1. Welsh Rural Health Plan Developing the “Rural Practitioner” role

2. Sub-group (25) LHBsLHBs WASTWAST WCVAWCVA Swansea UniversitySwansea University Coleg MenaiColeg Menai RCNRCN BMA BMA Local Authorities Local Authorities NLIAH NLIAH Institute of Rural Health Institute of Rural Health WAG WAG Deanery Deanery Distributed to LHB Directors of PCMH Discussed, amended and adopted by RHIG

3. Some fundamentals  Who is a rural health practitioner?  What are the skills needed for rural health practice?  Strategic level paper –Developing & delivering rural health care services  Model of care  Workforce development –More focussed work on role specific developments will follow (eg on Rural Medical Practice)

4. Rural Health Plan Access Integration Community Cohesion  All rural areas have different circumstances and needs  Lower numbers of staff, covering greater areas –Right person, right time, right place –Integrated teams with extended skills per person  Narrower range of services available locally  Very local sensitivity about service planning  Local engagement and “ownership” vital

5. Rural Practice Access (travel time) and Quality  Centralisation of hospital services –Cost effectiveness, critical mass, quality  Distance of travel to hospital services –Distance decay –Poor recognition of benefits of holistic rural services - enhancing patient autonomy and independence

6. Access “balance” points Advantages of local services v Advantages of centralised hospital services Every rural area is unique Each service type different Spectrum of best practice, matched to the needs of the specific rural area Mature health system will map out these balance point Complex from the centre – clear from the locality Drive by locality model in Setting the Direction

7. The “model of care” – potential developments described  Community hospitals  Doctors  Pharmacists  Nurses  Therapies  Paramedics  Nurses  Social care  Third sector  Out of hours / unscheduled care  Integrating services  Cross border matters

8. eg Community Hospital services  Primary Care  Day Hospital  Locality Clinics (E.g. Dermatology, COPD, Heart Failure, Falls Service, Palliative, GpwSI’s)  Therapists (Physiotherapy, Occupational Therapy, Speech and Language Therapy)  Podiatry, Dietetics  Renal Dialysis  Re-ablement  Rapid Response  Family Planning  Child Health Services  Mental Health Services  Third Sector  Carers Centre  Out Of Hours Services  Out-Reach Specialist Clinics  Social Services  Imaging and Diagnostics  Minor Injury Units  Dementia Care  Community Dental Services  Child and Adolescent Mental Health Services  Substance Misuse Services  In Patient Beds: Short Stay Assessment  Management of exacerbations of chronic conditions  Rehabilitation  Respite  Palliative Care  Step up/Step Down beds

9. Workforce re-design (team)  Lots of policies in place in Wales –Locally creative and innovative solutions needed for rural areas  Integrated team approach / extended roles => competency based developments (eg D4C)  Flex job plans  Matching skill mix with dispersed workforce  Developments / integration across sectors  Career progression of local staff  Exploit IT

10. Education and Professional Development (individual)  Skill development across the workforce  Formal training in IT / telemedicine  To improve recruitment & retention –Increase clinical learning placements –Address access (to training) issues

11. Rural “Medical” Education  Promotion of “Rural Medicine” –Defining and developing competencies  Specific skill sets for rural practice  A shift in generalist –specialist paradigm  Diploma in Rural Medicine  Increased placements  Undergraduate  Foundation programme  Some speciality training posts in rural areas  General Practice  VTS scheme badge’d and focussed on Rural Medicine  A reasonable proportion of Fellowships in rural areas  Considerations of the difficulties of access to Professional Development.

12. Rural “Health” Education  Strengthened collaboration NHS / Education  Increased placements in rural areas  Non-medical prescribing  Flexible educational support / mentoring  Development of lectureships (nursing, medicine & allied health) => stronger academic infrastructure for Wales

13. Welsh Rural Health Plan Delivering Rural Health Care Services