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

2. Geography Rural General Hospitals Elements of the service Curriculum solutions

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

4. NHS Highland

5. 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

6. Present Situation (Gen Surgery)
Hospital Establishment In Post
Wick
Fort William ?
Oban
Shetland
Orkney
Western Isles

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

8. Communication

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

10. “Electronic Patient Record”

11. “Electronic Patient Record”

12. PACS (Picture Archive & Communication System)

13. Air Transfer

14. Transfer and Retrieval
service

16. 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.

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

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

19. 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

20. Shape of Training Review
(2013)

22. 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)

23. Working Patterns in Remote & Rural Scotland

24. Working Patterns in Remote & Rural Scotland

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

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

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

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