Shaping the Future Together: Remote and Rural General Practice Working Group report

Chair’s Foreword

The Remote and Rural Group (the Group) was formed by Scottish Government and BMA in June 2018, to support the implementation of the new GP Contract for remote, rural and island populations. This recognises that there is no ‘one-size-fits-all’ approach to implementation. Delivering high quality general practice and primary care is a shared endeavour throughout Scotland. Colleagues who work in remote and rural areas encounter additional challenges, requiring distinct roles and contributions.

The Scottish Government and BMA agree that there is much potential value for rural communities in the policies introduced under the new Contract. In the Joint Statement, they also recognise that to support rural areas to release this potential they require tailored solutions, at national, regional and local levels.

The Group’s membership was drawn from a diverse field of expertise across rural primary care. It includes GPs, other clinicians, administrative and support staff from Health Boards and Health and Social Care Partnerships (HSCPs) working in a range of rural environments. The current Group membership, including public representation, is provided in Annex A. In line with its refreshed terms of reference (Annex B) the multidisciplinary membership of the Group will be augmented to reflect its wider remit.

We have sought to enhance our understanding of how implementation is progressing with an extensive programme of engagement. We have visited many remote, rural and island communities across Scotland to listen to the experiences of colleagues at first-hand (see Figure 1).

We witnessed and were encouraged by the distinguished work of GPs, multidisciplinary clinical teams and support staff. We saw and heard the difficulties they face, at times very stark. We also observed how they were innovating and overcoming these difficulties, working with their local communities and other care providers. Many colleagues described this as a vital aspect of remote and rural general practice. We were privileged to observe this at first-hand.

As part of our work, we also commissioned research to examine evidence of descriptors and models of remote and rural general practice and primary care, both nationally and internationally. We have engaged with and welcome the work of Health Care Improvement Scotland, the Scottish School of Primary Care and Rossall Research & Consultancy.

The new GP Contract encourages and seeks to support GPs to work more collaboratively and progressively in their efforts to support and enhance general practice, and to ensure it is fit for the future. Scotland’s rural GPs and multidisciplinary team members, in concert with HSCPs, Health Boards and communities are striving to achieve this. While transformation of primary care services is essential - it will be neither easy nor quick. This is reflected in variable progress to date in implementing Phase 1 of the GP Contract throughout Scotland. A quickening of pace is now required.

We believe that there is more the Scottish Government and BMA can do to support GPs, Health Boards and HSCPs to implement the Contract in remote, rural and island areas. The recommendations and key messages set out in this report are intended to help realise that.

The positive progress to date is welcome but there are many more miles to travel.

The Scottish Government and BMA have both agreed that the Group should no longer be considered ‘short-life’. Instead it will remain in place at least over the course of the three-year period of implementation set in motion in April 2018, with a refreshed remit to increase opportunities for the Group to offer advice. Most importantly, this applies not only to the transitional period for implementing Phase 1 of the Contract, but also to inform what comes next, as the Scottish Government and BMA undertake further joint negotiations to shape the future.

Getting right the future of general practice and primary care, the lynchpin of NHS Scotland, is of paramount importance, both for those who receive and deliver services. This needs to be done well, done with resolve and done together. We hope that this Report will help to underpin that aspiration for remote, rural and island communities throughout Scotland.

Acknowledgements

In closing, I am indebted to Group members for their ongoing commitment and support, and to all clinical, support and administrative colleagues that we have visited or spoken to during our engagement programme. The contribution and support of the public and the Royal College of General Practitioners Scotland (RCGP) Patient Partnership in Practice (P3) Group, is much appreciated. Finally, I am particularly appreciative of my support team, for their steadfast professionalism.

Lewis D Ritchie

Chair, Remote and Rural Working Group

Key Messages

• The original remit of the Remote and Rural Group (the Group) was to support implementation of the Contract in remote and rural areas. This was the basis for our initial extensive programme of engagement visits speaking to, hearing and learning from colleagues. This learning has helped to inform this report.
• The Group was formed at a time of considerable change in the national primary care landscape. Delivering primary care transformation was recognised as needing shared vision, novel relationships, effective collaboration, good communications, trust and flexibility. This should be driven by local priorities, within the context of nationally agreed principles, delivered by strong clinical and managerial leadership.
• Over time, the work of the Group has sought to assist implementation of the Contract, but also to inform future policy and contractual developments. We have sought to act as a sounding board via workshops and to directly gather views from those planning, providing and redesigning services locally in remote, rural and island communities.
• For these reasons, the Group, with the agreement of Scottish Government and the BMA, will continue to work as a forum with direct engagement of GPs, clinicians, service planners and public representatives.
• As part of its revised terms of reference (included as Annex B), the Group will, as appropriate, provide advice to the Scottish Government and BMA on remote and rural aspects of the current and future iterations of the GMS Contract, including Phase 2.