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.
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.”
- 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.
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: –