Remote and Rural Steering Group Report

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Remote and Rural Steering Group Report

• Background
• Dewar report 1912
• Acute Services Review - Professor Sir David
  Carter
• RARARI
• Future Practice and Securing Future Practice -
  Professor Sir John Temple
• Healthcare in a Rural Setting BMA Board of
  Science
• Building a health service for the Future -
  Professor David Kerr - National Framework for
  Service Change
• Rural Access Sub-group
• Delivering for Health - SEHD

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Remote and Rural Steering Group

• The Primary Care Framework
• Rural General Hospitals
• Rural Educational Strategy
• Emergency medical Retrieval service
• Remote and Rural Training Pathways
• General Practice
• General Medicine
• General Surgery
• Anaesthesia
• 5th Workstream

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The Primary Care Framework

• Healthcare community resilience, self care and
  anticipatory care
• Organisation Extended Primary Care Team ?
  Extended Community Care Team
• Emergency Care and Out of Hours Solutions
• Range of Diagnostic Tests to be available
• Community Hospitals
• (Developing Community Hospitals A Strategy for
  Scotland 2006)

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The Primary Care Framework

• Extended Primary Care Team (EPCT)
• Encompass a partnership approach with other
  agencies
• Incorporate GP and other health and social care
  professionals
• The wider team includes ambulance paramedics and
  technicians
• Core EPCT should be co-located
• Extended Community Care Team (ECCT)
• Includes EPCT professionals from social care,
  housing, education, NHS 24 and the voluntary
  sector
• Based in a purpose built building

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The Primary Care Framework

• General Practitioners with Special Interest
  (Specialist in Primary Care)
• Training of GPs
• Community nursing and AHPs
• Community Pharmacists

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Rural General Hospitals

• Delivering for Health states that patients can
  expect that
• If they stay in remote and rural areas, the NHS
  will provide them with a core set of services in
  Rural General Hospitals

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Rural General HospitalsDefinition
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Rural General Hospitals

• Needs Assessment
• Lack of Intensive Care, low risk pregnancies,
  diagnostic capability, cancer care with
  specialised units, recruitment and retention
• Rapid appraisal
• Variation in intervention rates, wide spectrum
  of activity, variation in emergency and elective
  intervention rates, day case activity variations,
  elective intervention rates for patients with
  cancer

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Rural General Hospitals

• The RGH will have a medical workforce which is
  predominantly consultant led
• The RGH is regarded as a level 2 facility
• The RGH must be part of a network with larger
  centres this will include the development of
  obligate networks
• RGHS will network with each other to develop
  agreed evidence based protocols
• A core range of services will be provided in all
  RGHs

10
Rural General Hospitals

• Unscheduled Care
• Planned Care
• Diagnostics
• Support

11
Rural General Hospitals

• Core Medical Services - Anaesthesia, General
  Medicine, General Surgery
• Maternity - Midwife run
• Networked Medical Staff - Radiologists,
  psychiatrists and laboratory medicine
  specialists
• Visiting Services
• Other Services - Child health, mental health,
  endoscopy, imaging and laboratories

12
Rural General Hospitals

• Allied Health Profession Services
• Locally Based - Physiotherapy, occupational
  therapy, diagnostic radiography, dietetics,
  podiatry, speech and language therapy
• Visiting - Orthoptics and orthotics
• Travel to Access - Prosthetics, art therapy and
  therapeutic radiology

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Rural General Hospitals

• Diagnostic Radiographers
• Radiography Consultant/Lead Clinician/Manager
• Advanced Generalist Radiographer
• Generalist Practitioner Radiographer
• Assistant Practitioner
• Radiographic Support Worker (Generic Support
  Worker)

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Rural General Hospitals

• Allied Health Professions
• Consultant
• Professional Lead/Manager
• Specialist Practitioner
• AHPwiSI
• Advanced Generalist Practitioner
• Specialist Generalist Practitioner
• Practitioner
• Assistant Practitioner
• Support Worker

15
Rural General Hospitals

• Nursing Workforce
• Multi skilled generalist nurse
• Multi skilled generalist nurse with special
  skills
• Acute Care Nurse
• Intermediate Care Nurse
• Specialist Nurse
• Nurse led services
• Nursing Support Worker

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Rural General Hospitals

• Support Workers (Nursing and AHP)
• Rehabilitation
• Self and anticipatory care
• Health promotion
• Chronic conditions
• Short term home based nursing service
• Early supported discharge
• Young families
• Basic observations and screening

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Rural Education Strategy

• Remote and rural specific education must be
  increased
• The possibility of developing a specialist degree
  for practitioners working in remote areas should
  be explored
• The remote and rural environment should be
  recognised as a rich source for training
  opportunities
• Remote and Rural Healthcare Educational Alliance
  (RRHEAL) has been established
• Introduce education programmes which are specific
  to the needs of remote and rural practitioners
• Ensure educational programmes are accredited
• Develop robust systems that establish a critical
  mass of remote and rural learners to ensure
  viability

18
Remote and Rural Training Pathways

• Training pathways for anaesthesia, medicine,
  surgery and general practice have been drawn up
• Fifth workstream
• Information packs
• Support and advice on negative and positive
  aspects of professional living in remote and
  rural areas
• Formal networks with larger centres to facilitate
  professional development, job swapping, skill
  maintenance, professional leadership and learning
• Use of technology for professional development,
  training, networking and meetings
• Proleptic appointments

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Remote and Rural Training Pathways

• Research into the attractiveness of GPwiSI in
  remote and rural areas
• Remote and rural areas as a resource for doctors
  in training
• Adoption of the training curricula
• Implementation of MMC should not destabilise
  remote and rural systems
• A pilot study should be set up to test the hybrid
  acute medicine/general practitioner role

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Infrastructure to Support Remote and Rural
Practice

• Support networks
• Obligate these will include formally agreed
  specialist clinical links, with an obligation to
  support local delivery of care and local decision
  making within the RGH. This will be available in
  a number of core specialities on a 24/7 basis
• Lateral - between remote practices or RGHSs to
  develop agreed standards, protocols, trainiing
  and development to support and share good
  practice
• Vertical with larger more specialised centres
  to deliver specific aspects of healthcare

21
Infrastructure to Support Remote and Rural
Practice

• Quality Assurance and Governance
• Remote and rural healthcare should be judged on
  the basis of standards developed for NHS
  Scotland
• Remote and Rural Clinical Advisor
• Remote and Rural Reference Group

22
Infrastructure to Support Remote and Rural
Practice

• E-health
• The concept of utilising e-health in the remote
  and rural setting must permeate every aspect of
  service planning and delivery

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Emergency Medical Retrieval Service

• Review the existing EMRS pilot
• Recommendation to extend the pilot to the West of
  Scotland to cover 3 RGHS and 13 community
  hospitals
• Independent evaluation
• Roll out across Scotland if appropriate
• Approved by Cabinet Secretary June 2007 planned
  commencement April 2008

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