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

Annex C - Rural Fund Allocation 2019/20

Dispensing Fund

1. The Scottish Government invested £301,080 for territorial Health Boards to support GP dispensing practices.

2. As part of the 2018 GP Contract Offer, the Scottish Government committed to establish a short life working group to consider the current dispensing arrangements for practices in Scotland and look for mutually beneficial improvements. Consequently, £300,000 is being allocated in 2019/20 to support dispensing GP Practices. This money has been allocated solely to the Health Boards which have dispensing GP Practices, in relation to how many dispensing practices each Health Board has.

3. This funding is to be used to support Dispensing Staff Training and implement the Falsified Medicines Directive.

4. Additional training is available through the Buttercups Dispensing Course to assist practice staff working in dispensing practices. Funding will be made available for dispensing staff to register for the Buttercups training course in 2019-20. This funding will be backdated to 1 April 2019 for those practices whose staff have already undertaken or applied to undertake the training in 2019/20.

5. The European Parliament and the Council of the European Union adopted the Falsified Medicines Directive in 2011. In 2019, the full requirements will be implemented. The directive is designed to protect patients and the supply chain from counterfeit medicines. Meeting the requirements of this directive will require practices to obtain Dispensing IT software. This allocation includes funding of £2,000 for each practice to help meet the requirements of the directive.

6. The allocation for NHS Highland, includes an additional £1080 for development of National Guidance for Dispensing Doctors.

PHEC Reimbursement Fund

7. The Pre-Hospital Emergency Care (PHEC) Fund of £100,000 was set up to reimburse remote and rural GP Practices for having GPs and practice employed practitioners (with BASICS training) on call for their expertise in an event of emergency near them. This fund will begin on 1 January 2020 and will cover claims made until 31 March 2020.

8. This is intended to clearly recognise the distinct additional pre-hospital emergency response skills required by rural GPs and clinicians, and to encourage remote and rural GPs and practitioners to provide high quality pre-hospital emergency care to a recognised standard. This will help develop a comprehensive co-ordinated network of trained and equipped BASICS Responders across remote and rural Scotland.

9. Currently, there is no standard national payment to rural GPs and practices for providing a pre-hospital emergency response, except for those in North Highland and the Western Isles. GPs in other rural areas do it as a voluntary part of their rural GP role and receive no additional funding for it. Therefore, we propose to reimburse remote and rural GP Practices for having GPs and practice employed practitioners (with BASICS training) on call for their expertise in an event of emergency near them.

Change Management

10. The GP Contract is a substantial reform programme that requires some services to be delivered differently. In some cases, these will be moved out of general practice into community settings and the primary care workforce will adopt expanded and enhanced roles. A fund of £117,252 was set up to assist the three island Health Board/HSCPs with administrative/project management support required to implement the GP Contract and MoU.

11. Health and Social Care Partnerships (HSCPs) as commissioners of primary care services should have resources to put in place to implement the contract.

12. In some cases, project management support is funded out of the Primary Care Improvement Fund (PCIF) to implement the Contract although this has not been the case uniformly, especially for smaller boards.

13. Therefore, a fund of £117,252 is set up to directly support the three island Health Board/HSCPs with administrative/project management or quality improvement support required to implement the GP Contract. NHS Orkney, Shetland and Western Isles are each allocated £39,804.

IT Support Package

14. In 2019/20, investment of £3,085 million is being made available for Health Boards to improve IT infrastructure within GP Practices. The main purpose of this investment is to improve the basic infrastructure, such as hardware and software, used by GP practice and multi-disciplinary team staff and to enable the development of the services set out in the MoU and the subsequent Primary Care Improvement Plans developed by HSCPs and Local Medical Committees.

15. To address the issue of smaller, rural Health Boards being unable to make the same improvements as larger Boards, we are allocating an additional £200,000 from the Rural Fund. NHS Borders, Dumfries and Galloway, Highland, Orkney, Shetland and Western Isles will receive funding on this basis.

