Remote and Rural General Practice Working Group minutes: September 2018

Attendees and apologies

Chair

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

Present

• Colin Angus (CA), Chair, P3 Group RCGP
• Andrew Buist (AB), Chair, SGPC, BMA
• Jonathan Ball (JB), GP, Highland
• Andrew Cowie (AC), SGPC, Deputy Chair
• Fiona Duff (FD), Senior Rural Advisor, Scottish Government
• Richard Foggo (RF), Deputy Director and Head of Primary Care Division, Scottish Government
• Kath Jones (KJ), Associate Medical Director, North Highland HSCP, NHS Highland (on behalf of Paul Davidson)
• Denise McFarlane (DM), GP, Grampian
• David Prince (DP), SGPC, BMA
• Joyce Robinson (JR), Argyll and Bute Primary Care Lead
• Martine Scott (MS), Programme Manager, Scottish Rural Medicine Collaborative
• Emma Watson (EW), Senior Medical Advisor, Health Workforce, Scottish Government
• Chris Williams, RCGP Scotland

By Videolink

• Hugh Brown (HB), GP, Ayrshire & Arran
• Sean Coady (SC), Head of Primary Care, Moray HSCP (on behalf of Pam Gowans)
• Charles Dunnett (CD), GP, Dumfries & Galloway
• David Hogg (DH), Chair, RGPAS
• Ralph Roberts (RR), Chief Executive, NHS Shetland, & Chair Scottish Rural Medicine Collaborative
• Charlie Siderfin (CS), Medical Advisor, Scottish Government
• Tony Wilkinson (TW), GP, Orkney
• Brian Michie (BM), GP, Western Isles

Apologies

• Kirsty Robinson (KB), GP, Borders
• Pam Gowans (PG), CO, Moray HSCP
• Paul Davidson (PD), AMD, NHS Highland

Secretariat

Joseph McKeown (JM), Policy Manager, Primary Care Team, Scottish Government

Items and actions

Welcome and introduction

1. The Chair welcomed everyone to the meeting. The apologies list was not read. The Chair noted Paul Davidson’s absence due to his recent accident and all group shared the Chair’s best wishes for him and his family while he recovers.

Note of previous meeting

• Paper – RRGPWG(18)02 – 02

2. The minutes of the last meeting (12 June 2018) was approved.

Action Tracker

• Paper – RRGPWG(18)02 – 03

3. Item 6 -  AB will not be able to attend provisional next meeting on 6 December 2018. The Scottish Government will look to quickly revise that date as soon as possible. (ACTION)

Terms of Reference

• Paper – RRGPWG(18)02 – 04

4. The Chair led a discussion on the terms of reference. A small number of minor corrective amendments were raised and agreed. AB proposed that the exclusions section should clarify that discussion of ‘national contracts’ specifically are excluded. The following points were raised during the discussion:

• that the terms should clarify that there is an expectation that the group will be asked to comment on relevant rural aspects of Phase 2. The Chair agreed and an action noted to include a form of words to that effect
• DH raised that implementation of Phase 1 should be the priority for the group. The Chair agreed it is important for the group to prioritise its work appropriately
• the group agreed that it is important that AB attend all future meetings as far as practicably possible, to support the function of the group as a sounding board for rural contractual issues
• the group discussed its potential role in clarifying the definition of ‘remote and rural’ general practice. New national definitions would require academic and technical work that the group itself would have to commission but could not deliver itself. This would cause significant delay to the group’s work. DH noted that Rural GPs have evolved into a fragile eco system and the group needs to agree on a definition – ISD definition would suit RGPAS. DH also proposed that the RGPAS map with red/green dots showing difference practice funding should be included in scope of definitions. A precise definition would reduce local flexibility to adapt to local circumstances and limit practices who can benefit from the contract
• the National Oversight Group will make a first assessment of PCIPs plans when it next meets in September 2018, and the rural group can consider that assessment at its next meeting (ACTION)
• the group agreed to consider issues on a case by case basis was preferable as it would provide, reassurance around flexibility of implementation

Communications Plan

• Paper - RRGPWG(18)02 – 05

5. JM introduced this item. A small number of amendments were raised and agreed:

• the group agreed a policy of proactive release. The presumption will be that a paper can be shared publicly unless the paper is marked as official sensitive
• the Secretariat will add the VOICE toolkit to the paper, which is a well-established patient engagement tool (ACTION)
• CA agreed to develop a paper for discussion at the next meeting how Health and Social Care Partnerships could engage with patients around redesigned service delivery (ACTION)

