A collaborative effort amongst clinicians to produce a module for the Practice Based Small Group Learning (PBSGL) network on the management of serious illness in children.

Now here’s a potentially controversial idea. In return for doing nightshifts, should NHS staff be entitled to an earlier retirement? This idea came to me during a 4am callout. A recent general recommendation from our accountants to check for any gaps in national insurance contributions, took me to the HMRC website. It informed me – cheerfully, I felt – that I had contributed 14 full years of national insurance, and I had another 32 to go until retirement. The 10-minute car journey to the hospital presented an opportune moment to reflect on whether this makes me feel young, or depressed. Click the link button to read more…

Case Presentation to the BASICS Scotland Conference in Carnoustie, about a prehospital BASICS callout for premature labour.

The value placed on staff development is often a useful barometer to the culture and outlook of an organisation. An engaged and valued workforce tends to be a happy, productive and effective workforce. Of course, in the NHS, numerous pressures mean that it can be difficult to achieve the Zen approach to staff happiness that big multinationals like Google and Apple are often cited as being able to achieve. However, whilst recognising the frustrations, limitations and sometimes downright atrocious decision-making to be found in our NHS, most of us still manage to find professional satisfaction with the patient contact that is part-and-parcel of daily GP-ing, fixing unwellness, reducing suffering and the privilege of fostering therapeutic rapport. Click the link button to read more…

I remember the frustration of reading this article in the BBC News back in 2014, when Scottish GPs were being criticised by Reform Scotland for not embracing online appointment booking and prescriptions. The Scottish Government was quoted as saying ‘online services are currently available to all GP practices in Scotland’ and that it was ‘continuing to work to promote and encourage practices to use these services’. As IT lead for our practice, my jaw dropped somewhat. Click the link button to read more…

According to Icelandic folklore, when scrambling over volcanic rockscape it is not uncommon to experience the sensation that you are being joined by groups of people behind you. And yet, when you turn around, no one is there. The Icelandic term for the mysterious and unseen individuals responsible for this, is Huldufolk (yes, pronounced hool-de-foke), or ‘the hidden people’. I sometimes get the same feeling when hearing promises of what the ‘wider primary care team’ will offer us in the next version of the Scottish GP contract; especially in rural areas. Click the link button to read more…

Objectives: Together with fellow GPs we want to explore aspects of  GP participation in emergency teams.  We present research on the GPs’ key contributions, how decisions are made and how leadership is enacted.  Our ambition is to strengthen the awareness of the GP’s role as a primary care emergency team member. Background: In 2010 a Norwegian study found that GPs are alerted in less than half or pre-hospital emergency incidents.  Furthermore, when alerted, the GPs choose to participate in less than half of the call-outs (Zakariassen & Hunskår 2010). White papers have called for increased GP participation in such incidents. Others, however, have questioned the utility of GP participation and suggested that patients may be better served by emergency medical technicians alone (Kindt et al 2013). Consistent with this view Norwegian GPs have reported lack of experience with common emergency procedures (Wisborg & Brattebø 2001).  However, recent focus group studies suggest that although their role may have changed, GPs still have an important role in the pre-hospital emergency incidents. (Hjortdahl et al 2014, 2016). For our workshop this will be the point of departure, as we share research and experiences relevant to the GP’s role as a team member. Based on a complete sample of emergency incidents in the island community Austevoll, Norway, Sverre Rørtveit was able to study the GP’s contribution in terms of practical skills and an overall ability to assess the seriousness of the situation.  In the municipality of Alta, Norway, Helen Brandstorp explored leadership and learning processes in team training sessions based on simulated emergency incidents. On the Island Arran on the west coast of Scotland numerous holidaymakers get injured during outdoor activities along the coast and in the high mountains.  Arran Resilience was formed to bring the coastguard, mountain rescue, police, fire and ambulance together for joint exercises, aiming to improve communication and teamwork (Hogg 2015). Session Content:  We will start with a short onsite survey regarding the GPs’ role in emergency incidents, confidence in emergency medicine procedures and whether the GP would participate in hypothetical emergency call outs. We proceed with four short presentations: – Triage during pre-hospital, emergencies – how do GPs decide? (Rørtveit) – Confidence in emergency medicine procedures among GPs (Holte-Ambjørnsen) – Leadership in the course of pre-hospital emergencies – what does it look like? (Brandstorp) – Arran Resilience: Networking island emergency responders. (Hogg) The session ends with feedback from the onsite survey, comparison with a recent survey of 1000 Norwegian GPs and a general discussion (Hjortdahl & Halvorsen).

