Remote and Rural General Practice Working Group minutes: March 2019

 

Attendees and apologies

Chair

Professor Sir Lewis Ritchie (LR) – Chair, Scottish Government (SG)

Present

• Naureen Ahmad (NH), Head of Primary Care Workforce, Scottish Government
• Colin Angus (CA), Chair, P3 Group, RCGP
• Andrew Buist (AB), Chair, SGPC, BMA
• Lara Cook (LC), Senior Policy Manager, Scottish Government
• Andrew Cowie (AC), Deputy Chair, SGPC
• Fiona Duff (FD), Senior Advisor, Scottish Government
• Richard Foggo (RF), Head of Primary Care Division, Scottish Government
• Liam Kearney (LK), Implementation Team Leader, Scottish Government
• Patricia Moultrie (PM) Deputy Chair, SGPC
• David Prince (DP), SGPC, BMA
• Kirsty Robinson (KB), GP, Borders
• Teja Bapuram (TB), Policy Officer, Scottish Government (Secretariat)

By Videolink

• Paul Davidson (PD), AMD, NHS Highland
• Charles Dunnett (CD), GP, NHS Dumfries & Galloway
• Pam Gowans (PG), CO, Moray HSCP
• David Hogg (DH), Vice - Chair, RGPAS
• Denise McFarlane (DM), GP, Grampian
• Joan Pollard (JP) Associate Director of Allied Health Professions, NHS Dumfries & Galloway
• Ralph Roberts (RR), Chief Executive, NHS Shetland, & Chair, SRMC
• Charlie Siderfin (CS), Medical Advisor, Scottish Government
• Emma Watson (EW), AMD (Quality Improvement), NHS Highland
• Tony Wilkinson (TW), GP, Orkney

 Apologies

• Jonathan Ball (JB), GP, Highland
• Hugh Brown (HB), GP, Ayrshire & Arran
• Joanne Jenkins (JJ) Senior Nurse, NHS Lanarkshire
• Joyce Robinson (JR), Argyll and Bute Primary Care Lead

Items and actions

Welcome and introductions

The Chair welcomed everyone to the meeting, particularly NA and LC who joined the meeting to discuss Primary Care Workforce and Rural Fund.

Note of previous meeting

(RRGPWG(19)01 – 02) 

The minute of the last meeting (11 December 2018) was approved without further comments.

Engagement And Action Tracker

(RRGPWG(19)01 – 03) 

TB went through the action log, advising of closed and carry forward actions. In addition, TB shared the engagement tracker with the group for information.  

PG provided an update on her conversations with Chief Officer colleagues on what public engagement has occurred through development of local Primary Care Improvement Plans. Chief Officers reported back that they have asked for some level of engagement, Dumfries and Galloway was highlighted as a good example. PG agreed to collate the information received and share with the Group.  

CA welcomed case studies of good practice around patient engagement becoming part of Primary Care Improvement Plans and primary care transformation.

Action: LR to meet with PG to discuss information collated from Chief Officers around public engagement.

Summary of engagement

(RRGPWG(19)01 – 04a)

LR provided a brief overview of the work the Group has done over the last year. The main points were:  

• the Group has progressed from considering the issues facing rural general practice to considering potential solutions
• the Scottish Government team have engaged with a wide range of stakeholders across rural Scotland, and keen to do more
• the Group now needed to consider its work programme for the year ahead and how it shared the excellent work underway in rural primary care across Scotland 

Case studies

(RRGPWG(19)01 – 05a and b) 

FD provided an update on the work underway to identify case studies highlighting examples of good practice in rural primary care. The main points were:

• three case studies have been provided so far: Pharmacy Anywhere in Highland, Community Links Workers in Shetland and Pharmacotherapy in Dumfries and Galloway
• further case studies have commissioned, including VTP and Community Treatment and Care Services in Western Isles and First Point of Contact Physiotherapists in Highland
• however, the team welcomed more suggestions and thoughts on where any gaps may be. It was noted that mental health in primary care and urgent care were a gap at the moment 
• CA suggested contacting Lanarkshire Health Board for their approach to Vaccinations and Community Treatment and Services. RF reiterated the importance of this learning process and suggested the search be extended to reach wider groups, particularly Chief Officers network as they should be sharing lessons learned. RR suggested SRMC can look into sharing lesson around their recruitment work 

FD proposed that these case studies would be shared on Health Improvement Scotland’s iHub. The group agreed to this approach.  

