Working Patterns in Remote & Rural Scotland Prof John Duncan VP RCSEd Consultant Surgeon Director of Teaching University of Aberdeen Raigmore Hospital INVERNESS

Geography Rural General Hospitals Elements of the service Curriculum solutions

NHS Scotland Scotland 14 Terrestrial Boards Moving to integrated health & social care ? Reduction in Board numbers

NHS Highland

20% of the population live in 94% of the land mass Scottish Government Urban Rural Classification 20% of the population live in 94% of the land mass Very remote rural

Present Situation (Gen Surgery) Hospital Establishment In Post Wick 3 1 Fort William 3 3 ? Oban 3 2 Shetland 3 3 Orkney 3 2 Western Isles 3 1

Access to Specialist Care Neurosurgery Plastics Cardiothoracic Paediatric Surgery ENT Urology Vascular (including vascular access) Oncology

Communication

Elements to Facilitate Care Communication Telemedicine “Electronic Patient Record” PACS Transportation

“Electronic Patient Record”

“Electronic Patient Record”

PACS (Picture Archive & Communication System)

Air Transfer

Transfer and Retrieval service

General Surgery Curriculum 6.10 Remote and Rural Surgery Small numbers Requires particularly good judgement and wide range of skills Maintenance of elective skills difficult. Range of surgery depends on local circumstances Accident and emergency department cover is necessary in all posts and in some posts some orthopaedic trauma and elective urology is included.

General Surgical Exam Specialities Pre 2014 Upper GI Colorectal Transplant Breast Vascular Endocrine General General Surgery of Childhood Remote & Rural

General Surgical Exam Specialities Pre 2014 Post 2014 Upper GI Colorectal Transplant Breast Vascular Endocrine General Military General Surgery of Childhood Remote & Rural

Current Supply & Demand (Annualised) Consultant Adverts CCT Graduates TOTAL 142 137 CR 34 48 UGI 28 Breast 27 29 Vascular 11 20 Transplant 6 10 Endocrine 1 General 30

Shape of Training Review (2013)

Remote & Rural Undergraduates University of Aberdeen Started 2005 10% of students in year 4 Whole of year 4 in Inverness (Remote GP attachments) Peripheral clinics Focused evening tutorials Pre hospital care course R&R options year 5 Review of outcomes Graduate Entry School (2018)

Working Patterns in Remote & Rural Scotland

Working Patterns in Remote & Rural Scotland

Case study - Wick Caithness Decreasing population Increasing elderly population Conventional model 3 Surgeons 3 Anaesthetists 3 Physicians

Case study - Wick Caithness Inability to recruit 1 Surgeon 1.5 Anaesthetists 0 Physicians All trainees removed

Case study - Wick New model Rural Practitioners Gen Surg One substantive Gen Surgeon Visiting Gen Surgeon–weekdays Acute medicine cover from Inverness

Case study - Wick New model Rural Practitioners Gen Surg One substantive Gen Surgery Visiting Gen Surgery–weekdays Acute medicine cover from Inverness Expensive