Credential in rural and remote health

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.

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.

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.

In June 2019 the GMC agreed that NHS Education for Scotland would be responsible for the delivery of the Rural and Remote Health Credential. Work has been ongoing since 2020 with the General Medical Council (GMC) on the development of a curriculum involving four nation stakeholder engagement. Membership of the Rural and Remote Health Credential Expert Steering Group was drawn from across the four nations, comprising a range of organisations with an interest in the development of the credential

The curricula is based on higher level outcomes and incorporates the GMC defined Generic Professional Capabilities.

The Credential Development body within NES are continuing to work with the GMC on the delivery phase and Digital colleagues in house on E Portfolio design.

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:

• Act as 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, paediatric and psychiatric conditions
• Manage the in-patient care of patients suitable to be cared for in small rural hospitals
• Contribute to the safe transfer and retrieval of acutely ill patients who require next level care, alongside specialist retrieval teams.

An initial capability assessment will be undertaken to align training to learning needs. Learning needs will vary according to previous experience.

The following key criteria will apply:

• The indicative training time is up to 2 years
• Doctors on the GP register will be able to display a wide range of knowledge, skills, behaviours and attributes, reflecting the broad nature of General Practice
• Doctors practising in non-training grade positions will be expected to demonstrate appropriate experience and existing competencies attributed to rural and remote practice and/or emergency patient care. Typically, this will include recent experience of working in a rural and remote context for a period of at least 1 year
• If a doctor considers having achieved the capabilities in practice and are practising at the level laid out in the curriculum, consideration may be given to the accelerated award of the credential. This would normally involve them providing evidence of how they meet the capabilities in practice to the UK Rural and Remote Credential Board. The Board may conclude either that further training is required within the credential pathway, or that sufficient evidence has been provided and that the Doctor should be recognised as holding the Credential.

Blended learning in different contexts (sites, simulation, distanced 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.