This document discusses challenges facing general practice in remote and rural environments. It notes that remote and rural general practice requires different skills than urban practice due to factors like low population density, long travel times to specialists, and responsibility for dispensing medications. The document also outlines potential strategies to improve recruitment and retention of practitioners for remote areas, such as stable contracts, support for ongoing training, exposure to rural medicine early in training, and ensuring non-physician staffing needs are met. Contract issues like over-reliance on certain pay incentives and the need to subsidize rural populations are also addressed.

1. Sustaining General Practice
in Challenging Environments
Remote and Rural Perspective
By Dr Susan Taylor

2. Remote and Rural General Practice
is Different
 Historical Background
 Innovative Solutions may help urban problems
 Remote and Rural Medicine is a speciality

3. Recent Publications
 BMA – Healthcare in a Rural Setting
 Building and Health Service Fit for the Future
(Professor David Kerr)
 Delivering for Health – Scottish Executive 2005

4. Centre for Rural Health –
www.abdn.ac.uk/crh
 Clinical Peripherality
Index – from 0-100
 Based on :-
 Population Density
 Something
 Drive time to Consultant
hospital
 Drive time to Health
Board Headquarters

5.  Geography
 Population Density
 Generalist Skills Required
 Dispensing – new Pharmacy Contract with no
clear plan for Dispensing Doctors

6. Recruitment and Retention 1
 Retain current practitioners
- Stable contract
- Ability to maintain skills ( BASICS, ATLS etc)
- Adequate backfill staff- eg Associate GPs
- OOH opt out or adequate pay and support to
continue on-call
- Reduce practice management burdens

7. Recruitment and Retention 2
 Recruit New Staff
- Training issues with new MMC structures
- Need to target all areas of training:-
Prior to medical school – support mentoring schemes
to help rural pupils into Medical School
2 Bring medical students to remote practices
3 Get Remote 1y care involved with FY training
4 Give GP registrars access to remote General Practice
5 Enhance Rural Fellowship schemes for post-Registrar
experience

8. Recruitment and Retention 3
 Non GP staff
 Issues around skill mix, community nursing vs
practice nursing, lack of professional practice
management skills, ambulance provision

9. Contract Issues
 New GMS
Many remote GPs highly dependent on MPIG
Minimal outside earning capacity
QOF and Enhanced Service payments capitation led
Dispensing Income not reliable
Historical need to subsidise remote and rural populations
 Salaried and Section 17 C options variable and may not
be sustainable

10. Social Issues
 Increasing population in Highlands and Islands
 Aging population
 GPs increase stability of communities ( CRH
research)
 Collaberation with social services over respite
care, availability of home carers, access to
affordable housing