Remote and Rural Steering Group Report

1. Remote and Rural Steering Group Report Background • Dewar report – 1912 • Acute Services Review - Professor Sir David Carter • RARARI • Future Practice and Securing Future Practice - Professor Sir John Temple • Healthcare in a Rural Setting – BMA Board of Science • Building a health service for the Future - Professor David Kerr - National Framework for Service Change • Rural Access Sub-group • Delivering for Health - SEHD

2. Remote and Rural Steering Group • The Primary Care Framework • Rural General Hospitals • Rural Educational Strategy • Emergency medical Retrieval service • Remote and Rural Training Pathways • General Practice • General Medicine • General Surgery • Anaesthesia • 5th Workstream

3. The Primary Care Framework • Healthcare – community resilience, self care and anticipatory care • Organisation – Extended Primary Care Team → Extended Community Care Team • Emergency Care and Out of Hours Solutions • Range of Diagnostic Tests to be available • Community Hospitals (Developing Community Hospitals – A Strategy for Scotland 2006)

4. The Primary Care Framework • Extended Primary Care Team (EPCT) • Encompass a partnership approach with other agencies • Incorporate GP and other health and social care professionals • The wider team includes ambulance paramedics and technicians • Core EPCT should be co-located • Extended Community Care Team (ECCT) • Includes EPCT + professionals from social care, housing, education, NHS 24 and the voluntary sector • Based in a purpose built building

5. The Primary Care Framework • General Practitioners with Special Interest (Specialist in Primary Care) • Training of GPs • Community nursing and AHPs • Community Pharmacists

6. Rural General Hospitals • Delivering for Health states that patients can expect that: “If they stay in remote and rural areas, the NHS will provide them with a core set of services in Rural General Hospitals”

7. Rural General HospitalsDefinition

8. Rural General Hospitals • Needs Assessment Lack of Intensive Care, low risk pregnancies, diagnostic capability, cancer care with specialised units, recruitment and retention • Rapid appraisal Variation in intervention rates, wide spectrum of activity, variation in emergency and elective intervention rates, day case activity variations, elective intervention rates for patients with cancer

9. Rural General Hospitals • The RGH will have a medical workforce which is predominantly consultant led • The RGH is regarded as a level 2+ facility • The RGH must be part of a network with larger centres – this will include the development of obligate networks • RGHS will network with each other to develop agreed evidence based protocols • A core range of services will be provided in all RGHs

10. Rural General Hospitals • Unscheduled Care • Planned Care • Diagnostics • Support

11. Rural General Hospitals • Core Medical Services - Anaesthesia, General Medicine, General Surgery • Maternity - Midwife run • Networked Medical Staff - Radiologists, psychiatrists and laboratory medicine specialists • Visiting Services • Other Services - Child health, mental health, endoscopy, imaging and laboratories

12. Rural General Hospitals Allied Health Profession Services Locally Based - Physiotherapy, occupational therapy, diagnostic radiography, dietetics, podiatry, speech and language therapy Visiting - Orthoptics and orthotics Travel to Access - Prosthetics, art therapy and therapeutic radiology

13. Rural General Hospitals Diagnostic Radiographers • Radiography Consultant/Lead Clinician/Manager • Advanced Generalist Radiographer • Generalist Practitioner Radiographer • Assistant Practitioner • Radiographic Support Worker (Generic Support Worker)

14. Rural General Hospitals Allied Health Professions • Consultant • Professional Lead/Manager • Specialist Practitioner • AHPwiSI • Advanced Generalist Practitioner • Specialist Generalist Practitioner • Practitioner • Assistant Practitioner • Support Worker

15. Rural General Hospitals Nursing Workforce • Multi skilled generalist nurse • Multi skilled generalist nurse with special skills • Acute Care Nurse • Intermediate Care Nurse • Specialist Nurse • Nurse led services • Nursing Support Worker

16. Rural General Hospitals Support Workers (Nursing and AHP) • Rehabilitation • Self and anticipatory care • Health promotion • Chronic conditions • Short term home based nursing service • Early supported discharge • Young families • Basic observations and screening

17. Rural Education Strategy • Remote and rural specific education must be increased • The possibility of developing a specialist degree for practitioners working in remote areas should be explored • The remote and rural environment should be recognised as a rich source for training opportunities • Remote and Rural Healthcare Educational Alliance (RRHEAL) has been established • Introduce education programmes which are specific to the needs of remote and rural practitioners • Ensure educational programmes are accredited • Develop robust systems that establish a critical mass of remote and rural learners to ensure viability

18. Remote and Rural Training Pathways • Training pathways for anaesthesia, medicine, surgery and general practice have been drawn up • Fifth workstream • Information packs • Support and advice on negative and positive aspects of professional living in remote and rural areas • Formal networks with larger centres to facilitate professional development, job swapping, skill maintenance, professional leadership and learning • Use of technology for professional development, training, networking and meetings • Proleptic appointments

19. Remote and Rural Training Pathways • Research into the attractiveness of GPwiSI in remote and rural areas • Remote and rural areas as a resource for doctors in training • Adoption of the training curricula • Implementation of MMC should not destabilise remote and rural systems • A pilot study should be set up to test the hybrid acute medicine/general practitioner role

20. Infrastructure to Support Remote and Rural Practice • Support networks • Obligate – these will include formally agreed specialist clinical links, with an obligation to support local delivery of care and local decision making within the RGH. This will be available in a number of core specialities on a 24/7 basis • Lateral - between remote practices or RGHSs to develop agreed standards, protocols, trainiing and development to support and share good practice • Vertical – with larger more specialised centres to deliver specific aspects of healthcare

21. Infrastructure to Support Remote and Rural Practice Quality Assurance and Governance • Remote and rural healthcare should be judged on the basis of standards developed for NHS Scotland • Remote and Rural Clinical Advisor • Remote and Rural Reference Group

22. Infrastructure to Support Remote and Rural Practice E-health The concept of utilising e-health in the remote and rural setting must permeate every aspect of service planning and delivery

23. Emergency Medical Retrieval Service • Review the existing EMRS pilot • Recommendation to extend the pilot to the West of Scotland to cover 3 RGHS and 13 community hospitals • Independent evaluation • Roll out across Scotland if appropriate • Approved by Cabinet Secretary June 2007 – planned commencement April 2008