2018 hasn’t been the best year. But it has harboured one joyous milestone: the 70th anniversary of the foundation of the NHS. Yet whilst we celebrate this jewel of the British way of life it has also been a year when the sustainability of this method of delivering our healthcare has been questioned. Beset by spiralling costs and staff shortages, where we go next? In the North of Scotland this has become especially evident in rural areas. We know from the press that Moray, Caithness, Skye and Argyll are struggling to deliver the care we have come to expect. What is less known is how, over one hundred years ago, a previous crisis in health care provision led to the very creation of the NHS (more…)
Last month marked twenty-five years of me being a partner at Dingwall Medical Group, astonishingly, consulting from the same room throughout all those years. During this awesome quarter-century I have developed many strong and meaningful relationships with my patients, – some of whom I did not find easy in the early days, though I’m pretty sure they may have felt the same way about me. However, it is many of these patients of whom I now find myself the most fond. I have grown to understand what matters to them and, having walked with some of them though their medical journey over the last 25 years, I get great satisfaction from not only understanding what they most need from me but also, learning what they see as of no benefit to them whatsoever. (more…)
This is my contribution to the Scotland Policy Conferences Keynote Seminar: Next steps for primary care in Scotland held on Wednesday, 21st January 2015 at the Crowne Plaza, the Roxburghe, 38 Charlotte Square, Edinburgh .
I was a GP Trainee in 1991, and I vividly remember being taught that there were 3 studies of the treatment for patients with Myocardial Infarction that each showed patients were better off with treatment at home rather than admission to hospital. I became adept at treating crashing left ventricular heart failure at home, at a time when GPs were most valued for their role in unscheduled care. My goodness things have changed since then.
This post originates from a 3 minute motion I proposed for the Scottish Local Medical Committee Conference on Friday 14th March 2013. The motion was: –
This conference recognises the importance of the Dewar Report of 1912 & the subsequent Highlands & Islands Medical Service of 1913 in being the first contract for comprehensive medical services between General Practice & the Government & recognised as a blueprint for the NHS with lessons from that time that remain highly relevant today.
Ross-shire 40% of deaths uncertified, (Scotland 2%)
Impossible to recruit doctors, relevant factors: – low income, poor housing, transport difficulties, lack of security of tenure & no locums for holidays/professional development,
“sparse population, wild landscape & a rudimentary road network”
No access to the latest technology: – telephone, Internal combustion engine
Failure of philanthropic provision; particularly the chaotic organisation of nursing services
Solutions in the report were developed by a small group of thoughtful doctors, members of the Caledonian Medical Society
The following year, in 1913, the Highlands & Islands Medical Service was established as the world’s first state funded comprehensive health service
It was the model of care quoted in the final plans for NHS (P72 of this link) submitted to the government in February 1944; they said: –
“This method of central administration, free from restrictive conditions & anything resembling vexatious control, has proved an outstanding success”
Today the NHS is again under scrutiny, with particular challenges in R&R areas of Scotland.
We are again successfully using Dewar’s methods: –
Described the complexity of the issues in a Mindmap
Developed a Bench testing methodology to test new proposed models of care
Next month; Welcome Trust funded conference in Fort William to address “remote health care provision and the sustainability of remote communities.”
So: –
As we consider a new “more Scottish” GMS contract we mustn’t put the problems of Remote & Rural Health care into the “too difficult” box but instead embrace it as one end of the spectrum of General Practice in Scotland
Remember that solutions from rural areas can be successfully rolled out nationally
A recent meeting of colleagues raised the possibility of a new style of Enhanced Service for Highland GPs with the purpose of stimulating ideas from within practices on how to develop services and create links with other practices or other parts of the NHS infrastructure. I wanted this to reward initiative and recognise success. It would also seek to replicate the excellent sharing of best practice that was seen at the recent QoF QP external review meeting held at the Drummossie Hotel. This is what I sketched out: –
milesmack 