REMOTE AND RURAL

At the single-handed GP practice in Bernera in the Western Isles, currently staffed by a locum doctor, the Skills for Health remote and rural healthcare competence framework is being used to map its future.

The big picture 'competence map', drawn up by a team headed by former Remote And Rural Areas Resource Initiative director of strategy Dr Malcolm Alexander, has been used to assess the population's healthcare requirements and how best they can be met.

'The map allows you to broaden your thinking when considering a new area or a vacancy in an existing remote area, in which it can be extremely difficult to recruit, ' says Dr Alexander, now the associate medical director of NHS 24, Scotland's equivalent of NHS Direct.

'You can consider how you might replace the service and not the person.'

The new competences are being piloted in Scotland, following the success of a four-year countrywide initiative which supported more than 160 projects.

'We want to understand what is fundamentally different about working in a remote area compared with working in the city, ' says Dr Alexander.'We need the competence map to give us an idea of what this task involves.'

He says the threefold benefits of the competences include enabling teams to turn the spotlight on themselves, to examine the breadth of tasks covered and whether the existing skill-mix needs to be adjusted.'When this was used in three sites, it proved good for morale and offered scope for reconfiguring services, moving towards multi-disciplinary working, ' says Dr Alexander.

At a more strategic level, the competences can stimulate debate at senior management level of the needs of the remote and rural community sector, which often takes second place to the concerns of the acute sector.

'They can raise strategic awareness and influence high-level planning of how this sector needs good network support and the time of senior professionals.'