Recruitment and Retention 1 • Retain current practitioners • Stable contract • Ability to maintain skills ( BASICS, ATLS etc) • Adequate backfill staff- eg Associate GPs • OOH opt out or adequate pay and support to continue on-call • Reduce practice management burdens

  7. Recruitment and Retention 2 • Recruit New Staff • Training issues with new MMC structures • Need to target all areas of training:- Prior to medical school – support mentoring schemes to help rural pupils into Medical School • Bring medical students to remote practices • Get Remote 1y care involved with FY training • Give GP registrars access to remote General Practice • Enhance Rural Fellowship schemes for post-Registrar experience

  8. Recruitment and Retention 3 • Non GP staff • Issues around skill mix, community nursing vs practice nursing, lack of professional practice management skills, ambulance provision

  9. Contract Issues • New GMS Many remote GPs highly dependent on MPIG Minimal outside earning capacity QOF and Enhanced Service payments capitation led Dispensing Income not reliable Historical need to subsidise remote and rural populations • Salaried and Section 17 C options variable and may not be sustainable

  10. Social Issues • Increasing population in Highlands and Islands • Aging population • GPs increase stability of communities ( CRH research) • Collaberation with social services over respite care, availability of home carers, access to affordable housing

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