This review was undertaken at a rapid pace and was an unstructured sample, which was identified from existing knowledge about the field, augmented by "snowballing" to find health care staff working on the frontline. Many of the participants had worked in different jurisdictions, which was useful for this review as it provided a rounded perspective. These people with stories to tell have progressive ideas for the rural community which can be effectively applied to Scotland. The interviews tapped into a well of hard-earned knowledge. Although the interviews were engaging, and views were insightful, the analysis presented here can only scratch the surface of the potential for future work together across international boundaries. The views expressed were therefore only in part academic, in fact one rural GP said "we don't have enough rural health academics… we don't sit still long enough". The participants were working in environments were change had been essential – so there were experienced rural medics espousing protocol driven multi-disciplinary teams, others describing long term success in interprofessional education, and a nurse practitioner who said "we did it…and the sky didn't fall in".
- Speaking to experts in other jurisdictions is highly informative. The issues are similar issues, however, little of it is recorded in published papers. Useful and relevant documentation has been collected from New Zealand, Australia and Canada. Everybody has been most welcoming in participating in this review.
- The documentation collated demonstrates that this review only scratches the surface of what might be possible to undertake, in terms of detail, and scope, in international rural health collaboration.
- With Zoom and other video links, there is real potential for service planners and health care providers to work more closely together at a transnational level, at low cost, without the need for foreign travel.
- Issues are complex, and so are the solutions, and nowhere entirely resolved.
The learning points of the review were:
- Interviews with international rural health practitioners and academics were a very effective and rewarding method of gaining perspectives useful to policy development in Scotland
- participants had lots of additional relevant information, not available in the formal literature.
- The process sparked interest and goodwill amongst participants
- The Issues in rural primary care are complex, and so are the solutions. Rural health care delivery is a challenge everywhere, not just Scotland.
- Culture and context are important in relation to health service delivery, and it is difficult to change established practices.
- Necessity drives change. The most challenging environments often have the most innovation. There is much to be learnt from indigenous health delivery models in relation to multi-disciplinary team working.
- Places were there had been less innovation appear more likely to be in crisis
- There are specific examples of excellence Scotland can learn from.
Elements that are missing:
- a detailed description of the Scottish contractual situation, although Gillies et al are providing key descriptors and challenges in Remote and rural general practice in Scotland to the Remote and Rural General Practice Working Group in parallel to this report.
- a view from England, Wales and N.Ireland - which now have independent and diverging health care delivery under the central concept of the NHS
- a stronger representation from Western European countries. This can be remedied by linking up with EU work, and potentially seeking funding. The European Commission recognise that capacity of health systems to deliver health services and meet the changing demands of care strongly depends on the availability of a workforce with the right skills and flexibility
- this work can be more closely aligned to international policy context, WHO in particular have undertaken important work.
- It would be useful align fully into the work on rural health established by WONCA, who for many years have brought family doctors from across the world together, this could be the mechanism to formalise ongoing collaboration.
The next stages for this work are to publish a paper, and capitalise on the findings, through presentations to relevant academics, policymakers and health service staff. The methods used here could be used again for other issues in health and beyond, for including international perspectives on policy development: "international proofing". From respondents in this review, it is evident that there is enthusiasm to develop this kind of approach.
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