Background Arran is an island community with finite – but committed – emergency medical resources.  Prior to October 2010 no mechanism existed for regular dialogue between emergency teams such as the ambulance, mountain rescue, coastguard and fire services.  We sought to change this with the aim of better networking and interagency training. Intervention We aimed to improve communication between team leaders, and sought to build a partnership based on four key principles: 1) Local ownership; 2) Can-do attitude; 3) Working within existing competences/frameworks; and 4) Cost neutrality. Evaluation We have now held twenty five liaison meetings.  In the initial stages we  ran eight island-wide workshops on casualty care, and until recently, organised three multi-agency exercises at very low cost.  Regular dialogue between teams has been facilities via a group email, and this has resulted in better understanding of each team’s skills and capabilities.  Our ‘Team Profiles Document’  summarises equipment, skills and personnel for each of our emergency teams, and is updated on an annual basis.  This is particularly helpful for new staff e.g. police officers to understand capabilities of the emergency teams.   We are now focussing on simulation training and refining the multi-agency response to cardiac arrest on Arran. There has been  interest in the Arran Resilience model of immediate care from other island and rural communities. In 2013 we were named the UK Resilience Team of the Year by the Emergency Planning Society Conclusion The Arran Resilience model offers a cost-neutral, easily implemented model of immediate care delivery to rural areas.  It seeks to recognise the skillbase of emergency teams, and improve co-ordination of emergency responses at high demand or in the event of a major incident or complexity.

BASICS (Scotland) provides education and support in prehospital emergency care to healthcare providers throughout remote and rural Scotland. Nationally, the organisation enables 176 healthcare providers who respond to prehospital emergency calls in their locality in support of the Scottish Ambulance Service. Given the geographical challenges faced by rural responders wishing to attend such meetings, a specific issue we faced was how to enable these meetings to be provided on a virtual platform which would allow participation in group discussion. This presentation considered the development of regular ‘virtual’ meetings whereby responders are able to discuss cases, be informed of latest service developments and obtain peer support for rural prehospital care in Scotland.

In this session, I aimed to summarise the important contribution of seminal works (such as A Fortunate Man, A Country Doctor and Single Handed), and consider how to share effective images that provide insight to the modern rural practitioner, and consider social media streams available to share this work. Find out more by searching for #RuralGPframed on twitter Learning goals:

• Derive inspiration to develop your own photography of rural practice
• Consider technical aspects of effective photo-journalism
• Consider how to share images effectively to inspire potential recruits to rural practice.

I was privileged to present data from this recent report on behalf of BASICS Scotland. ‘It is possible to provide tele-education, at scale, to rural primary care staff; this requires relevant course content, good technical support and appropriate contextual setting. Online delivery saves resource, and fits the way modern primary care practitioners are asked to work. The participants used the online supporting materials extensively, the potential benefits of this type of learning are as yet unknown, further work continues to find optimal modes of delivery, and to increase participation in live sessions.’

Presentation to the annual Scottish Trainees’ conference of the British Geriatric Society – background, case scenarios and workshop to introduce some of the challenges of providing complex care of the elderly and intermediate care in remote & rural settings.  Delivered with Deena Deans, physiotherapist at Arran War Memorial Hospital.  Lots of discussion and enthusiasm for #RealisticMedicine was evident from the participants!

Following Dr Thom O’Neill’s presentation to the RGPAS Annual Conference in November 2016, we were keen to develop factsheets and materials to assist rural GPs in Scotland develop their services and approach to LGBTQ+ patients.  Dr O’Neill was instrumental in developing the content for three resulting factsheets: LGBTQ+ Youth, Trans Youth and LGBTQ+ Elderly, with a strong emphasis on the challenges and specifics of rural communities. Since these factsheets were launched, we’ve had international interest including Canada, New Zealand and Australia, and individual practices in Scotland have reported various activities to improve local awareness of the issues highlighted in the factsheets.

This workshop was run for NHS Education for Scotland at their CPD Connect showcase event to plan future CPD strategy in Scotland.  The workshop aimed to give some perspective of the challenges of delivering CPD, some of the opportunities including recent work on videoconferencing as an enabler, and also to introduce the concept of ‘Clinical Courage’ and its place in the learning cycle.

‘A chance for some less-suspecting individuals to tell their story of inspiration derived from the generalism required from studying or working in a rural practice environment. There will be some cross-generational benefit from networking and story-sharing both during and after this workshop.’

