David R HoggProfessional Profile
22 Oct 2015

Being Rural: Exploring sustainable solutions for remote and rural healthcare.

(Poster presentation of previously published RCGP Scotland policy paper).


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.


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.

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.


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].

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