Action: SG to contact the following for case studies: 

• NHS Lanarkshire for information on their approach to VTP
• SRMC/RR for a case study on recruitment and retention work they are undertaking
• CA for a case study on community/patient engagement 

Dispensing group – update

(RRGPWG(19)01 – 06) 

FD reported that the Dispensing Group has now met twice, and have allocated funding of £501,889 from the rural fund to support dispensing practices through three initiatives, training for dispensing staff, implementation of the NSAIDs quality improvement project and funding to support the implementation of the Falsified Medicines Directive. 

The Dispensing Group website is now live.

Rural recruitment and retention

(RRGPWG(19)01 – 07)

NA was asked to provide an update on primary care workforce analysis.  

Integration Authorities were asked to provide four year forecasts for finance and workforce against the six MoU priorities (Template Cs). The paper provides an analysis of the returns and addressed whether the funding and structure is in place to ensure primary care reform takes place. 

The main points were:

• according to the returns, most Integration Authorities are on track to recruit staff within their budgets. However, it is worth noting this may be due to Integration Authorities recruiting staff within budget, rather than recruiting the number of staff required to deliver primary care reform
• work is underway with education institutes to ensure there is the capacity within the pipeline to provide workforce over the next three years
• it is important to ensure there are no unintended consequences, such as both primary and secondary care services both vying for the same staff

LR invited the group to discuss the contents of this paper and to consider what support the Rural Group can provide to local workforce planners to deliver the MoU priorities. The main discussions points were: 

• some of the members were concerned around the accuracy of the data used in the paper. NA acknowledged this and indicated that the analysis was done as an iterative process. That will develop and evolve as better data becomes available
• it was noted that the revised Primary Care Improvement Plans that will be shared April / May will provide an updated position on workforce planning

CS provided an update on ‘Rediscover the Joy of Holistic General Practice’ Campaign. The recruitment campaign has attracted many candidates and the boards will be shortlisting in coming weeks. CS stated after an evaluation of this campaign, it could be rolled out nationally.  

Rural fund – update

(RRGPWG(19)01 – 08) 

CS provided an update on how the Rural Fund has been spent in 2018/19. 

Through liaising with members of the Remote and Rural SLWG, the following themes that might benefit for further investment from the Rural Fund have been identified as:  

• implementation of the new contract and MoU
• infrastructure to support primary care redesign e.g. remote working
• understanding existing rural models of care underway in other countries
• workforce, including recruitment, retention and education 

LR thanked CS for the update. The main discussion points were: 

• concerns were raised that the potential scope of the Rural Fund might go beyond the agreed remit of the Rural Group. AB mentioned Group members were invited to note the contents of this paper, agree that the main themes set out above are ones that the Rural Fund should consider supporting, and identify any gaps, and consider specific proposals to be sent to Scottish Government to consider funding 
• AB raised his concern around the remit and continuity of the Rural Fund, and scope of the proposed ideas. AB noted that SGPC and SG will be negotiating on how to spend this Rural Fund 19/20 and has asked the Group how they thought is the best way to use this fund to prepare remote and rural practices for Phase 2 
• AB has suggested a meeting between LR, and RF to discuss the rural fund more in detail and how it can be invested to support Phase 1 in 2019/20 

Action: LR to meet with AB and RF to discuss the Rural Fund at next SG / SGPC meeting. 

Future work programme

(RRGPWG(19)01 – 09)  

Due to shortage of time, the group was unable to address this agenda item.  This will be picked up before the next meeting in June.  

AOB 

DH raised  the results of a RGPAS Survey on implementation of the new GMS contract. that was recently carried out. Two key points from the results were that members were concerned around fragmentation of care and limited availability of MDTs in rural areas. DH agreed to share further analysis of the survey once completed.  

In view of the findings, LR offered a meeting with DH and Alida McGregor, Chair, RGPAS to discuss concerns of RGPAS Members.  

Action: LR to meet with RGPAS Chair and DH to discuss survey results.  

Date of next meeting: 4th June 2019, Edinburgh. Venue TBC.