1. Smaller rural UK hospitals Ellie Pattinson NHS Employers, UK

2. 2 Rural and remote locations Nearly 1/3 of UK “predominantly rural” Approx 20% of population live in rural areas

3. 3 Some rural healthcare challenges Access Ageing population Specific healthcare needs Recruitment & cover Cost Critical mass

4. 4 Rural healthcare provision Large specialist hospitals District/Rural General Hospitals Community hospitals/satellite units Integrated community provision

5. 5 Some EWTD challenges Limited staffing resource Harder to manage variable demand Travelling time can limit direct clinical care Serious impact of SIMAP/Jaeger: Inactive time Compensatory rest

6. 6 EWTD solutions Fewer doctors in hospitals out of hours Nurse and GP-led out of hours Cross cover, extended roles Community provision & more use of ambulance Technology Transport

7. 7 Case study: Scotland Rural island healthcare GP to work 1:4 nights Supporting out of hours walk-in services and Emergency Medicine team 75% inactive SIMAP/Jaeger effect: GP cannot remain in the hub hospital with their team

8. 8 Case study: Wales District General Hospital Surgical trainee resident rota Senior doctors on standby Substantial inactive time Consultants called out at night may have to cancel planned activity next day SIMAP/Jaeger effect: cut in patient contact time, cut in training time, short-notice cancellations

9. 9 A parallel case study: England Specialised hospital Specialist cancer hospital Trainee resident rota More senior doctors on standby Substantial inactive time at night SIMAP/Jaeger effect: cut in patient contact time, cut in training time, more delayed and cancelled care Change to legislation would improve care and training whilst maintaining rest requirements

10. 10 Conclusions Rural healthcare presents special challenges Range of tailored solutions.......restricted by SIMAP/Jaeger Significant effect on patient care and doctor training EWTD changes could allow better patient care in rural areas and specialised hospitals