Credential in Rural and Remote Health (Unscheduled and Urgent Care)
“We are excited and enthused that the value and distinctive nature of Rural and Remote Health is being acknowledged and championed through a Credential in Rural and Remote Health. The credential has been developed in partnership with stakeholders across the UK. The team is led by Professor Alan Denison, Postgraduate Dean, and by Dr Pauline Wilson, Associate Postgraduate Dean and Director of Medical Education in the Shetland Islands, in the far north of Scotland”.
Prof Emma Watson,
Executive Medical Director at NHS Education for Scotland.
In June 2019, the General Medical Council (GMC) agreed a process for the five early adopters for GMC credentials. The five early adopters were:
- Interventional Radiology (Acute Stroke) – Royal college of Radiologists
- Pain Medicine – Faculty of Pain Medicine
- Cosmetic Surgery – Royal College of Surgeons
- Liaison Psychiatry – Royal College of Psychiatrists
- Rural and Remote Health – NHS Education for Scotland
In September 2020, work began on the development of a Credential in Rural and Remote Health focusing on unscheduled and urgent care.
The context of rural and remote healthcare
Practising medicine in rural and remote areas is challenging. Compared to their urban counterparts, doctors practising in these locations may be described as ‘extended generalists’. They provide a wider range of clinical service, sustain a heavy workload and carry a high level of clinical responsibility, all in relative professional isolation. Recruitment and retention in rural and remote areas is challenging, with impact on both rural General Practices, and the staffing of smaller District/Rural General Hospitals (<100 beds) by doctors who possess the extended spectrum of emergency and inpatient clinical skills and competencies to deliver safe care without the wider specialty support available in larger hospitals. This is necessary because Acute and Emergency Medicine Consultants may not practice within these smaller hospitals.
The need for the credential
Although bespoke posts (such as “Rural Practitioner/Emergency Medical Practitioner/Rural Emergency Physician”) have emerged as a pragmatic response to service need, there is currently no shared underpinning competency framework. While appointees commonly have a General Practitioner background, their clinical training and skill levels often vary significantly.
The credential will provide a consistent approach to the training of the “extended generalist” required to provide unscheduled and urgent care in rural and remote hospitals and at the interface with the community. The Credential in Rural and Remote Health (Unscheduled and Urgent Care) aligns with the key principles of the UK Shape of Training Review.
The purpose of the credential
The credential in Rural and Remote Health will help to address the service and patient safety need for General Practitioners as well as doctors in non-training grade positions working in these contexts to extend and enhance the skills not covered in speciality training. In doing so the credential will:
- Provide a supportive training framework doctor wishing to practice in remote and rural areas where there is an expectation that they will provide acute care in rural and remote hospitals and at the interface with community
- Enhance practitioner’s skills and expertise in the provision of emergency medicine at the interface between primary and secondary care. It will support these doctors by providing the competences required to recognise, stabilise and manage an acutely unwell patient, for up to 24 hours if evacuation is necessary, as well as the management of appropriate inpatient cases
- Help to create a flexible and healthy development and training culture for doctors in rural and remote areas
- Support more flexible career development and facilitate credential holders to change career direction.
The scope of the credential
Holders of the credential in Rural and Remote Health will not have the scope of practice equivalent to doctors on the specialist register for other GMC-approved curricula. It is a generalist credential of core emergency skills capable of being delivered in a non-specialist environment, with liaison with specialists as required. Holders of the credential in Rural and Remote Health will be able to undertake clinical roles in small hospitals in a rural and remote context that are in addition to the usual scope of practice of a General Practitioner, including:
- Senior decision maker in acute and emergency presentations
- Perform a range of emergency care practical skills
- Interpret a range of emergency diagnostic tests
- Diagnose, assess and manage a range of acute medical, surgical, trauma and psychiatric conditions
- Manage the in-patient care of patients suitable to be cared for in rural hospitals
- Contribute to the safe transfer and retrieval of acutely ill patients who require next level care, alongside specialist retrieval teams.
Aligned with “Excellence by Design”, the Rural and Remote Health credential curriculum is outcomes-based. Progression will therefore depend on capability rather than time. Attainment of the competencies may accordingly be achieved at different times depending on clinical placements as well as pre-credential experience and training.
The curriculum will be delivered through a variety of learning experiences and will allow learners to achieve the capabilities described through a variety of learning methods. There will be a balance of different modes of learning from experiential learning ‘on the job’ to more formal courses. The proportion of time allocated to different learning methods will vary depending on the previous experience of the learner. Training will be constructed to enable learners to experience the full range of educational and training opportunities available and there will be robust arrangements for quality assurance in place to ensure consistent implementation of the curriculum.
Where are we at?
In April 2021, the curriculum for the credential was submitted to the GMC Curriculum Advisory Group. The curriculum is composed of three generic and nine clinical capabilities in practice as well as a range of essential procedural skills supported by an overarching supervision and assessment framework.
In December 2021, the credential team were advised that the Rural and Remote Credential curriculum had been endorsed by the GMC but due to ongoing work on the GMCs framework for credential delivery they were not at the stage to give final approval.
Preparing for delivery
Throughout 2022, the credential team has continued to work with the other early credential adopters and the GMC on how delivery and quality assurances of the credentials will work in practice. High level discussion is ongoing between the GMC and the statutory education bodies as they work to finalise the overarching governance arrangements. It is anticipated that this work will conclude by the end of 2022.
Work is ongoing to have a workable e-portfolio in place by the end of March 2023. This piece of work is central to the quality assurance of the credential and will make it easier for credential learners to collate their evidence.
It is hoped that 2023 will see those doctors who already meet the credential requirements awarded with the credential as well as learners embarking on the credential journey.
The credential will provide a consistent approach to the training of the ‘extended generalist’, who is often required to provide unscheduled and urgent care, both in rural and remote hospitals and directly with patients in their community. The credential will also support a more flexible career development for doctors, allowing holders of the credential to change their career direction or enhance their skills and expertise. Most importantly, it will also provide reassurance to people living in rural and remote areas of the UK that, whatever the challenges of their location, they can expect to receive good and safe care.
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