Remote and rural general practice and the new GP contract

I was delighted to be asked to speak at the Rural GP Association of Scotland (RGPAS) annual conference, which was held in Inverness on 5 and 6 November.

 RGPAS represents the interests of remote and rural GPs, many of whom are single handed GPs with list sizes under 1500. For the second year running the meeting of around 45 was boosted by inclusion of a mixture of medical students from Aberdeen, Glasgow and Dundee, a Foundation doctor and 3 post-CCT Rural Fellows giving the attendance a welcomed freshness. 

 There was interesting discussion around the need for medical schools to select more students from rural areas, to provide more opportunities for exposure to rural general practice, and for training that specifically addresses the varied needs of these doctors. There were some great presentations from the students on their ideas to improve rural general practice.

 I gave a presentation on the SGPC vision for Scottish general practice, where the GP is the clinical expert in the community, leading and supported by an expanded primary healthcare team, concentrating on more complex and undifferentiated illness, and all working to the top of their licence. I think it would be fair to say the response from conference was that the model would need further adaptation in order to work in these very small and remote practices where the GP often works alone or in very small teams. Rural GPs are understandably anxious about their current sustainability, their funding and difficulties in recruiting and retaining colleagues. 

Some representatives said that they felt undervalued for the numerous non contractual services they provide (like responding to emergencies) and many are hoping for stability of funding from the future GMS contract negotiations. They do not want responsibility for service provision unless they also have some say over how it is delivered. Paul Gray, Director General NHS Scotland, who also attended, acknowledged the key role general practice plays in NHS Scotland and said that it was his hope that the new contract would improve the stability of the workforce.

 Are you a GP working in a remote or rural area? Let us know your views on the vision for the future GP contract ( ) and share your ideas for improving sustainability in remote and rural areas.

 Andrew Buist

Deputy chair, BMA's Scottish GP Committee