Recruitment and Retention of Health Care Providers in Remote Rural areas

Urban comparison area

Aberdeen City is the 3rd largest and one of the most densely populated cities in Scotland, with a population density of 1,151 persons/sq km. Population density within Aberdeenshire sits at 36 persons/sq km with approximately 63% of the population living in the main towns. This reflects the rural nature of the region.

The estimated population for Grampian 2009 was 544,980, an increase of 1% from 539,630 in 2008. The population of Grampian accounts for 10.4% of the total population of Scotland. The population currently has a relatively high proportion of under 20s and fewer over-65s compared with the Scottish average, reflecting employment-driven in-migration in recent decades.

By 2033 the population of Grampian is projected to be 605,307, an increase of 12.71% compared to 2008. The population of Scotland is projected to increase by 7.27% between 2008 and 2033.

NHS services for the Grampian region are provided by NHS Grampian, and are overseen by one single NHS Board. NHS Grampian covers an area of over 3,000 square miles of city, town, village and rural communities.

The Board is supported from headquarters at Summerfield House in Aberdeen. Senior managers for the functions which cover the whole of Grampian are based here, including financial overview, corporate planning, and central responsibility for protection and promotion of public health.

NHS Grampian consists of acute services, corporate services and three Community Health Partnerships (CHP) and works closely with the local authorities.  NHS Grampian is also very closely linked with both the University of Aberdeen and The Robert Gordon University, especially in the fields of research, workforce planning and training. Care is provided throughout Grampian in 9 main hospitals, a 17 community hospitals, 84 GP Practices and various other specialist care units.

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  Aberdeen Royal Infirmary is NHS Grampian's largest hospital, situated at Foresterhill, Aberdeen. Royal Aberdeen Children's Hospital and Aberdeen Maternity Hospital are also housed at the Foresterhill site.
  
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  Woodend Hospital caters for many patients, including the elderly. 
  
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  Royal Cornhill Hospital provides inpatient and community support for mental health services.
  
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  A large number of outpatients are seen at the Woolmanhill Hospital in the city centre. 
  
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  Roxburghe House is a new purpose-built unit providing palliative care for terminally ill patients.
  
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  Dr Gray's Hospital is the district general hospital based in Elgin, Moray.
  
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  Children with special needs are cared for at the Raeden Centre jointly with Aberdeen City Council.
  
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  The Oaks is another purpose-built unit which provides specialist care and support for people with cancer and other progressive illnesses in Moray.
  

Community hospitals are hospitals where most patients are admitted, and cared for, by their own GPs. They normally deal with:

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  Acute medical care where patients cannot be cared for at home, but where the expertise and / or the specialist diagnostic facilities of a major specialist hospital are not required.
  
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  Post acute care including rehabilitation.
  
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  Casualty services.
  
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  Palliative care.
  

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  Diagnostic facilities (such as x-ray, ultrasound, sigmoidoscopy, cardiac assessment, telemedicine).
  
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  Therapeutic facilities (such as physiotherapy, occupational therapy, minor surgery, day hospital).
  
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  Facilities for joint teams (such as community nursing teams and social work / care management teams).
  
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  Specialist outpatient clinics.
  
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  Intermediate care clinics.
  

The following Table is a breakdown of Medical and Dental Staff. (Headcount)

In addition to the above there are approximately 123 GPs carrying out sessional work within Community Hospitals.

7. Training and education

The University of Aberdeen has its Highland Medical Education Centre based in the Centre for Health Science in Inverness where around 80 medical undergraduate students are based at any one time. 18 of these students work through a rural option, providing specialised teaching for application in remote and rural medicine.

The University of the Highlands and Islands (UHI) in collaboration with NHS Education for Scotland and the Health Boards in Highland, Western Isles and Dumfries and Galloway provide BSc degree level education in Oral Health Science for 14 students per year. This degree allows graduates to register with the General Dental Council as Dental Hygienists / Therapists.

Outreach training for final year Dental students (BDS) is provides at the Inverness Dental Centre, Centre for Health Science for the University of Dundee Dental School and at the Spynie Dental Centre in Elgin for students from the University of Aberdeen Dental School.

Vocational training schemes are organised for dental graduates working across the Highlands, with 20 Vocational Dental Practitioners currently working in dental practices across the region. These are graduates in their first year post-qualification, who have supervised clinical experience in general dental practice for a year, with supported learning carried out at the education centres in Inverness and the peripheral centres.

NES also supports training for dental nurses, dental administrators and dental practice managers.

Undergraduate and Postgraduate Nurse Education

Stirling University Highland Campus is sited within the Centre for Health Science in Inverness and also in the Western Isles. The University delivers pre and post registration nurse training. On average there around 400 students being taught from this campus with placements offered across the region.

Other types of health care education can be studied across Scotland and the United Kingdom; placements for students are available in many of the Allied Health Professions in NHS Highland. Most of the health care professionals are trained at a university level and take a minimum of 4 years at Bachelor level. Students undertaking these degrees are based out with the Highland area in Glasgow, Edinburgh, Dundee or Aberdeen.

NHS Education for Scotland (NES) is responsible for the design, development, commissioning and provision of post graduate healthcare training in Scotland. The delivery of postgraduate healthcare training requires a partnership approach between Deaneries, NES, universities and local Health Boards.

NHS Education for Scotland (NES) hosts the Remote and Rural Healthcare Education Alliance (RRHEAL). RRHEAL coordinates and delivers education to meet the specific needs of the multidisciplinary remote and rural healthcare workforce. RRHEAL works to increase access to remote and rurally relevant education and training for the remote and rural workforce.

There are four Deaneries in Scotland – the North Deanery is responsible for 5 Health Boards: Western Isles, Orkney, Shetland, Grampian and Highland. All North of Scotland Deanery Foundation Programmes (134 posts) offer as a minimum 4 months in a remote or rural placement, Aberdeen-based with a placement in one of the 6 Rural General Hospitals (RGHs).

NES provides funding for general dental practitioners working in the remote and rural areas of Scotland who wish to undertake postgraduate training to Masters level. The Scottish Dental Postgraduate Rural Training Fellowship has been in place for eight years, and has a high record of retention of participants in the remote and rural areas. Fellows undertake a part-time Masters degree in a relevant clinical subject at one of the three participating Scottish University Dental Schools, whilst working in either the General Dental Service or the Salaried Dental Service of the NHS. They are financially supported with payment of university fees, travel and subsistence to university teaching days and a percentage of their salary is paid by NES. Currently there are nine Postgraduate Rural Fellows, working in Grampian, Highland, Argyll and Bute, Western Isles, and Dumfries and Galloway.

8. Recruitment and Retention:

There is also a need to redesign the workforce who provides care in rural general hospitals as current models are considered to be largely unsustainable. Issues that contribute to the vulnerability of the rural general hospital workforce also have an impact across rural community services and workforce. There is a need to develop new and adapted roles to support redesign of the rural hospital workforce. This requires high standard education and ongoing training programmes to be accessible and affordable.

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  Recruitment – There are difficulties in attracting sufficient applicants for posts which results in a lack of availability of appropriately skilled staff. Therefore there is a need to ensure staff have the range of skills required to deliver care across breadth of practice required in remote and rural settings.
  
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  Placement issues – There is a lack of availability or exposure for Scottish undergraduates to remote and rural working. Remote and rural placements may have to be self funded by some professional groups while others are supported to meet rural placement costs.
  
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  Retention/ staff turnover - There is a higher level of locum use within remote and rural hospital settings. This results in increased costs and high turnover of staffing. There are difficulties in identifying longer term work for partners of new recruits.
  

9. Summary