We look forward to working with the newly elected Government and Matt Hancock, the Secretary of State for Health to ensure that rural areas have access to health services and are fairly funded.

News stories that have been featured on our rsnonline.org.uk website include:

Winter pressures increasing for care services
The MJ reports that more than 90 per cent of adult care directors are concerned at their ability to cope with winter pressures or provider failure
The Association of Directors of Adult Social Services (ADASS) autumn survey, released last week, found that 90 per cent of 151 directors surveyed have ‘some concerns, or insufficient capacity to manage’ winter-related pressures over the coming months and 93% gave the same reaction to the prospect of managing the failure of a large provider.

Average journey times to public services across England revealed
The Department for Transport calculates journey times from neighbourhoods across England to eight types of local service  on foot and using public transport
Destinations range from job centres to GP surgeries and food shops. Results this year found that some of the longest journeys take place in Herefordshire – as residents take nearly 30 minutes to reach key services.

Rural Domestic abuse in the spotlight
The National Rural Crime Network (NRCN) has published a report noting that, on average, abuse lasts 25 per cent longer in rural locations, with victims half as likely to report abuse
Avon and Somerset Police believe that those living in rural areas are at high risk of under-reporting for a number of reasons such as: lack of access to available services due to location, fear of reprisals from tight-knit communities, as well as the stigma and shame associated with domestic abuse.

Councils need billions more for adult care
The Institute for Fiscal Studies has reported that Councils need ‘billions of pounds in additional funding to meet the rising costs of adult social care’, and this is just to maintain services at current levels. 

RSN provide a range of opportunities for colleagues to come together to discuss issues affecting rural health. Member organisations are welcome to attend these events for free.
Click the links below for more info:

Rural Health and Social Care Meeting 
This takes place in London twice a year.
The most recent meeting took place on 2nd December at LGA HQ.  The minutes are available here

Our regional seminar programme of 7 events includes one on Rural Health and Wellbeing in July. It was kindly hosted by West Suffolk Council and took place in late July.  Open to members of the RSN and RHCA, there were 4 speakers who shared their expert knowledge with delegates.  Kate Pym from Pym’s Consultancy, Sheila Childerhouse, the Chair of West Suffolk NHS Foundation Trust and Jonny Haseldine, the Parliamentary Assistant to Anne Marie Morris MP.  Full details and notes of the meeting are available at the link above.

In addition, the Rural Health and Care Alliance hosted a seminar on technology and health in Lincoln on 12th November.  Presentations on the day from:

• Lincolnshire Sustainability and Transformation Partnership
• Medical Technologies Innovation Facility
• Greater Lincolnshire LEP Local Industrial Strategy

- These are all available here
- We are just setting our programme of seminars for 2020. You can see the programme here.

Whitehall updates the Index of Multiple Deprivation
The 2019 version of this Index does not solve rural concerns, but it is likely to be widely used and should not be ignored, says Brian Wilson.

The RSN's Observatory is the place to discover the statistics behind key issues facing rural communities in England, issues that the RSN is striving to highlight and tackle through its work. The Observatory is additionally a great place to understand the numbers that define the communities within our membership through an expanding group of analyses, with this body of work soon to be given its own area on the RSN website called Member Insights & Analysis.
It also includes statistics on Housing, Health & Wellbeing, the Economy, the Environment and Travel and Transport.

Recent analysis includes:

Annual Population Survey: Wellbeing
Through the answers given to four questions taken from the Annual Population Survey it is possible to gauge levels of life satisfaction, happiness, estimates of the feeling that things in life are worthwhile, and anxiety. This analysis presents this information against similar authorities to assist in monitoring local attitudes.

Employment and Support Assessment
Employment and Support Assessment (ESA) is an income replacement benefit for people below state pension age.  If someone has a health condition or disability, and for that reason are unable to work, ESA offers financial support and personalised help so that they can return to work if they are able to.  The following analyses looks at the Employment and Support Assessment caseload as a proportion of total local authority population estimate, both for district and unitary authorities.  The analysis shows the relative level of caseload and compares to key averages to provide a barometer of a local authority's particular situation.

Scottish rural GPs to receive more BMA help due to inequitable contract (2 Dec 2019, Pulse)
GP leaders in Scotland have voted to support rural GPs more following the consequences of implementing the new Scottish GP contract.
Scottish LMC members voted in favour of a motion recognising phase one of the Scottish contract has not resourced rural GPs in an ‘equitable’ way as GPs working in urban areas.