I was invited to give evidence to the Health & Sport Committee on behalf of the Royal College of GPs Scotland, about the challenges surrounding recruitment & retention to rural areas. I joined a relatively large panel, and a lively discussion ensued.  You can watch the proceedings in the video clip attached to this entry.

Student workshop run for around 30 student participants attending the BASICS England & Wales Conference, on career considerations and opportunities for developing interests in critical, retrieval and prehospital care in Scotland.  We covered the spectrum from retrieval medicine and hospital specialty training, to rural medicine and opportunities in general practice.

In this presentation, we provided a perspective of rural prehospital care in Scotland.  We outlined the structure and function of BASICS Scotland, how this is supported by the Sandpiper Trust, and some recent work into the efficacy of videoconferencing for clinical governance purposes.

In 2016 the RCGP ran a video campaign to highlight the different roles of GPs and career options. They came to Arran to film me and some of my patients and colleagues, to give an insight into the opportunities and challenges of rural general practice. It was great fun to work with TallBoy Productions on this. https://www.youtube.com/watch?v=rZsncqLzoXQ

It’s the time of year when school pupils find out their exam grades, on which their life trajectories seem – at least at this time of year – mapped out as a result. Cue the usual debates about whether this year’s exams were more easy or difficult, and for us medic folks, whether academic prowess (as measured by our exam system) is the best means by which to initially select students for medicine. Click the link to read more…

Approximately 60 researchers with a special interest in generalism in rural medicine met in Tromsø, Northern Norway, for this mini-symposium.  The intention was to create a place to share knowledge, plans and ideas; get an overview of what is going on around the world; a chance to revisit and clarify goals; thinking of the values we really want to define; do research that captures what makes rural generalism so different & important; and finally, do some initial collaborative work. I participated in four workshops covering Clinical Courage, Telemedicine and Curriculum Development for Rural Practice.  At least two articles are in the pipeline as a result of attending this symposium, along with additional research links and new collaborative opportunities.

‘All you need now is for someone to give birth!’ And at that moment, we highlighted to Brendan – one of our elective students – that there was indeed someone in labour upstairs in our maternity suite. Click the link to read more…

I am angry. I am burnt out. I am overpaid. I am set for a gold-plated pension. I am the reason why A&Es are too busy. I am a failed specialist. Apparently, when I read the papers. There is a problem universally acknowledged that GPs have an image problem. Students are telling us this. Patients are telling us this. The media is spinning this. Click the link to read more…

Review of the WONCA Rural Medical Education Guidebook – a great resource for all clinicians involved in teaching rural and remote healthcare.

Professional isolation is a recurring issue in the delivery of rural and remote health care. However, collaboration is now more feasible with developments in technology and connectivity. At an international scale, collaboration offers clear opportunities for good ideas and great work to be shared across distances and boundaries that previously precluded this. This article reflects a presentation given to the Rethinking Remote conference in Inverness (Scotland) in May 2016. A number of factors with regard to infrastructure and engagement are considered, along with ways in which the opportunities of collaboration between individuals and large centres can be optimised. Social media and increased connectivity pave the way for easier access to great practice across international sites that share similar challenges.

This talk was given to the Rethinking Remote 2016 conference, held in Inverness on May 23-24.  I was asked (and delighted to try!) to explore some of the opportunities and challenges around international collaborative working.  We also managed to successfully conduct a live Skype discussion with Prof Phil Cotton and two of his colleagues in Rwanda. This video was taken by a team from Armchair Medical ( armchairmedical.tv ) who have kindly made this recording available for public consumption. I’ve taken a look at their other videos and would recommend having a look at what they have on offer (I have no conflict of interest).

Introduction New cloud-based services enable delivery of high quality care whether in the field or in a well-equipped city-centre hospital. Health workers can use a range of mobile devices, to suit the situation and enable flexibility. In this new ICT-enabled healthcare it is possible to reach high levels of operating efficiency without sacrificing standards of care and the experience of service users (patients). However, use of cloud services assumes that devices will have internet access where and when they are used. This degree of connectivity cannot unfortunately be taken for granted across much of Scotland´s landmass. Delivering connectivity suitable for mobile devices is not trivial in remote rural areas, however new technologies and approaches are bringing down the costs. Objectives This presentation will consider:

• Advanced services that can be delivered where connectivity allows, and the positive impact they can bring to remote communities – including remote monitoring and telecare
• The connectivity challenges faced in remote areas and the factors contributing to the issue
• Ad-hoc requirements (e.g. for a summer tourist festival or emergency incident)
• Emerging connectivity technologies, showing how a connectivity strategy could be evolved to meet remote requirements
• Examples of remote areas (including international examples) where emerging technologies enable a revolution in service delivery

Conclusions Connectivity is a vital component to allow innovative solutions to be considered in the rural environment. This workshop will explore ways in which rural connectivity can be delivered effectively, and consider some of the benefits of connected healthcare.

