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Delivering for Remote and Rural Healthcare: The Final Report of the Remote and Rural Workstream

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Remote and Rural Healthcare - The Vision

This project was established to develop a framework for sustainable healthcare within remote and rural Scotland. The changing nature of care and the increasing complexity of needs are just some of the challenges that must be met to ensure accessible healthcare in remote and rural Scotland. This Report recognises the interdependence of individual services and focuses on the integration between different aspects across what is described as the 'continuum of care'. This is defined as self care and preventative care within the local community through the different levels of supported care up to that which requires the resources provided by a tertiary centre. Figure 1 below summarises the integrated network model that is proposed.

Figure 1: Model of remote and Rural Healthcare

Figure 1: Model of remote and Rural Healthcare

This model describes how much of clinical care can be provided within local communities, with only a minority of cases requiring further referral outwith that community.

Within the remote and rural communities of Scotland, there are a limited number of health and social care professionals, whose skills and expertise need to be shared if communities are to have local access to the widest possible spectrum of care. The development of Extended Community Care Teams ( ECCT) will ensure that a robust system of locally available services is both available and sustainable.

All remote and rural areas will also have access to intermediate care services, some within a Community Hospital ( CH) and others delivered through augmented care within a patient's home. Whilst some communities have access to a Community Hospital, others may have a Rural General Hospital ( RGH), which may fulfil the Community Hospital function or these may be separate.

Services must be well planned and co-ordinated with a greater focus on more collective and collaborative responses within and across communities. This will include the formalisation of networks to ensure that larger centres are obligated to support and sustain healthcare services in remote and rural areas.

Remote and Rural Staffing model

Healthcare is currently delivered by a range of professionals, some working in isolation and others working in teams. Future models for healthcare delivery are based on integrated teams, demonstrating a range of competencies, defined by patient need. These competencies can overlap, between traditional professional roles, to the benefit of holistic care and utilises resources to better effect. Most of the team will be based within the remote and rural community, in primary or community care, within the hospital service or in combination, some team members will be based in the larger centre, with responsibility for supporting local delivery and providing a visiting service, where appropriate.

Staffing Model

The following models shown in Figures 2 and 3, describe a stratified workforce, highlighting those roles and competencies that should be within the remote and rural community team and those in other agencies or levels of healthcare. The variation in local services will determine the level of competence required within a particular area.

Figure 2: Remote & Rural Staffing Model

Figure 2: Remote & Rural Staffing Model

Figure 3: Remote and Rural Team Competencies

Figure 3: Remote and Rural Team Competencies

In order to sustain the competent workforce, appropriate training and education is required. This workforce must be supported in a variety of ways including formal networks and mentoring arrangements with larger centres, up to date equipment, modern Information Technology ( IT) and technological links and robust transport systems.

These are discussed in greater detail in the relevant chapters.

Commitment

This model of care for remote and rural communities, incorporating formal working links between remote and rural areas and those in larger centres, should be introduced.