1. Clinical Peripherality August 2004 G M Swan, S. Selvaraj, D Godden, K.Walker

2. A study funded by RARARI, conducted by University of Aberdeen, Centre for Rural Health Aim  To identify the roles and needs of remote and rural healthcare staff - implications for training Objectives  An exploration of factors affecting service provision in remote and rural LHCCs.  A profile of the training needs of staff in a remote and rural LHCC

3. © Hugh Noble www.tartanhen.co.uk Study Area  3 LHCCs in West Highland  c7000 square miles  53 practices + 6 branch surgeries

4. Settlement size classification of study area with urban comparison SHoS Levels Level 2 Urban Level 3 Accessible Level 4-7Level 8 Very Remote Study Area5% 17%73% Inverness84%16%--

5. Methods  Practice profiles were generated  Spectrum of roles for each practice was defined  Geographic and demographic characteristics of practices explored using factor analysis  Relationship between the derived factor and roles was examined

6. Data Sources  Platform project  Census  SHOS  Scottish Neighbourhood Statistics  SIMD  Route planners  Internet  HIE, BEAR,Hitrans  Ambulance  Primary Care development units  etc

7. Generation of practice profiles

8. InvernessLochaber 400 300 200 100 0 - A & B WR SS&L Minutes Travel time from practices to nearest acute hospital

9. 400 300 200 100 0 - Inverness WR SS&L Lochaber A & B Minutes Travel time from practices to Health Board 400 300 200 100 0 -100

10. Ambulance Response data Minutes

11. Classification of practices by LHCC LHCCSingle handed More than one GP Single handed & p/t associate Practices with vacancy A & B121528 Lochaber542 WR,SS & L 38 4

12. Spectrum of Roles - Components  Minor surgery, pharmacy, hospital cover  Patients across water, temporary residents score, branch practice, shared practice, out of hours cover  Helicopter escort, GP registrar, undergrad teaching, postgraduate teaching, occupational health, police surgeon, airport duties, rescue team duties, sports team duties  Practice nurse, practice HCA, administrator, counsellor, health visitor, district/family health nurse, midwife, CPN, chiropodist, dentist

13. Correlation of Clinical Peripherality with spectrum of roles R = 0.685

14. Conclusions  Rural LHCCs are characterised by low population density and prolonged travel times to acute hospitals and educational facilities  A “Clinical Peripherality” factor has been derived from these indicators  Clinical Peripherality correlates with the spectrum of roles adopted by rural practitioners

15. December 2004 I.Hepburn G.Swan, S Selvaraj D.Godden K.Walker

17. Implications Service development Education of healthcare professionals Training and development policy

18. Recommendations  Generic training  Multiprofessional  Cross agency  Clinical training  Multidisciplinary  Multiprofessional  Rural teaching  Delivery and scheduling  E health resources  Roadshow delivery  Innovative scheduling  Allocation of resources  Linking institutional and personal objectives  Further research  Evaluation of Tele-education  Evaluation of roadshow delivery of training

19. Taking the work forwards  NES Regional working  Partnership working with North of Scotland Planning group  Multiprofessional education  Commissioning educational programmes tailored to local need  Rural proofing Elderly Care competences

20. National rural healthcare Professional and policy reports Kerr: 1 Virtual Rural Clinical School TeleTechnologies Centre Locally delivered care Unscheduled care Out of Hospital care BMA: 2 Recruitment and retention Accessibility and impact of distance Sustainability IRH: 3 Access to services/transport Primary care Community care Specialist services Hospitals Patient and public involvment

21. References 1. National Framework for Service Change, May 2005 http://www.show.scot.nhs.uk/sehd/nationalframework/Reports.htm Rural Access group report http://www.show.scot.nhs.uk/sehd/nationalframework/Documents/re moterural/Final%20Draft170505.pdf 2. Rural Health Good Practice toolkit, July 2005 http://www.ruralhealthgoodpractice.org.uk/index.php?page_name=t oolkit_menu 3. Health care in a rural setting, January 2005 http://www.bma.org.uk/ap.nsf/Content/healthcarerural/$file/rural.pdf

22. Contact details : NHS Education for Scotland Professor Gillian Needham gillian.needham:nes.scot.nhs.uk Dr Kim Walker Kim.walker@nes.nhs.scot.uk Beverley Beasant beverley.beasant@nes.scot.nhs.uk Gillian Swan gillian.swan@nes.scot.nhs.uk Centre for Rural Health, University of Aberdeen Professor David Godden www.abdn.ac.uk/crh

23. What are the differences in your health systems? What are the models of best practice that emerge? What can you learn from this debate? What single piece of wisdom can we take forward to the conference forum?