Background In Scotland 20% of the population live in a remote or rural area spread across 94% of the land mass that is defined as remote and rural. The Scottish Government has, in its Quality Strategy outlined the need for equitable access to high quality healthcare services for all patients regardless of personal characteristics including geographic location. NES works in partnership with territorial Health Boards and medical schools to address rural recruitment and retention through a variety of initiatives and the longest established of these is the GP Rural Fellowship, which has been in place since 2002.The current model involves co-funding arrangements between NES and participating Boards supporting a maximum of 12 fellows per year. Summary of work A survey of all previous rural fellows was undertaken in the first quarter of 2014 including all fellows that had undertaken the fellowship in the 11 academic years from 2002/03 to 2012/13. A total of 69 GPs were recruited to the fellowship in this period with a response rate of 98%. Summary of results A total of 46 graduates are working in rural areas or accessible small towns (71%), 39 in substantive general practice roles (60%). Conclusions Scotland’s GP Rural Fellowship programme is an example of successful collaboration between education and service and the results of this survey suggest that approximately three quarters of graduates are retained in important roles in rural Scotland. Take-home message Scotland´s GP Rural Fellowship is an initiative that positively impacts on rural recruitment and retention.

On why clinical guidelines need to reflect the range of expertise and time available to address health concerns, in the context of busy surgeries and patients with complex health needs.  See link to article.

Let’s stop for a second to think how much we could gain if all those involved – particularly HR departments – could work more effectively to value our future colleagues – and their partners and families – to take up positions that we are spending so much energy trying to advertise. There are of course other factors affecting the recruitment crisis within general practice, but for those who are up for the challenge – and who have recognised it as a stimulating career – we should be doing everything possible to make their move a feasible and fair prospect.  See link for article.

Presentation to Glasgow University GP Society about the attractions and challenges of rural practice.

Poor progress in harnessing advances in IT is holding back innovation and the ability to provide patients with modern health care.  See link for article.

Thinking back to my own student days, I found myself repeating advice that I had received whilst a student in Stornoway: ‘Seize every opportunity. And never lose sight of the diagnostic power contained within your patient’s story combined with sound clinical examination.’  Inspiring the next generation with generalism. See link to article.

Context:  In Scotland 20% of the population live in a remote or rural area spread across 94% of the land mass that is defined as remote and rural. NHS Education for Scotland (NES), NHS Scotland’s training and education body, works in partnership with territorial health boards and medical schools to address rural recruitment and retention through a variety of initiatives. The longest established of these is the GP Rural Fellowship, which has been in place since 2002. This article describes this program and reports on a survey of the output of the Fellowship from 2002 to 2013. The Rural Fellowship program:  The Fellowship is aimed at newly qualified GPs, who are offered a further year of training in and exposure to rural medicine. The Fellowship has grown and undergone several modifications since its inception. The current model involves co-funding arrangements between NES and participating boards, supporting a maximum of 12 fellows per year. The Health Boards’ investment in the Fellowship is returned through the service commitment that the Fellows provide, and the funding share from NES allows Fellows to have protected educational time to meet their educational needs in relation to rural medicine. Given this level of funding support it is important that the outcome of the Fellowship experience is understood, in particular its influence on recruitment to and retention in general practice in rural Scotland. To address this need a survey of all previous rural Fellows was undertaken in the first quarter of 2014, including all Fellows that had undertaken the Fellowship between 2002–03 and 2012–13. A total of 69 GPs were recruited to the Fellowship in this period, of which 66 were able to be included in the survey. There was a response rate of 98% to the survey and 63 of those that responded (97%) were working currently in general practice, 53 of whom were doing so in Scotland. A total of 46 graduates of the Fellowship in the period surveyed (71%) were working in rural areas or accessible small towns in Scotland, 39 in substantive general practice roles (60%). Lessons learned: Scotland’s GP Rural Fellowship program represents a successful collaboration between education and service, and the results of the survey reported in this article underline previously unpublished data that suggest that approximately three-quarters of graduates are retained in important roles in rural Scotland. It is unclear however whether the Fellowship confirms a prior intention to work in rural practice, or whether it provides a new opportunity through protected exposure. This will form the basis of further evaluation.

