The isle of Arran is nowhere near as remote as some Scottish communities, but as one local GP highlights in today's Herald, even in larger villages like Lamlash there is virtually no mobile signal.
Shortages in rural areas of mobile signals, mobile data services and high- speed broadband are just some of the issues highlighted by the Royal College of GPs (RCGPs) Scotland in a report on the growing crisis facing GPs in rural areas. The crop of problems must be addressed before they compromise patient safety.
Doctors who cover rural communities report that there are advantages to working their beat, including greater flexibility and autonomy and the opportunity to live in beautiful places. But the downsides, as well as technological impediments, are the risk of social or professional isolation and, in the absence of a local network of other medical support services, long hours. This goes some way to explaining why there are such problems in the recruitment and retention of rural GPs.
The problems are clearly serious and the RGCPS is doing its bit to tackle them, such as promoting the image of rural general practice and making adjustments to the application process so that those from remote areas find it easier to win places on university courses (they are more likely to return to rural areas after qualifying than those who are town born and bred).
But this is not just a question of better marketing. Scotland's GPs are also trying to cope with growing demand from an ageing population and a budget that is not keeping pace, as highlighted by The Herald's NHS: Time for Action campaign. There is, wisely, a drive to ensure the elderly are cared for in the community instead of in hospital for as long as possible, but this puts a greater burden on primary care services. In strung-out rural areas, the costs of caring for patients at home is even higher. Therefore any drive to boost recruitment and retention of GPs in rural areas must be underpinned by better funding of GP services as a whole.
One simple "win" would be better provision of broadband and mobile data services. It is absurd that technological innovations being introduced into the Scottish NHS to improve efficiency and save money are unworkable in the very rural communities that would stand to benefit the most from them, due to outmoded equipment and lack of connectivity. About 95 per cent of Scotland should have fibre broadband coverage by the end of 2017, but the RCGPs understandably wants clarity on which parts of the country will still be left out.
The Scottish Government stresses that health boards will soon have flexibility to specifically incentivise GPs to work in areas that are more difficult to recruit to, which is eminently sensible. Relying on locums is not only costly, but highly unsatisfactory for patients.
But the effectiveness of all these measures must be carefully monitored to make sure the situation does indeed improve; otherwise those living in rural areas are at risk of becoming second class NHS patients.
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