Credential in Rural and Remote Health

Dr Alistair Innes is one of four NHS Highland doctors to receive the Rural and Remote Health Credential award and one of seven in the UK overall as announced by NHS Education for Scotland (NES).

The Credential award acknowledges the complexities of providing good and safe care in remote and rural communities. It recognises too the competencies and critical skills doctors bring to their practice of rural medicine and the example they set for future practitioners.

Alistair is a rural emergency physician at Broadford Hospital on Skye, the most northerly of the Inner Hebrides islands off the west coast of Scotland.

Alistair graduated from Aberdeen University in 1998 and spent his training years firstly in Inverness, then central Scotland. He trained in medicine, emergency medicine (EM), anaesthesia and general practice combining the job satisfaction he got from generalism with his interest in acute care. In 2005, he applied for a post on Skye. He is a Fellow of the Royal College of Emergency Medicine (RCEM), and sits on the RCEM Scottish Board as Remote and Rural representative.

Reflecting on that time, Alistair said:

“The job on Skye offered the ideal combination of all my previous experience. That was 20 years ago now and it's the best job in medicine. The community is small enough that continuity of care runs through each day and offers a wonderful place to set down family roots and bring up the kids.

“The Rural Emergency Physician role is an amalgamation of Emergency Medicine, GP Out-of-Hours, in-patient care and on occasion, critical care - all practised with the added benefit, and challenge, of being rural. You get the breadth as well as the depth and the clinical responsibility that comes with it.

“I enjoy the interaction with people and the clinical zing I get from knowing I did an excellent job.

“The variety any one day at work can bring is vast, and with next level care 100 miles away, there are numerous hats that need worn to look after people when they are most vulnerable. Situational awareness is important too, of your own limitations, if a person needs to go somewhere else and when to involve the retrieval team.

“Some of our elderly population are less willing to travel to the mainland for tests. So, you can be working at the top of your licence, but you have to be pragmatic about it to help the people you are caring for.

“We serve a population of between 15,000 and 18,000 on Skye. On top of that more than half a million visitors come to the island every year, and they too may become ill or require care.

“We’re a small clinical team of ten people, but not all full-time, so staffing is always tight. Yet despite extremely limited resource and staffing, we still offer some of the best care to the people we serve.

“There is complexity to remote and rural working which is not well understood in urban medical environments. That is why I’ve been involved in the development of the credential from the outset, to succeed in gaining better recognition for the complexities of rural medicine.

““When I applied for the Credential, I had already done some groundwork the previous year documenting the emergency medicine patients I had treated. This helped me a lot. Yes, it took time to link it all to the curriculum, but I was confident. I’ve been doing this job for 20 years and I know what I am doing. The process was straight forward, fair, yet rigorous.

“The curriculum development and satisfying the GMC as to the robustness of the project took several years. Now it has reached fruition, it will be good to see it establish a firmer recognition of the complexity of rural health and the skill set of those who work in this setting.

“We now have recognition for the first cohort of doctors. Early career doctors will see that and may want to develop these skills too. The Credential will be a great framework for them to work from to achieve them.”