The realisation that I have now surpassed my First5 years as a GP has been rather more significant than I anticipated.

Concluding my first revalidation a few months ago seemed an anticlimax, with no ceremony, brownie points or free pens involved. Instead came the prospect of completing a new round of PSQs and MSFs, with the resetting of the revalidation clock. It didn’t feel the same as the other five-year milestones of a ‘typical’ GP career – qualifying MRCGP, and five years previous to that, qualifying in medicine.

Click the link button to read more…

(Poster presentation of previously published RCGP Scotland policy paper). Introduction Remote and rural healthcare in Scotland has reached a crisis with problems with recruitment & retention for general practices throughout the whole country. The causes of the crisis are complex and multi-factorial and have the potential to adversely impact on safe and effective patient care. Within Scotland, significant initiatives have already been taken by NHS Education for Scotland and others. These include a Schools programme, remote & rural training track for GP trainees and a longstanding rural fellows scheme by NHS Education for Scotland. However, problems remain and Royal College of General Practitioners (Scotland) felt that a fresh strategic approach was needed. Methodology The RCGP Scotland Remote & Rural Strategy Group was formed in 2013 to stratify RCGP Scotland’s work on rural & remote matters. Representation was sought from rural GPs, as well as NHS Education for Scotland, NHS Highland and the RCGP Rural Forum. The work of the 2012 Dewar Group was helpful in stimulating initial discussion that led to the production of a ‘Being Here’ mindmap produced by Miles Mack, which subsequently informed the wider view taken towards factors that have an impact on GP recruitment & retention in remote and rural areas, such as connectivity and professional isolation. Several meetings have been held between 2013 and 2015, with ongoing email communication to advance priority areas which we have identified as being most pertinent to the ongoing challenge of the recruitment and retention of rural GPs in Scotland. Results & Discussion Discussion with remote and rural GPs and many other stakeholders identified the following factors. These constitute a particularly challenging set of circumstances in which to recruit and retain both GPs and other healthcare professionals to remote and rural environments. • Connectivity (mobile phone/broadband) • Transport • Fragility of support services • Workload (including the 24 hour commitment) • Professional development • Education & Training • Professional and social isolation In 2014 RCGP Scotland developed and published a major policy document with stakeholders, Being Rural, to highlight these issues and to ensure focussed action to address them. All are important but the issue of poor mobile phone and broadband connectivity is a major deterring factor for young GPs and other health professionals. http://www.rcgp.org.uk/rcgp-near-you/~/media/Files/Policy/A-Z-policy/RCGP-Being-Rural-policy-paper-and-appendix-2014.ashx Since then, the ‘Being Rural’ paper has informed media inputs from RCGP Scotland, helped to galvanise understanding of some of the less obvious factors involved in GP retention, and stimulated discussion with other key stakeholders, such as public and private organisations contributing to the Scottish Government’s 2020 digital vision for world-class connectivity. With regard to rural recruitment, our work has been further informed by reflecting on the concept of a ‘rural medical workforce pipeline approach’, an overview of which was described by Norris (1). The pipeline conceptualizes a joined-up approach from provision of effective school-based work experience, through to attractive fellowship and other postgraduate opportunities within rural practice. Conclusion Recruitment to remote and rural areas is dependent on the factors outlined above. RCGP Scotland has outlined its strategic plan to address them with stakeholders who include Scottish Government, the British Medical Association, Health Boards, and NHS Education for Scotland. Actions include advocacy with Government on the urgent need to improve connectivity, buddying for practices between urban and rural areas and development of a novel education package for GPs who wish to move from urban to rural practice. Furthermore, we believe that there would be benefit in achieving a more integrated approach to the longitudinal aspects of training for, and recruitment to, rural practice, by learning from international experiences of the ‘pipeline approach’. Norris TE (2014). Addressing rural health workforce shortages: The pipeline concept. Chapter 1.2.3; WONCA Rural Medical Education Guidebook. http://www.globalfamilydoctor.com/groups/WorkingParties/RuralPractice/ruralguidebook.aspx [accessed 27th August 2015].

