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 Historical Background Innovative Solutions may help urban problems Innovative Solutions may help urban problems Remote and Rural Medicine is a speciality Remote and Rural Medicine is a speciality

3. Recent Publications BMA – Healthcare in a Rural Setting BMA – Healthcare in a Rural Setting Building and Health Service Fit for the Future Building and Health Service Fit for the Future (Professor David Kerr) Delivering for Health – Scottish Executive 2005 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 Geography Population Density Population Density Generalist Skills Required Generalist Skills Required Dispensing – new Pharmacy Contract with no clear plan for Dispensing Doctors Dispensing – new Pharmacy Contract with no clear plan for Dispensing Doctors

6. Recruitment and Retention 1 Retain current practitioners 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 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 Prior to medical school – support mentoring schemes to help rural pupils into Medical School 2 Bring medical students to remote practices 3 Get Remote 1y care involved with FY training 4 Give GP registrars access to remote General Practice 5 Enhance Rural Fellowship schemes for post-Registrar experience experience

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

9. Contract Issues New GMS 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 Salaried and Section 17 C options variable and may not be sustainable

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