A Highland GP on life the universe and anything…

Posts tagged ‘rural fragility’

Why the Highlands & Islands should be especially proud of the NHS

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.

In 1912 the Dewar Committee was set up to investigate lack medical services in the Crofting Counties & the results were startling:-

  • 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”
  • Depopulation, poverty, poor housing & overcrowding
  • 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
  • Finally that the centenary of the Dewar Report & Highlands & Islands Medical Service deserves to be celebrated & recognised for its outstanding contribution to the development of the health services in this country.

I’m glad to say the motion was passed unanimously.


Dewar 2012- an outline for an qualitative research project in Remote and Rural General Practice

“What are the factors that make remote and rural General Practice a rewarding and satisfying career choice and what more could be done to increase that reward and satisfaction to ensure a sustainable future for remote and rural healthcare”.


Dewar 2012 – The Fragility of Remote & Rural Healthcare

Please follow this link to the Mindmap : –

Being here Dewar 2012

Dewar 2012 Being Here v2.1

This mind map came about as I tried to tie together the complexity of the  challenges of  providing sustainable health care in the Highlands and Islands of Scotland.

I would love to see it grow and expand but I will need help from anyone with an interest or more insights on the subject.

This work is building on the work of the a group that I belong to, celebrating the centenary of the publication of the Dewar Report.

27.7.2012 Thanks for comments on Twitter and Facebook. The Mindmap (v1.3)has been updated with increased emphasis on “Practitioner Isolation” and “Domestic Logistics”. I see recent survey showing Western Isles to be happiest place in UK to live – should there be more about the positives to remote and rural practice? I have also added RPAS as important stakeholders with URL. Keep the comments coming! -Miles

15.8.2012 Updated (2.0) to try and make it a little easier to to visualise. Never going to be easy to capture the complexity with clarity.

9.10.2012 very grateful for the chance to share our enthusiasm for all things Dewar at RCGP conference last week. Lets hope this can lead to some evidence of change soon.