Aim Arran is an island community with finite – but committed – emergency medical resources. Prior to October 2010 no mechanism existed for regular dialogue between emergency teams such as the ambulance, mountain rescue, coastguard and fire services. We sought to change this with the aim of better networking and interagency training. Methodology We aimed to improve communication between team leaders, and sought to build a partnership based on four key principles: 1) Local ownership; 2) Can-do attitude; 3) Working within existing competences/frameworks; and 4) Cost neutrality. Twenty five liaison meetings involving team leaders have now been held. We have identified core educational opportunities, run eight island wide workshops for 57 responders, and are carrying out some original work on designated rendez-vous points. All emergency teams have had the opportunity to refresh their skills in CPR and triage, and we have had useful discussion about major and multiple incident responses on the island. Results & Discussion We have now held twenty five liaison meetings. In the initial stages we ran eight island-wide workshops on casualty care, and until recently, organised three multi-agency exercises at very low cost. Regular dialogue between teams has been facilities via a group email, and this has resulted in better understanding of each team’s skills and capabilities. Our ‘Team Profiles Document’ summarises equipment, skills and personnel for each of our emergency teams, and is updated on an annual basis. This is particularly helpful for new staff e.g. police officers to understand capabilities of the emergency teams. We are now focussing on simulation training and refining the multi-agency response to cardiac arrest on Arran. There has been interest in the Arran Resilience model of immediate care from other island and rural communities. In 2013 we were named the UK Resilience Team of the Year by the Emergency Planning Society. Also nominated in this category were London Fire Brigade, and the Metropolitan Police team responsible for the 2012 London Olympics. Since then we have been able to focus on the sustainability and relevance of Arran Resilience activities. Conclusion Arran Resilience offers a cost-neutral, easily implemented model of immediate care delivery to rural areas. It seeks to recognise the skillbase of emergency teams, and improve co-ordination of emergency responses at high demand or in the event of a major incident or complexity.

The challenge of providing rural healthcare is exacerbated by inequalities that are often subtle and indirect. Complexity is the result of intrinsic and extrinsic factors, which can be more explicit when faced with provision of healthcare within the domain of generalist and isolated practice. These pressures often result in ‘inevitable innovation’ and rural practice continues to offer novel and effective means of addressing the rising tide of complexity in general practice. I shall consider several scenarios from his experience as a rural GP, and present examples of where he has found and shared innovation which may be replicated in other areas of practice.

Dr David Hogg offers an insight into the varied life of a rural GP on the Scottish isle of Arran

WHAT’S the difference between the skeleton of a seal’s flipper and a human foot? With a new-found respect for the range of anatomy required by vets (not just one species!), this is the question I found myself entering into Google at the end of a busy Saturday on call.Such is rural practice. We provide a wide spectrum of medical care on Arran. It’s hugely stimulating, often challenging and occasionally daunting. The limitations imposed by being the only doctor on-call, or by transport logistics of ferry or helicopter, are relatively blatant. However, our patients tend to be understanding – whether residents or visitors – and an acceptance of the need to find common sensibility in dealing with medical uncertainties can be a helpful element of pragmatism from which to manage patient expectation. [Full article available from link].

Oral presentation to a worldwide audience at the WONCA World Rural Health Conference.

This paper cites the issues of poor connectivity (mobile and broadband), problems with recruitment and retention, increasing workload and fragility of support services as some of the main threats to patient care. In particular, the College in Scotland is calling for the eradication of the current inequalities in access to good primary healthcare provision by addressing these areas, and is keen to work with Scottish Government, health boards, partners and stakeholders to prevent a deepening crisis. Dr Miles Mack, Chair Elect of RCGP Scotland and one of the author’s of the report, told the Herald newspaper, “Smartphone capabilities fail in a great deal of rural areas, as there’s no data service at all. Then there’s mobile connectivity – how do you call an ambulance if your phone doesn’t work?” He also expressed grave concern about the difficulties in recruiting GPs to rural areas telling the newspaper that some health boards have to rely on expensive locums, who may not have the appropriate skills to run GP services, as they cannot attract permanent staff to rural locations.

Chapter (50) for The Good GP Guide. Published by RCGP. Edited by Matt Burkes and Alec Logan.

A collaborative effort amongst clinicians to produce a module for the Practice Based Small Group Learning (PBSGL) network on the systematic management of prehospital emergencies that might present in general practice.

Buying the equipment for your medical bag is an important—and potentially expensive—necessity for your career in general practice. In this article we outline some of the things to consider to ensure that your kit is reliable and cost-effective. Being prepared will enable you to react to the more common medical scenarios that you will face outside your practice and stay within the guidance of the General Medical Council. 10.1093/innovait/inq029