The NHS People Plan seeks to address workforce shortages, to build leadership capability and to develop a workforce with the skills to match future service delivery plans.  This includes creating skills to work in multidisciplinary teams and to enable more digital adoption.  The NHS Long Term Plan for England flags the scale of workforce shortages, aiming to more than halve the vacancy rate for hospital nurses.  Within the social care sector, which has a larger workforce than the NHS, high vacancy and turnover rates are also a notable feature, most obviously in domiciliary care services.

A particular challenge in rural areas has been attracting and retaining doctors, both in GP practice and at smaller hospitals, which can impact the availability of specialist skills.  However, rural health and care workforce issues are much broader than this and partly reflect the impact that vacancies have within small teams.  Small teams are also likely to offer fewer opportunities for career development.  Relevant, too, is that most training institutions are based in urban centres.

The following questions are intended to help improve rural service planning and design:

  1. How well does workforce planning match with the evidence base about local health needs and trends?  How can it ensure that any specific needs from rural locations are identified?  How could monitoring of staff vacancy and turnover rates be used to gather rural data?
  2. How realistic and sustainable are future workforce plans for rural parts of the area?  How will those plans ensure professional teams with the capacity and range of skills to serve across rural geographies?  Is there a need to build team working or collaboration skills?
  3. What options can be explored to ensure that professional staff have career development or progression opportunities, without them necessarily needing to move away from the area?  Could this be expanded to offer some health research or teaching opportunities nearby?
  4. In rural areas which have a modest resident population, but which experience a seasonal influx of visitors or tourists, how much variation in demand for services is experienced?  What approaches could improve planning for and management of this variation?
  5. What policies are in place to ensure the wellbeing of professionals who work in rural and more isolated settings?  How accessible is support for any that develop mental health needs?  Is a lone worker policy in place for staff whose jobs involve home visits or regular travel in rural areas, where a mobile phone signal may be patchy?
  6. To what extent is the extra time and cost involved taken into account for staff whose roles involve home visits or regular travel to outlying locations and is that realistic?  When such services are commissioned e.g. domiciliary care, how do contracts cover extra travel costs?
  7. What training or development opportunities exist to prepare professionals, including GPs, who move into more remote areas, giving them the breadth of knowledge and confidence to work alone (with less access to professional back up)?  How might that be improved?
  8. How could rural based professionals be helped to access opportunities to maintain and update their knowledge, not least for CPD and mandatory training?  For example, could training sessions be held at more local facilities or as outreach training on site?
  9. How could valuable networking and peer learning opportunities be facilitated for rural based professionals, without them having to make long or time-consuming journeys?  For example, can easier locations be found for face-to-face meetings and can these be supplemented by digital options?
  10. What opportunities arise from the formation of Integrated Care Systems, Primary Care Networks and community multidisciplinary teams to address workforce issues that are prevalent in rural areas?  For example, could they assist professional networking, career development and gap filling where vacancies arise?
  11. What opportunities exist to extend training and networking opportunities to those working or volunteering for organisations in the voluntary and community sector, that support or complement statutory health and social care services?
  12. What measures are in place to ensure that professionals moving into agricultural areas have sufficient knowledge of diseases most likely to be found among farming communities, such as zoonoses and farmer’s lung?

Case studies [not yet available]:

  • Rural GP training in Northumberland
  • Refugee doctors project in Lincolnshire

Other solutions to rural service delivery challenges could include:

  • Deploying other trained health care staff into selective tasks that were previously carried out by a GP.
  • Seeking to attract into vacancies in rural areas those health and care professionals who have plans to return to the workforce after a spell away.
  • Addressing local gaps in specialist knowledge or experience by giving local professionals access to specialist support via digital means or telehealth.
  • Making use of e-learning and distance learning approaches to improve access to training opportunities.
  • Forging links with a university medical school in the region, who could offer rural skills teaching, placements or similar.  Rural experience could be offered at different levels, from Foundation students to those achieving their Certificate of Completion of Training.
  • Considering whether rural working can be turned into a selling point when recruiting to fill vacancies.  Positives could include the rural environment, community strength and a chance to develop a broader set of medical skills.
  • Putting in place buddying or mentoring arrangements for less experienced staff who may feel isolated working in rural locations.  This could involve mentoring by recently retired professionals.