Chair Report for RGPAS 2018

Chair’s Report for RGPAS AGM – held on Friday 9th November 2018

Welcome to our annual conference! As ever, we are delighted to see RGPAS members congregate in Inverness again this year, and we hope that our programme is providing ample opportunity to access relevant clinical updates, as well as offer time to calibrate and provide/receive support and ideas from fellow RGPAS members.

This is coming to the end of my second year as RGPAS Chair. I remember taking over from long-serving chair Susan Taylor, at a time when I found it easy to be enthusiastic about rural general practice, and keen to explore ways of networking rural general practice across Scotland. A day in my consulting room, seeing patients with a wide spectrum of presentations, remains the privileged, enjoyable and satisfying work that I trained for. I hear from our members that they feel the same way.

However, it has been a difficult year for rural general practice in Scotland.

The body-blows that have been dealt to rural healthcare services, through lack of insight, perspective and a centralisation agenda, continue to cause anxiety, frustration and despondency. Reconciling the admirable strategic aspirations from projects like Realistic Medicine with the operational realities of health policy and decision-making that isn’t rural-proofed, is becoming ever harder. The disconnect between aspiration and reality is widening, and when that means local services break down, it is often the generalist rural GP who is left to pick up the pieces and do what they can. Long waits for physiotherapy and other MDT appointments, non-existent mental health services, BASICS requests to support technician-only ambulance crews (or no ambulance at all), rushed hospital discharges with subsequent patient confusion and anxiety, limited patient transfer services (including helicopters)… the go-to for patients caught in these voids is often the rural GP and the teams that they run.

I, like many rural colleagues, experience the results of this on a daily basis, with the dilemma of ‘cracking on’ with providing services or advice that remains unfunded, unrecognised, and undervalued. We do it because the fundamental privilege of being a GP – trusted, engaged, in a position to help – is not lost on us. And, because of our generalist skills and approach, we often can help. However the effectiveness (and cost-effectiveness) of rural GPing and our teams, has been devalued in the new contract, and it seems that any attempt to recognise this spectrum of generalist care has been placed on the ‘too difficult’ pile.

We presently seem to be in a position of considerable bewilderment, threat and uncertainty. This is what our members are telling us, and this is what I feel myself. The new GP contract has thrown us into a position of our work seemingly being devalued by centralised mechanisms which seem to have demonstrated a worrying lack of perspective of the healthcare needs of Scotland’s rural communities. A contract that seems to be strong on rhetorical aspiration, has failed to connect the strategic aims of policy with the operational realities of delivering realistic, cost-effective and patient-centred rural healthcare. Realistic Medicine needs realistic resource, realistic funding, realistic MDT provision and realistic use of the generalist skills on offer from rural GPs and their teams. Until we achieve a realistic contractual framework for the work we do, and the services required by our communities, we will remain in a frustrating sense of limbo.

RGPAS has raised its profile to effectively represent some of the key aspects of delivering healthcare in rural communities of Scotland. Much of this has been dependent on, frankly, amazing levels of commitment and goodwill from the RGPAS committee, supported often by RGPAS members to provide information, motivation and guidance. I wish to record my thanks to them again here, as we would not have achieved anything without this background work – the vast majority of which has been provided through goodwill and personal time.

We need to keep focussed on the opportunities to see this improved. Perhaps things will become worse before they are taken seriously, but when our Government realises the effects of devaluing rural general practice, we need to do what we can to enable a changed approach. Our patients and communities will be key to articulating our concerns and perspectives, and I’m hoping that their views will be incorporated into future design of rural health services. Already we have seen inspirational motivation from some patient representatives to explain their concerns,

including a recent petition to the Scottish Parliament Public Petitions Committee. Much thought (particularly from our committee members) went into our official response to that, such that I have attached a copy of our letter to this report. It is the most recent ‘position statement’ on our concerns that we have issued to date.

Aside from our contract concerns, the last year has seen a number of notable successes. Our 2017 annual conference was another step up in scale, mood and feedback – including an energetic student presence (with undergraduate scholarships funded via RGPAS funds). Our focus at that time was on the positives of being a rural GP in Scotland, helping to inspire the next generation, but also a focus on members’ wellbeing and mental health. Alida MacGregor (Vice Chair) set a new bar level in running sessions that were engaging, and which enabled lots of important reflection on the importance of reducing stress and anxieties in the rural GP workplace.

We have seen benefits from a more streamlined membership database via the WebCollect system. My thanks go to Malcolm Elder (Treasurer) and Isla Hislop (Membership Secretary) for their regular work on this system to update records, reconcile payments and attend to member queries. The system allows more automation of membership administration tasks, but it still requires regular maintenance and Malcolm and Isla have continued to provide this throughout the last year. Please bear with us with any occasional issues with clarifying who has paid, and who has current subscriptions – it can be an onerous task to sort, particularly with our increased membership numbers – and your assistance with this is very much appreciated.

Committee meetings have been enabled by ongoing use of GoToMeeting to connect us all by videoconference. There have been several points of the year when it has been incredibly stimulating to realise that we have good representation from across Scottish rural practice, and to see committee members linked together from Hillswick in Shetland, to Arran, Carradale, Benbecula, Inverness and beyond. The process of recording minutes from these meetings has been subject of welcome review by Kate Dawson and Susan Bowie, and their work is greatly appreciated.

Representation to a number of key developments has been both invited and provided by committee members. Douglas Deans has engaged on a very regular basis in the set up of the new Faculty of Remote & Rural Healthcare, and we will receive an update on the progress of this new establishment at our AGM. Kate Dawson has provided RGPAS representation to the Scottish Rural Medicine Collaborative, and it is clear that her insight, energy and tenacity for identifying positive ways forward has been a welcome addition to the SRMC Board. Much support and sounding-board advice continues to be provided from all committee members. Alida MacGregor has been a hugely supportive Vice-Chair, and Richard Weekes and Phil Wilson have brought specific and valued input from their military and research backgrounds.

Jim Finlayson continues to administrate our chatline – a key feature of RGPAS Membership, and I’m grateful for his ongoing maintenance of this.

The future

There is plenty going on. As a members’ organisation we must remain focussed on what will offer our members most support and benefit from the activities we do. This year will see some inevitable changes to the committee and leadership to drive forward RGPAS engagement over the next year. I will be stepping down as chair, and a number of other committee members also feel that they have served their time, or are keen for new blood to take over their roles.

Please give serious thought as to whether you can assist with RGPAS committee roles and work. The roles can be as engaged or light as the committee wishes. The central purpose of RGPAS is to connect and support its members, and I look forward to seeing how this aim is achieved with whatever direction RGPAS goes in next.

Thank you for the opportunity to take the helm of RGPAS for the last 2 years. It is time for me to step back from that, but I will continue to support RGPAS in whatever ways I can – there are many good people in RGPAS who continue to offer inspiration, advice and counsel despite current challenges and concerns. It remains a privilege to be a rural GP in Scotland, and to be associated with others who identify similar satisfaction and privilege from rural GP work.

Dr David Hogg. 8th November 2018.

Link to the Scottish Parliament Public Petitions Committee page – including RGPAS responses to the concerns about implementation of the new GP contract in rural areas.