Rethinking Education: Enhancing Education for Remote, Rural & Island General Practitioners Pam Nicoll, Programme Director, RRHEAL , NHS Education for Scotland Dr Charlie Siderfin, General Practitioner, Isles Network of Care NHS Orkney / GP Associate Advisor, NES

Rural GP VC Education Network The Rural GP VC Education Network was established by RRHEAL as a test for change and to share good practice and CPD amongst remote and rural practitioners in Scotland. In collaboration with Rural GP colleagues, RRHEAL designed, co-ordinated and delivered an initial series of three networked sessions from September 2015 to January 2016. the Network’s primary purpose should be the delivery of high quality education for rural practitioners, with a clear focus on making a difference to practice. The sessions should stimulate discussion and collaboration with regard to the development and delivery of primary care services in remote, rural and Island areas across Scotland with an emphasis on gathering information, identifying where things have gone particularly well, and sharing those ideas amongst fellow rural practitioners. The use of VC allows participants the benefit of group networking without having to travel vast distances and physically be in the same place. However, in order to maintain manageability and bearing in mind bandwidth challenges in some remote and rural areas, it may become testing to honour the volume of requests for VC linked sites in the future. Other modes of engagement and web conferencing options may need to be considered.

Content, delivery and structure Four at distance clinical, meet-up sessions using VC and ‘Jabber’ (a desktop VC application) enabling a wide range of participants to join . The sessions were designed to focus on selected ‘hot rural practice topics’ enabling rural practitioners to link up, share evidence-based presentations, facilitated discussion and consider applications to clinical practice. Sessions focused on: 1. A Rural Proofed Acute Coronary Syndrome Pathway 2. Major Trauma Suicide Prevention/Mental Health and Psychiatry over the internet Managing frailty in remote and rural settings - ideas for the challenges ahead The sessions were co-ordinated and supported by RRHEAL staff and facilitated by a GP with experience and expertise in VC facilitation.

A total of 47 individuals participated in the three sessions A total of 47 individuals participated in the three sessions. Four people participated in all three sessions, twelve in two sessions and twenty-nine in one session. Although this Network was initially targeted at rural GPs, other rural practitioners attended the sessions. Of the 43 participants whose profession was known, the largest proportion were GPs (56%; n=23), 14% (n=6) other medical staff, 7% (n=3) medical students and 23% (n=10) advanced nursing or AHP practitioners. (Figure 7)

k Feedback 90%) n=18) of the session participants rated the VC facilitation as ‘excellent’ or ‘good’ all (n=23) rated their overall experience of engaging in the session by VC as ‘excellent’ or ‘good’. knowledge was ‘significantly improved’ or ‘improved’ for the vast majority of participants (95%-100%) most (87%; n=13) found the length of the sessions to be about right. only 33% (n=5) of participants reviewed the content prior to the session pre-administration, presentation and content was rated as ‘excellent’ or ‘good’ by most (91%-100%) 45% (n=5) thought the interval between sessions was about right, with an equal number considering the interval too long most (91%) of the session participants rated the timing of the sessions as ‘excellent’ or ‘good ‘and in the final survey The ‘pilot’ sessions were very well received and there is widespread support for continuing the Network which evaluation reveals should be open to all remote, rural and Island practitioners, in particular, those such as advanced nurse and AHP practitioners who have clinical responsibility for patients in isolated or remote areas. There was consensus that the Network should be facilitated and administered by RRHEAL/ NES. Respondents agreed that the Network’s primary purpose should be the delivery of high quality education for rural practitioners, with a clear focus on making a difference to practice. The sessions should stimulate discussion and collaboration with regard to the development and delivery of primary care services in remote, rural and Island areas across Scotland with an emphasis on gathering information, identifying where things have gone particularly well, and sharing those ideas amongst fellow rural practitioners. The use of VC allows participants the benefit of group networking without having to travel vast distances and physically be in the same place. However, in order to maintain manageability and bearing in mind bandwidth challenges in some remote and rural areas, it may become testing to honour the volume of requests for VC linked sites in the future. Other modes of engagement and web conferencing options may need to be considered. The consensus appeared to be that participants would value an ongoing discussion forum which would need to be moderated. But there was also concern it may complicate matters and there was much to be gained from keeping things simple. (50% (n=7) indicated that they would be prepared to travel to link in to future sessions 53% (n=8) of participants linked in via VC from a local hospital site

A full evaluation and further information on the GP VC education series can be found at www.rrheal.scot.nhs.uk