16. A further £200,000 from the Primary Care Rural Fund is being allocated to Health Boards to support the deployment of Attend Anywhere (NHS near me) to remote and rural practices. ‘Attend Anywhere’ is increasingly being seen as viable tool to support GP practices and the wider multi-disciplinary team and the development of primary care services in rural areas.

17. This funding is to assist with the deployment of Attend Anywhere to remote and rural general practices.

18. NHS Ayrshire and Arran, Borders, Dumfries and Galloway, Grampian, Highland, Orkney, Shetland, Tayside and Western Isles will each receive £22,000 for the deployment of Attend Anywhere.

19. The Scottish Government invested an additional £400,000 to support wider IT improvements and the deployment of Attend Anywhere (NHS near me) to remote, rural and island GP practices. This funding has been allocated as part of the Primary Care Digital Improvement letter of 12 September 2019 issued to eHealth leads.

20. The Scottish Government is allocating £342,218 to NHS Highland to support the Scottish Rural Medicine Collaborative. This funding has been allocated as part of the Primary Care Fund: GP Recruitment and Retention 2019/20.

Rediscover the Joy

21. The Scottish Government allocated £69,450 to NHS Shetland to support the Rediscover the Joy in General Practice Project.

22. The Scottish Rural Medicine Collaborative (SRMC) project ‘Rediscover the Joy of General Practice’ was successful in recruiting 33 GPs to its first Rural GP Support Team in 2019. When asked about what attracted them, applicants cited the project’s clear aims and vision, the emphasis on values, supportive teamwork, flexible working structures and collaboration across 4 Health Boards to address rural recruitment. The provision of training and a unified system for pre hospital emergency care provision allowed experienced urban GPs to consider working in rural and remote areas. SRMC will continue to work collaboratively with other organisations and stakeholders to achieve this.

Recruitment and Retention Support

23. The Scottish Government allocated £200,000 to support Rural Relocation expenses, and £400,000 to fund Golden Hellos as set out in the Statement of Financial Entitlement. These initiatives will help address workforce challenges across remote, rural and island general practice. This funding was allocated as part of the Primary Medical Services (Revenue) Allocations for 2019-20.

Breakdown of Overall Rural Fund ­Expenditure* – 2019-20

NHS Board	Dispensing Fund	PHEC Reimbursement Fund	Change Management Fund	Rediscover the Joy	Scottish Rural Medical Collaborative	Relocation Package and Golden Hello	Rural IT top up	Attend Anywhere	Total
Ayrshire & Arran	£9,890	£5,505				£34,000		£22,222	£71,617
Borders	£9,890	£1,835				£11,000	£30,000	£22,222	£74,945
Dumfries & Galloway	£39,560	£5,505				£34,000	£30,000	£22,222	£131,287
Fife	£3,297								£3,297
Forth Valley	£3,297					£8,000			£11,297
Grampian	£26,374	£8,257				£61,000		£22,222	£117,853
Greater Glasgow & Clyde	£3,297								£3,297
Highland	£136,245	£56,881			£342,218	£300,000	£50,000	£22,222	£907,566
Lanarkshire	£3,297					£4,000			£7,297
Lothian						£15,000			£15,000
Orkney	£9,890	£3,670	£39,084			£27,000	£30,000	£22,222	£131,866
Shetland	£26,374	£8,257	£39,084	£69,450		£38,000	£30,000	£22,222	£233,387
Tayside	£3,297	£3,670				£34,000		£22,222	£63,188
Western Isles	£26,374	£6,422	£39,084			£34,000	£30,000	£22,222	£158,102
Total	£301,080	£100,000	£117,252	£69,450	£342,218	£600,000	£200,000	£199,998	£1,929,998

*Figures in table are rounded to nearest pound

£10,000 is spent on Dr David Heaney Review

A grant of £40,000 is awarded to BASICS Scotland

£20,002 is set aside for expenses of the Remote and Rural Working Group

Including above expenditure, Primary Care Rural Fund totals to £2 million.