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

Summary of Recommendations

Our recommendations are grouped under two headings that represent common themes emerging from discussions. Refining Rural Enablers sets out recommendations to support the ongoing process of implementing Phase1 of the GP Contract, by tailoring the response to implementation challenges to fit a remote and rural context. Preparing for the Future carries across some of those ideas but also builds on the Group’s refreshed role as an ongoing forum for dialogue with rural GPs and other stakeholders in order to support any future contractual developments, including Phase 2.

Preparing for the Future

The Scottish Government and the British Medical Association should:

1. Continue to state their unequivocal commitment to maintaining the Income and Expenses Guarantee, under current contractual and funding arrangements.

2. Ensure that new terms and conditions arrangements, developed as part of Phase 2 or any further iteration of the GP Contract, clearly recognises the diversity of remote and rural general practice.

This seeks to provide a long-term sustainable footing for rural practices and their local communities. A comprehensive plan for consulting with remote and rural stakeholders on any wider contractual changes should be agreed. This must include and embrace the views of the public and the communities served.

3. Develop a set of criteria for the use of the Rural Fund, recognising and supporting the distinct role of rural GPs and multidisciplinary team members (MDTs).

4. Continue to develop a package of support for dispensing practices through the Dispensing Working Group that will protect and enhance the sustainability of Scotland’s dispensing practices.

Refining Rural Enablers

The Scottish Government in concert with all stakeholders should:

5. Establish a National Centre for Remote and Rural Health and Social Care, to foster and promote innovation and excellence within Scotland and internationally.

6. Renew efforts to make maximum use of information technology and digital connectivity in the provision of remote and rural primary care.

7. Continue to improve pressing physical infrastructure issues across remote, rural and island general practice to better support multidisciplinary working, training and education.

8. Work closely with HSCPs, territorial and national (special) Health Boards and Bodies to establish change management support and capacity for remote, rural and island communities. In turn, these endeavours should also help non-rural areas across Scotland.

9. Work together with the Scottish Rural Medicine Collaborative, to develop innovative solutions to support recruitment and retention of remote and rural GPs and broadening multi-disciplinary team workforce, at all career stages.

10. Further promotion of the recruitment of medical, nursing, pharmacy and allied health professional (AHP) students is required. This includes more opportunities for student rural replacements and support for the expansion of training practices and training opportunities in remote, rural and island areas.

11. Review the method of funding allocations to territorial Boards with significant remote and rural areas, including Island Boards, in the light of changing demographics, care needs and evolving models of care provision.

12. Ensure that there are proportionate mechanisms in place to assess and evaluate new models of care provision in remote, rural and island areas and to assimilate and disseminate best practice.

Group Members, speakers and attendees at the September 2019 Workshop