Welsh Rural Health Welsh Rural Health PlanPlan

Developing the Developing the

““Rural Practitioner”Rural Practitioner”

rolerole

Sub-group (25)Sub-group (25)

• LHBsLHBs• WASTWAST• WCVAWCVA• Swansea UniversitySwansea University• Coleg MenaiColeg Menai• RCNRCN

• BMABMA• Local AuthoritiesLocal Authorities• NLIAHNLIAH• Institute of Rural Institute of Rural

HealthHealth• WAGWAG• DeaneryDeanery

Distributed to LHB Directors of PCMH

Discussed, amended and adopted by RHIG

Some fundamentalsSome fundamentals

Who is a rural health practitioner?Who is a rural health practitioner?

What are the skills needed for rural health practice?What are the skills needed for rural health practice?

Strategic level paperStrategic level paper– Developing & delivering rural health care servicesDeveloping & delivering rural health care services

Model of careModel of care Workforce developmentWorkforce development

– More focussed work on role specific developments will More focussed work on role specific developments will followfollow

(eg on Rural Medical Practice)(eg on Rural Medical Practice)

Rural Health PlanRural Health Plan Access Access

IntegrationIntegration Community CohesionCommunity Cohesion

All rural areas have different circumstances and needsAll rural areas have different circumstances and needs

Lower numbers of staff, covering greater areasLower numbers of staff, covering greater areas– Right person, right time, right placeRight person, right time, right place– Integrated teams with extended skills per personIntegrated teams with extended skills per person

Narrower range of services available locallyNarrower range of services available locally

Very local sensitivity about service planningVery local sensitivity about service planning

Local engagement and “ownership” vitalLocal engagement and “ownership” vital

Rural Practice Rural Practice Access (travel time) and QualityAccess (travel time) and Quality

Centralisation of hospital servicesCentralisation of hospital services– Cost effectiveness, critical mass, qualityCost effectiveness, critical mass, quality

Distance of travel to hospital servicesDistance of travel to hospital services– Distance decay Distance decay – Poor recognition of benefits of holistic rural services - Poor recognition of benefits of holistic rural services -

enhancing patient autonomy and independenceenhancing patient autonomy and independence

Access “balance” pointsAccess “balance” points

Advantages of local services v Advantages of centralised hospital services

Every rural area is unique Each service type different

• Spectrum of best practice, matched to the needs of the specific rural area

• Mature health system will map out these balance point

• Complex from the centre – clear from the locality

• Drive by locality model in Setting the Direction

The “model of care”The “model of care” – potential developments described– potential developments described

Community Community hospitalshospitals

DoctorsDoctors PharmacistsPharmacists NursesNurses TherapiesTherapies ParamedicsParamedics NursesNurses

Social careSocial care Third sectorThird sector Out of hours / Out of hours /

unscheduled careunscheduled care Integrating Integrating

servicesservices Cross border Cross border

mattersmatters

eg Community Hospital serviceseg Community Hospital services Primary CarePrimary Care Day HospitalDay Hospital Locality Clinics (E.g. Dermatology,Locality Clinics (E.g. Dermatology,

COPD, Heart Failure, COPD, Heart Failure, Falls Falls Service, Palliative, Service, Palliative, GpwSI’s)GpwSI’s)

Therapists (Physiotherapy, Therapists (Physiotherapy, Occupational Therapy, Occupational Therapy, Speech Speech and Language and Language Therapy)Therapy)

Podiatry, DieteticsPodiatry, Dietetics Renal DialysisRenal Dialysis Re-ablementRe-ablement Rapid ResponseRapid Response Family PlanningFamily Planning Child Health ServicesChild Health Services Mental Health ServicesMental Health Services Third SectorThird Sector Carers CentreCarers Centre

Out Of Hours ServicesOut Of Hours Services Out-Reach Specialist ClinicsOut-Reach Specialist Clinics Social ServicesSocial Services Imaging and DiagnosticsImaging and Diagnostics Minor Injury UnitsMinor Injury Units Dementia CareDementia Care Community Dental ServicesCommunity Dental Services Child and Adolescent Mental Child and Adolescent Mental

Health ServicesHealth Services Substance Misuse ServicesSubstance Misuse Services In Patient Beds: Short Stay In Patient Beds: Short Stay

AssessmentAssessment Management of exacerbations ofManagement of exacerbations of

chronic conditionschronic conditions RehabilitationRehabilitation RespiteRespite Palliative CarePalliative Care Step up/Step Down bedsStep up/Step Down beds

Workforce re-design (team)Workforce re-design (team) Lots of policies in place in WalesLots of policies in place in Wales

– Locally creative and innovative solutions needed for Locally creative and innovative solutions needed for rural areasrural areas

Integrated team approach / extended rolesIntegrated team approach / extended roles=> competency based developments (eg D4C)=> competency based developments (eg D4C)

Flex job plansFlex job plans Matching skill mix with dispersed workforceMatching skill mix with dispersed workforce Developments / integration across sectorsDevelopments / integration across sectors Career progression of local staff Career progression of local staff

Exploit ITExploit IT

Education and Professional Education and Professional Development (individual)Development (individual)

Skill development across the workforceSkill development across the workforce

Formal training in IT / telemedicineFormal training in IT / telemedicine

To improve recruitment & retentionTo improve recruitment & retention– Increase clinical learning placementsIncrease clinical learning placements

– Address access (to training) issuesAddress access (to training) issues

Rural “Medical” EducationRural “Medical” Education Promotion of “Promotion of “Rural MedicineRural Medicine””

– Defining and developing competencies Defining and developing competencies Specific skill sets for rural practice Specific skill sets for rural practice A shift in generalist –specialist paradigmA shift in generalist –specialist paradigm Diploma in Rural MedicineDiploma in Rural Medicine

Increased placementsIncreased placements UndergraduateUndergraduate Foundation programmeFoundation programme Some speciality training posts in rural areasSome speciality training posts in rural areas

General PracticeGeneral Practice VTS scheme badge’d and focussed on Rural MedicineVTS scheme badge’d and focussed on Rural Medicine A reasonable proportion of Fellowships in rural areasA reasonable proportion of Fellowships in rural areas

Considerations of the difficulties of access to Considerations of the difficulties of access to Professional Development.Professional Development.

Rural “Health” EducationRural “Health” Education Strengthened collaboration NHS / EducationStrengthened collaboration NHS / Education

Increased placements in rural areasIncreased placements in rural areas

Non-medical prescribingNon-medical prescribing

Flexible educational support / mentoringFlexible educational support / mentoring

Development of lectureships (nursing, medicine & Development of lectureships (nursing, medicine & allied health) => stronger academic allied health) => stronger academic infrastructure for Walesinfrastructure for Wales

Welsh Rural Health Welsh Rural Health PlanPlan

Delivering Rural Health Delivering Rural Health Care ServicesCare Services