Engagement Tracker

• Paper – RRGPWG(18)02 – 06

6. JM introduced this item. The Chair updated the group as to the visits he has undertaken since the tracker was circulated:

• the Chair has been very heartened by visible clinical commitment, professionalism, and joy, of teams working under difficult circumstances. He also noted that he had seen visible stress, and heard worry, about present circumstances and uncertainty about the future
• the Chair asked the SG and SGPC representatives to consider how best to reasonably diminish uncertainty of the future around Phase 2. FD agreed that while visits showed MDT working was welcomed there was uncertainty about how and when it would be delivered, and uncertainty about the future, particularly moving into Phase 2 was a key issue
• the group noted that the contract is in the first six months of a three-year journey and there are difficulties everywhere, but also solutions

Risk Register

• Paper – RRGPWG(18)02 – 07 

7. JM introduced this item. The Chair asked group to reflect on the paper in terms of completeness and mitigation factors and offer suggestions by correspondence in time to be included for the next meeting in December (ACTION)

8. The group agreed to invite representatives of the wider multidisciplinary team into the group (ACTION)

Scottish Rural Medicine Collaborative (presentation)

9. RR presented a short summary of the work of the SRMC. MS delivered a further detailed presentation on the group’s work. The Chair then led a discussion and the following points were raised:

• the Chair thanked both for speaking and noted that he attended the SRMC workshop two weeks ago and was very impressed with the good work they are doing and made clear that the group would like to help SRMC to deliver it’s good work
• MS confirmed SRMC is looking at work to expose medical students to rural general practice early on in their training, and is considering doing this through its Bureau work in future. EW also described work she is taking forward through John Gillie’s undergraduate group, through the ScotGem programme, and through Longitudinal Clerkships, and through university remote and rural medical societies. The key message of this work is that student time in practices is important, and so practices need time and support to provide it
• the SRMC have also produced a proposal to support co-mentoring between  rural GPs. A discussion then followed regarding the role of this Group in considering undergraduate education and wider aspects of recruitment and retention. DH intimated that whilst undergraduate education was a very important aspect of recruitment and retention, and that this is recognised internationally, it did not fall within the remit of the Rural Group and was already being covered by workstreams of a number of other projects already. He expressed concern that the objectives and work of the SLWG might become distracted from the core purpose of implementing the new contract in rural communities. The Group agreed.  He also advised that partly in relation to increased uncertainty and workload from new contract implementation, he and his GP partners had taken the decision to withdraw from undergraduate teaching on Arran despite having an active and successful programme to date

Proposed Rural Group Work Plan

• Paper – RRGPWG(18)02 – 08

10. RF to lead a discussion on this item. RF set out the proposal for the group to gather case study examples as outlined in the paper. These examples should be coproduced by the group, and demonstrate local solutions that are within scope, and out of which might come more support from the Scottish Government or support from groups such as SRMC. The group discusses the proposal and the following points were raised:

• the group agreed the need to have a way of mapping, sharing, recording of where successful implementation is taking place. This could involve video diaries and other mediums, and be supported by evidence that it has worked
• the Chair invited the group to consider and propose, by correspondence, specific issues the group should focus on in this work. DH suggested vaccinations; pharmacotherapy; the feasibility of the multidisciplinary team; how to support a framework for dialogue between GPs and Boards to support the redesign of services, while recognising and supporting those services that only GP-led services can provide(ACTION)
• the group noted the risk of duplication of work as feasibility studies are being taken forward through PCIPs. However the group has a role in helping to identify those areas where creative solutions to challenges, and support to clear away misunderstandings
• RF confirmed that an analysis is happening with support from Chief Officers and the group will be sighted on it in the future. The Integrated workforce plan is scheduled for publication at the end of the calendar year and will include MDT workforce pipeline concerns. The Oversight group will also be looking at workforce plans in each PCIP and the Rural group can be updated on progress at the next meeting
• DH also raised whether greater use of telemedicine and telehealth care opportunities would support services such as pharmacy. FD confirm dispensing group will pick this up, AC also confirmed greater use of telemedicine is supported by BMA.

Future meetings and AOB

• Paper – RRGPWG(18)02 – 09

11. The group discussed dates of next meetings. JM led a discussion on the forward planner inviting members to suggest specific items for discussion at the December meeting. (ACTION)

Remote and Rural General Practice Working Group minutes: September 2018

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