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Healthcare in a rural setting

January 2005
Board of Science

Social isolation
The disincentive of professional isolation, particularly the lack of opportunities for CPD, has been discussed within education strategy. The need to provide solutions to the problem of social isolation is explored here.

Community involvement
Schemes to support healthcare professionals and their families within the community are vital as an aid to retention. A series of studies in North America found that healthcare professionals who choose to remain in rural areas over a number of years are likely to be well integrated socially. Those who do not fully integrate are less likely to remain in the area. To aid retention in a rural area, communities could make efforts to include healthcare professionals in local activities and allow them to become appropriately integrated in social networks. [go to reference 63]

Case study – The Rural Medical Family Network of New South Wales (Australia)
The Rural Medical Family Network of New South Wales64 aims to aid integration within the community by reducing isolation and creating social networks. Services include:
• supporting medical families in rural/remote medical practice
• creating a 'friendship network' to lessen feelings of loneliness and isolation experienced by some families
• providing comprehensive family programmes at CPD weekends/medical conferences that encourage the whole family to attend
• offering assistance to medical students interested in rural living
• running initiatives such as ‘meet and greet’ sessions, crisis assistance and spouse retraining/education grants.

Evidence suggests that involving the local community at the beginning of the recruitment process can be effective. Communities that share responsibility for finding solutions to local recruitment problems often find that these are more effective than imposed solutions. [go to reference 65] The community can firstly become involved in selecting students for rural placements and working with them as part of their medical training. As highlighted earlier, providing students with rural placements increases the likelihood of them working in a rural practice after qualification. Communities can also be involved in finding solutions to a local recruitment crisis.

Case study – Flinders University Rural Clinical School:
involving the community (Australia)
In year three of the four year Graduate Entry Medical Programme at Flinders University Rural Clinical School, students showing an interest in rural practice have the chance to move to rural regions for the academic year and follow the Parallel Rural Community Curriculum Programme. Students have the choice of two regions to spend the year in, one being the Riverland region within the central-eastern area of Southern Australia, where community involvement is seen as paramount.

Initially, community involvement was provided through the students making patient visits at community centres. It then grew as students began giving health prevention talks to service clubs and working with the community to run particular schemes. The community has now established a Community Liasion Committee with responsibility for selecting a sub-quota of students beginning the four year Graduate Entry Medical Programme. These students have a rural background and develop close links with the community throughout their course, undertaking rural placements in the region in years one and two, before their year-long placement in year three of the course. The committee is responsible for developing a programme for the initial visits in years one and two. The local government for the region donates cash for fuel, to assist students with the cost of travel in rural South Australia, and the local health authority subsidises the cost of two houses being used as permanent homes for the students. [go to reference 45]

Case study – Involving the community in recruitment (Australia)
A study in Australia worked with two rural communities that were experiencing continuing difficulties in recruiting and retaining GPs. Components of the problem that each community could influence and which were most likely to improve recruitment and retention were discussed in depth. Each community identified a number of similar objectives and strategies that they could influence, despite the differences between them. This suggested that objectives/strategies could be implemented more widely, with minor changes to reflect local needs. [go to reference 65] The common strategies included:
• developing information packages for prospective applicants
• forming a welcome process that helps doctors and families settle in
• addressing quality and appropriateness of housing
• sponsoring a medical student to spend time in the community
• considering partners’ education and employment needs. [go to reference 65]

Concerns included the need to contribute community funding. In addition, past experiences may have left communities sceptical about efforts to recruit GPs.65

A rural ‘package’ can be designed to improve awareness of the distinctive and positive aspects of working in a rural environment. It can also address concerns that a professional’s family may have about living in a rural area, for example, schooling and employment opportunities. [go to reference 14] Funding to help with relocation costs and support in finding suitable housing should be provided. Access to healthcare for GPs, their families and the healthcare team, outside the local practice, should also be considered. There is a danger that those working in isolated rural communities may be disadvantaged in their personal healthcare provision, when compared to their urban colleagues. Primary care organisations need to ensure a defined service of external provision of GPs for doctors and their families living in remote communities in order that their own personal health needs are met outside the local community in which they live. The GPs for GPs scheme, set up by RARARI in the Highlands, provides an example of a scheme to fulfil such a need. [go to reference 6] Unmarried doctors may face an added difficulty in that the GMC prohibits a sexual or improper emotional relationship with a patient or someone close to them. [go to reference 66] In a rural area, however, everyone in the area is likely to be the doctor’s patient and community members do not easily have an opportunity to register elsewhere.

Recommendation 6
Schemes to support healthcare professionals and their families within the community are vital as an aid to retention.

• Communities can be encouraged to make efforts to include professionals and their families in local activities and integrate them in social networks. Primary care organisations could provide programmes offering ‘meet and greet’ sessions and crisis assistance.
• Communities can also be involved in finding solutions to local recruitment problems, and working with students on rural placements.
• A ‘rural package’ should be offered when recruiting healthcare professionals. This should address concerns that a professional’s family may have with moving to a rural area, as well as providing funding for relocation costs and housing support.
• Primary care organisations need to ensure a structured service of external provision of GPs for GP’s and their families in remote communities in order that their own personal health needs are met outside the local community in which they live. The needs of members of the community wishing to register elsewhere should also be considered.