Presentation to Rural Practitioners' Association of Scotland
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Transcript of Presentation to Rural Practitioners' Association of Scotland
The last of the true generalists
RPAS Inverness 2008Dr Malcolm Ward
Rural Practice Standing Group
The Rural Practice Standing Group was founded in 1993 to raise the profile of rural medicine in the United Kingdom through education, research and the dissemination of good practice in rural health care.
RPSG• Malcolm Ward chairman
• Gordon Baird Stranraer, past RPSG chairman
• John Wynne-Jones Director Institute Rural Health
• David Johnston N.I. RCGP chairman
• Paul Kettle GP Orkney
• Iain Mungall Northumbria, past RPSG chairman
• James Moore GP Devon
• Russell Walshaw GPC
• Aidan Egleston DDA
Current activity
• Quest for a Rural Faculty
• Submission to Faculty Strategic Review
• Response to Darzi interim report 12.07
• Response to Pharmacy White Paper PWP: response to proposals for legislative change
• Response to PCF consultation
• Clinical scenarios, literary review, web site
Key features of current 2005 NHS Pharmaceutical Services Regs (England)
• Controlled locality
• 1 mile/1.6km rule for patients
• New DD applications: 1.6km distance criterion surgery to nearest pharmacy
• Existing market towns protected
• Reserved locations
• Registration of Dispensing premises
• Amalgamations
PWP proposals-EnglandChapter 4 Dispensing:options
1. No policy change
2. Empower PCTs to commission dispensing in accordance with Pharmaceutical Needs Assessments
3. Distance criteria between GP surgery and pharmacy rather than patient to pharmacy
4. As 3 but where a second pharmacy within a given distance. Dispensing practices to dispense to whole list.
5. OTCs
Problem clinical scenarios
• Psychiatric emergencies, access to mental health services, alcohol/drug services
• Transport issues for hospital lab testing• Near point testing: INR,Troponin,
Biochemistry, FBC, D-Dimer (wide variation of use)
• Variation in availability of funding (LES)• Ambulance rural response times• Social services
The uneasy “gut feeling” cases
“ The best solution to those uneasy feelings is having access to good local consultant advice and the ability to arrange investigations without the consultant having to see the patient”
Susan Taylor
Threats to rural practice
• Last of the true generalists?: GPSI, NPs, ECPs
• Darzi Polyclinics• Privatisation by stealth• Loss of MPIG• Proposals to change Pharmaceutical Regs• NICE e.g. Minor surgery• Single handed GPs: OOH, recruitment,
political attitudes
Opportunities?
• Primary Care Federations• Practice Based Commissioning/increasing
range of services: near point testing (INR, D-Dimer, GTT, auto-analyzers) minor surgery, cryotherapy, counselling, advanced ear care, insulin initiation.
• Developing the skills mix
• LIFT, PFI
• Increased use of IT, video links with 2ndry care
Why a Rural Faculty?
RPSG• No constitutional
powers• No Council
representation• Lack of funding• Lacks democratic
infrastructure
Rural Faculty• Constitutional powers• Council
representation• Funding stream• Democratic
infrastructure
= empowerment
Key issues for rural patients
• Access to services• Threats to local services posed by centralisation policies
(Darzi report) • Poor public transport • Pharmaceutical services - GP dispensing• Community hospitals• Rural deprivation /mental health• Agricultural workers Health and Safety• Minor injuries and pre-hospital care as essential (rather
than optional) practice commitments.
Key issues for rural doctors• Professional isolation fuelled by difficulty in accessing educational,
Faculty, peer group and other meetings• Difficulty in getting locum cover• Broader range of skills required and maintenance there-of• The last true generalist• Patient management dilemmas: to admit or not to admit, refer or not
to refer, all the more difficult if the nearest DGH is inaccessible.• Problem of resourcing in house services ,diseconomies of scale • Dispensing• Community hospitals• Social & family pressures stemming from the GP being a key figure
in a small community off or on duty.• Most importantly the need to have these special demands
recognised for validation and accreditation.• Managing difficult patients with unreasonable demands: no sanction
of list removal
Geographical Faculties
Bedfordshire and Hertfordshire
Cumbria
East Anglia
East Scotland
Essex
Humberside
Leicester
Mersey
Midland
North and West London
North East London
North East Scotland
North of England
North Scotland
North Wales
North Wales
North West England
Severn
Sheffield
South East Scotland
South East & South West Thames
South East Wales
South London
South West Wales
Tamar
Thames Valley
Vale of Trent
Wessex
West Scotland
Yorkshire
Strategic Faculty Review Submission
• The case for a non-geographical rural faculty
• Endorsements
• Grass root survey of opinion1. Rural list server
2. DDA web site
3. (IRH website)
Faculty Objectives
• To promote good practice
• To promote and facilitate education and research relevant to rural practice
• To promote awareness of, and seek solutions to, key problems facing rural practice: access to services, OOH, rural deprivation, diseconomy of scale, professional isolation , holiday cover etc.
Rural Faculty Modelling:ideas for the pot
• Virtual Faculty
• Regional face to face meetings
• Locally elected representatives of regions/nations to attend UK meetings ? twice a year. ? 4 regions for England,1 or 2 reps per nation/English region
• Reps elect UK chair
• Seat(s) on UK council, national councils?
• Constitution
Faculty issues
• Dual membership? Rural + geographical?
• Split funding?
Benefits for College
• Engage existing members
• Gain new members
• Morale boost
• Pilot for widening concept of non geographical faculties
Risks for College if RF refused
• Further disengagement
• Membership losses
• Fragmentation: • Independent Rural College?• Intermediate Care College?• ???
RCGP gives green light for Rural Faculty!
28
Dispensing Stats 2003
England Scotland Wales N.Ireland UK total
Dispensing
doctors 4799 301 327 27 5454
Dispensing
patients3.37 million
0.275 0.188 ? 3.833