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RCSEd Publishes Standards for Rural Surgery

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07 Mar 2016

Problem of recruitment and retention of consultants in Scotland is most acute in remote and rural areas, which traditionally find staffing more challenging.

The number of unfilled hospital consultant posts in Scotland has more than doubled since 2012*, the Royal College of Surgeons of Edinburgh (RCSEd) has reported.

The RCSEd has published its report on the delivery of surgical services in rural areas to improve support for consultants and trainees based in some of Scotland’s most remote hospitals.

President of the RCSEd, Mr Michael Lavelle-Jones said he hoped the report would start a debate about the best configuration for rural communities: “It is quite clear that ‘one size does not fit all’ when it comes to service delivery in these challenging environments and that the needs and provision will vary depending upon the surgical specialty and the region. Reducing risks to as low as possible while balancing the desire for patients to be cared for close to home is the logical aim. The standards proposed are applicable well beyond this geographic boundary and are relevant to wherever surgical care needs to be delivered in a rural setting.”

The report comes following rapid changes in the provision of general surgery in rural hospitals over recent years. These have been driven by surgical services becoming increasingly centralised and specialised.

Written by a working group of surgeons with extensive experience in rural practice, the RCSEd’s report highlights the best ways to maintain standards through collaborative working between bigger city centre hospitals and smaller rural general hospitals.

One of the key recommendations is for more generally trained consultants, in line with the suggestions made in the Greenaway Report on surgical training. Other measures include multi-disciplinary team meetings in cancer care and multi-centre morbidity and mortality meetings to maintain standards in both types of hospitals.

The paper’s lead author, Mr Gordon McFarlane explained why it has become more challenging to provide surgical services in rural hospitals: “Advances in surgery have led to surgeons with skills in increasingly specialised areas. Surgeons in hospitals serving large populations can see a high volume of cases for their specialty area, but the provision of elective and emergency services to small communities spread over a considerable geographical area becomes more problematic.”

Added to this, many trainee doctors are not encouraged to see rural practice as an attractive career option and many senior consultants do not wish to move to rural areas for family reasons.

The authors stressed the recommendations were intended to help protect the continued provision of surgical services for rural communities of the Highlands and Islands.

*(Source: Scottish Workforce Information Standard System, Information Services Division (M) 36.)

Read the full report here.

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