Suffolk artist sketches to raise funds for farmers mental health (1 Nov 2019, BBC)
An artist has completed her "100 drawings in 100 days" challenge to raise money for farmers suffering with mental health problems.
Kate Batchelor, from Kessingland, sketched every day at locations across Norfolk and Suffolk from July.  Her drawings will be sold at an exhibition at the Norfolk Showground, near Norwich, this month.
A percentage of the money raised will go to charity YANA (You Are Not Alone), which supports the farming community.  Ms Batchelor said she grew up on a farm and understood "the stresses and strains" that workers faced.

A care home opens its doors to lonely elderly people on Christmas Day (11 Dec 19, Western Morning News)
A home care in Newquay is trying to invite elderlies in the community to attend their Christmas celebration as an effort to reduce sadness and depression as a result of loneliness.
Residents and Staff members at Anchor’s Kimberley Court have arranged a day especially for elderlies living in the town alone in the hopes of keeping the lonely elderlies in touch during special occasions such as Christmas day at the home care.

THE SOUTH WEST ACADEMIC HEALTH SCIENCE NETWORK

The South West Academic Health Science Network (SW AHSN) works to improve the health and patient experience of people in the South West by supporting and accelerating innovation and quality improvement. As the only body that connects NHS and academic organisations, local authorities, the third sector and industry, they are catalysts that create the right conditions to facilitate change. This is by spanning the regions health and social care economies, with a clear aim on improving outcomes for patients. They are uniquely placed to identify and spread health innovation at pace and scale; driving the adoption and spread of cutting edge ideas and technologies across networks.

The DDA’s 2019 Rural Practice Manifesto
By DDA chairman, Dr Richard West

This manifesto was developed in the run up to election and we expect the DDA would like the new Government to work with them on their proposals.

Welcome to the Dispensing Doctors’ Association’s Rural Practice Manifesto for the 2019 General Election.
As the election campaign begins in earnest, the NHS will run Brexit a close second as a key area over which the political parties are best-placed to preside.
The DDA invites election candidates to work with the DDA to answer the following calls to action:

1. Involve the DDA in the second phase of the consultation on drug reimbursement, so that dispensing practices and their patients are not disadvantaged when the changes are implemented
2. ‘Rural proof’ Primary Care Networks (PCNs) and support the call for an updated rural NHS funding formula that recognises the increased costs of delivering a robust and resilient health service in rural areas
3. Protect the unique rural GP one-stop-shop service that improves people’s access to scarce healthcare resource
4. Recognise that rural medical practices are the hub of their local communities, offering traditional family doctor GP services, creating skilled jobs for local people, and reducing social isolation
5. Lobby for urgent improvements to the rural infrastructure, particularly, public transport and broadband
6. Recognise that dispensing income is vital for the sustainability of high quality rural general practices

Taken together, these developments will see pressure removed from local district general hospitals providing my patient-centred care, closer to home as the NHS develops GP policy around the country.

The DDA encourages candidates from all parties in rural constituencies to visit their local dispensing practices during the election campaign.  Only by meeting the patients and the healthcare team will candidates see for themselves the vitally important, and often unsung, role of the dispensing doctor practice.

As usual, the special nature – and requirements - of rural GPs seem very far off the political radar. For the eight million patients of rural GP surgeries, and the doctors who provide the service, this is concerning – particularly given the predilection of NHS policy for general practice “at scale” despite the acknowledged workforce challenges, particularly in rural areas.

With its more elderly demographic, and higher incidence of chronic disease, rural general practice does not easily fit into NHS plans for appointment at 8am-8pm consultations, or with a virtual GP over Skype.  For many rural patients, the local surgery is at the centre of the community and it does not just offer them their GP service.  In addition, deprivation is more difficult to find and deal with and is often not accurately reflected in the NHS funding formula for practices in rural areas.

Rural practices located in areas where a pharmacy is not economically viable can also the highly popular, one-stop-shop GP dispensing service. This often subsidises the provision of the GP service, when it might not otherwise be viable. Many people are unaware of this and assume that the service will continue to be there because it always has been. Unrelenting pressure on dispensing margins and the search for ‘efficiencies’ within GP dispensing services will do little to secure a reliable future for this much-loved service.

The DDA’s Manifesto is designed to alert candidates from all parties, and their communities, to the importance of dispensing GP practices.  They are the hub from which health and social services should be delivered in the future and, if local health economies are not to be destabilised further, they must be preserved and invested in over the next five to ten years.

Dr Richard West MBE
Chairman of the Dispensing Doctors’ Association
Partner, Woolpit Health Centre, Suffolk 

What is the Rural Services Network?

What is the Rural Health and Care Alliance?