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Sir Lewis Ritchie Chair Remote and Rural General Practice Working Group

PE1845/S - Agency to advocate for the healthcare needs of rural Scotland

Thank you for asking my views on the above petition, as Chair of the Remote and Rural General Practice Working Group (the Group).

The Group was established in April 2018 to facilitate the introduction of the 2018 General Medical Services Contract in remote and rural areas in Scotland. As part of the work of the Group, a report was published in January 2020 on the Scottish Government website: Shaping the Future Together. The report describes the workings and progress of the Group to end December 2019 and contains ten recommendations for future priorities. The recommendations were accepted in full by the previous Cabinet Secretary for Health and Sport and former MSP, Ms Jeane Freeman OBE.

One of the recommendations in the report was that the Scottish Government should establish a National Centre of Excellence for Remote and Rural Health and Social Care, to foster and promote innovation and excellence in Scotland and internationally. For your convenience, I attach an Annex which sets out the specific recommendation and its rationale.

This delivery of such a Centre was included in the Rural Section of the SNP 2021 Manifesto for Government: Scotland’s Future, Scotland’s Choice.

The work of the Group and deliberations about the desirability of a National Remote and Rural Centre of Excellence was also flagged in the National Plan for Scotland’s Islands, published in December 2019.

Progress: I am aware that Scottish Government officials are presently working on defining the nature and scope of the Centre, in order to bring this Scottish Government commitment to fruition, as soon as practicable. Part of this work will be examining the potential role of a Rural Health Commissioner which has been successfully established in Australia for some years.

Summary: In relation to Petition PE1845, there are potential synergies in relation to the planned National Centre of Excellence for Remote and Rural Health and Social Care, including consideration of the potential role of a Rural Health Commissioner. I hope that you and your committee members will find this response and context helpful for your future deliberations. Please let me know if I can be of further assistance.

Annex

Shaping the Future Together – Report of the Report of the General Practice Remote and Rural Group – January 2020

Recommendation 5

The Scottish Government should establish a National Centre for Excellence for Remote and Rural Health and Social Care to foster and promote innovation and excellence in Scotland and internationally

Rationale

The time is right to support not only general practice, primary care and clinical practice in Community Hospitals and Rural General Hospitals, but also the wider project of health and social care integration by creating a National Centre for Remote and Rural Health and Social Care. The Centre should serve as a platform for inter-professional sharing that should promote and foster rural innovation both nationally and internationally. The Centre should be developed to deliver against a number of priorities:

• To be a multiplier for rural innovation - It should provide strategy and leadership for stakeholders working to improve remote and rural health and social care for patients and service providers. It should cover a broad range of fields including care quality, quality improvement and assurance, health and social care integration, recruitment and retention, training and education of clinicians, and e-health, digital technologies and telehealth care. Its role should support linking individuals and groups to develop and deliver collaborative projects and distil lessons to allow application of the learning to other areas of Scotland – rural and urban - and to deliver models at scale.

• To spread and contribute to Scotland’s Rural Healthcare story using data to show that our rural clinicians and service providers are exemplars - It should coordinate with groups such as the Primary Care Evidence Collaborative, the Remote and Rural Healthcare Alliance (RRHEAL) and the Scottish Rural Health Partnership (SRHP), to utilise the growing evidence base of innovation in remote and rural settings, explore projects to address unwarranted clinical variation in rural areas, and provide intelligence driven evaluations and recommendations to the Scottish Government and other stakeholders.

• To lead on promoting Scotland’s Rural Healthcare on a national and global stage - It should transform this work into a platform for engagement with regional, national and international stakeholder networks to promote Scotland’s success in delivering high quality healthcare. In collaboration with Universities, other academic and research groups such as the Scottish School of Primary Care, the nascent Faculty of Remote Rural and Humanitarian Healthcare of the Royal College of Surgeons of Edinburgh and others. It should help build networks that gather and disseminate the learning from other countries with successful rural healthcare delivery models.

The Centre should support delivery of a stronger response to the concerns of stakeholders in rural primary care and rural communities. The Centre should be developed in line with the Scottish Government’s National Performance Framework vision for Health and use evidence intelligently to continuously improve and challenge existing healthcare models and have a focus on resolving needs in order to achieve positive health, care and wellbeing outcomes.

This approach is supported by studies commissioned by the Rural Group to compare current models of MDT working in rural primary care provision in a range of developed countries. Health Improvement Scotland carried out a rapid review that indicated there is much value in further study of international solutions to delivering primary care services in remote, rural and island communities. The Group also commissioned research from Rossall Research & Consultancy, led by Dr David Heaney to identify and compare current models of multi-disciplinary team working in rural primary care provision in a range of countries. The research comprised 20 interviews of healthcare experts across 8 countries. Dr Heaney’s work concluded that the culture and context of rural communities has motivated innovation in health service delivery across the world.

That report and the additional work undertaken by the Scottish School of Primary Care (SSPC) and Healthcare Improvement Scotland (HIS), is available on-line via links in the report: Shaping the Future Together.

Additional Notes:

The work of the Remote and Rural General Practice Working Group was substantially curtailed by the Covid-19 Pandemic but has since been restarted, the last meeting taking place on 22 September 2021. Further information is available on the Remote and Rural General Practice Working Group website.