30 January 2018
- John Wynn-Jones, GP, World Organisation of Rural Doctors and Chair for Rural Practice;
- Dr Rachel Rahman, Centre for Excellence in rural Health Research, Aberystwyth University;
- Anna L Prytherch, Rural Health and Care Wales Project Manager; and
- Joy Garfitt, Assistant Director for Mental Health Service, Powys Health Board.
The seminar was chaired by Dr Dai Lloyd AM, Chair of the National Assembly for Wales’ Health, Social Care and Sport Committee. The seminar was structured around talks from each panel member, followed by a question and answer (Q&A) session with the whole panel. Questions were raised by attendees and a selection of questions submitted through social media in advance of the seminar.
John Wynn-Jones, GP began proceedings by setting out some of the issues relating to the recruitment and retention of young family doctors, and other healthcare professions, in rural areas. He set out three areas for action in order to tackle the problems of rural recruitment:
- Increase recruitment of trainee doctors from rural areas;
- Integrate a substantial rural component, up to one year, into undergraduate medical courses; and
- Develop a post graduate training programme focused on delivering rural healthcare services.
John Wynn-Jones also recommended that the overall academic skills of the Welsh rural healthcare workforce should be improved in order to support continuous improvement and develop an ‘academy without walls’.
Dr Rachel Rahman spoke about telemedicine, a concept which has been trialled extensively in Wales, but which has not really become mainstream practice, despite evidence highlighting patient support for such services. Dr Rahman identified some of the reasons that are holding telemedicine back in Wales:
- The lack of technological and broadband access in large part of rural Wales. This either bars access to telemedicine completely or results in poor user experience (due to internet access dropping out etc) which damages trust;
- The lack of technical support for health professionals using telemedicine, so that they can end up having to provide this support while also trying to deliver vital health support;
- The way financial incentives encourage short term capital expenditure, which leads to equipment being purchased without consulting the staff who would be using it. The focus on capital expenditure also ignores the need for ongoing support for staff using the equipment and the maintenance of that equipment; and
- The lack of buy in from urban colleagues who are needed to provide expert advice in rural areas. As urban professionals do not have to use telemedicine routinely, they are less inclined to put up with the ‘hassle’ of using a poorly supported innovation.
Anna Prytherch highlighted that in some respects rural health in Wales has its strengths, including better rates of individual wellbeing and lower levels of anxiety. However she outlined the challenges facing rural healthcare, some of which resonated with what the preceding speakers covered. Anna set out some of the opportunities and solutions to these challenges, including
- use of green (PDF 3.2MB) or social prescribing [Green/social prescribing schemes can include a range of interventions and activities, for example volunteering, gardening, sports, arts/creative activities, adult learning, and befriending];
- Better integration of the health and social care sectors;
- Increased sharing of best practice, lessons can be learnt from rural communities from across the world;
- The creation of new health-related roles to bridge the gaps in essential services;
- The creation of a rural specialism in healthcare training and practice;
- Improved physical and digital infrastructure to make connecting with services easier; and
- Developing more local training opportunities in rural Wales, including the creation of a mid-Wales school of Nursing.
Finally, Joy Garfitt talked about Powys Health Board’s repatriation of specialist services within its boundary (as opposed to sending patients to neighbouring health boards for treatment). Joy explained that this allows for the development of ‘made in Powys’ solutions to the challenges Powys faces. One of the key drivers of this was the reduction in the distress caused to patients required to travel long distances to access services.
In particular she focused on the repatriation of mental health services to Powys, a process which took three years and was completed in June 2016. Joy explained some of the challenges the Health Board faced during this process and how it overcame them. She reported that
- It had improved recruitment by taking a more personalised approach, by working with locum doctors and mid-career doctors to help them develop and plan their careers within the area;
- Reduced patient travel distances by investing in crisis and intervention teams and community based services; and
- Developing a ‘made for Powys’ model of out of hours service delivery by creating non-hierarchical task and finish groups.
The seminar concluded with a twenty minute Q & A session with all panel members. Click here to see the full seminar, including the Q&A session and more detail on the speeches outlined above.
Article by Joseph Champion, National Assembly for Wales Research Service