Splendid isolation

DAVID HOGG was still in training as a GP when he set up the RuralGP blog (ruralgp.com) in April 2009. The blog intends to be a resource for remote and rural GPs, GP trainees and nurses, and aims to provide up-to-date information about key events, discussions and initiatives in the UK rural health agenda.

David is originally from Edinburgh but trained in Glasgow, graduating in 2005. He progressed directly from FY2 into GP training in Ayrshire and completed his GP registrar year in Kilmarnock in August.

His rural interests were kindled by a student module in 2005 when he studied the provision of diabetes care on the Isle of Lewis. Since then he has maintained an interest in rural practice and will be spending the next year as a GP Rural Fellow on Arran.

“If I wasn’t doing medicine, I’d be an outdoor activities instructor,” says David. “But I get a lot of enjoyment from my job and wouldn’t swap my current position for anything else.”

How did the idea for the RuralGP blog come about?

I was at a meeting in London of the RCGP Rural Forum, and we were discussing how we could provide an easily accessible resource for rural GPs. We agreed to trial a blog for six months, using a variety of podcasts, presentations and stories. Most feedback has been positive, and we’ve decided to keep it running.

What is the purpose?

There’s a huge amount of information on the internet that is very relevant to rural and remote GPs, however without adequate signposting it can be difficult to know where to look for this. The RuralGP blog aims to highlight some of the important stories and useful links, as well as foster some degree of community amongst rural GPs.

How would you like to see it develop?

I think the internet has far more potential for rural practitioners than it is currently used for. Rural GPs have more difficulty in attending meetings, accessing peer support and going to courses, and there are ways of breaking those barriers with tools like Skype, webcasting, podcasting and email groups. The RuralGP blog is starting to assimilate some of these tools, as well as highlighting good examples of where this has been achieved already. The associated RuralGPNetwork is an email group of more than 150 rural GPs – it’s free to join and is currently hosting some very stimulating discussion between colleagues.

Whilst access to broadband in rural areas remains difficult for some, I think this will become less of an issue over the next few years.

What are the main challenges to being a rural GP?

I’ve only been in rural practice for a few weeks now, so I don’t claim to be an expert! However, living in a close community, as well as being “on call” for most of the time, can bring reward as well as occasional frustration. Rural GPs need to be generalists – last week I treated a chap with SVT, sutured some minor injuries and incised and drained an abscess. That’s on top of the usual GP presentations seen in any practice. It’s a stimulating career choice.

Are there any special skills needed?

Extended skills in all domains of general practice are useful – such as minor surgery, palliative care, emergency medicine, dermatology and general medicine. You may also find yourself attending a road accident, doing a ward round or applying a plaster cast. If you are new to the job, more experienced colleagues are usually happy to help you learn these skills, and there are going to be some exciting GP training programmes specifically for rural practice soon.

What qualities make for a good rural GP?

The cliché “every day is different” applies, so flexibility and resourcefulness come in handy. Referring someone to hospital can require a wait for the ferry, or a helicopter transfer… until that happens you are responsible for that person so it’s important to have some confidence in dealing with sick patients, including children. Being able to quickly integrate yourself into the community is important, as people are naturally curious about your background, and it’s important to be interested in people’s lives, not just the medicine.

What’s attracted you to pursuing rural general practice?

I love the outdoors, and my daily commute is second to none. Being able to offer a more personal service to patients is a major attraction. I became quite disillusioned with the many protocols, referral pathways and systems which are endemic – and perhaps necessary – in larger healthcare settings, and found it difficult to maintain continuity of care with my patients. Here on Arran, if I admit a patient to the hospital, it’s me who will oversee their admission and I hope that this will be conducive to a more effective recovery. I think there’s more accountability – which increases patient safety – and this also allows a far greater level of holistic care. The nursing staff here offer a fantastic level of care – they often know the patient personally – and we all take our turns in dropping bloods off at the ferry terminal and delivering the occasional prescription en route to something else.

Are there drawbacks?

There’s always a risk of “supermarket aisle” consultations, but the majority of patients respect your time off and offer a great level of support to health professionals. There’s ongoing interdependency – I’m as reliant on the service provided by the ferry, petrol station, baker or bank, as they are on me for medical services. Being on an island may give a sense of isolation too, but I manage to return to Glasgow on a regular basis whilst doing the Fellowship year here and participating fully in the on-call rota.

Other advice?

If any students or trainees want to know more about rural practice, I’m be happy to be contacted (david.hogg@nhs.net).

Interview by Jim Killgore, MDDUS editor