Credential in Rural and Remote Health

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

Charlie trained in London before he took an 18-month long post as a Medical Officer with the British Antarctic Survey. Next, he undertook GP training programme in the north of Scotland spending time in Elgin, Fort William and Wick. Charlie, his wife and young family then moved to a busy rural hospital in Kwa-Zulu Natal, South Africa for a year. There he learnt so much and developed procedural skills across medicine, surgery, paediatrics and obstetrics, whilst rapidly developing his clinical courage. A move to Western Australia for two years came next. Charlie worked as a single-handed GP with additional medical responsibility for the local 16-bedded hospital and emergency department.

He returned to the UK and settled in Orkney in 2003. Since then, Charlie has held various roles. For 14 years he led the development of the Balfour Hospital GP-led Acute Medical Team which had remote consultant support from Aberdeen, created a hospital GP Specialty Training programme and helped establish the Acute Care GP Rural Fellowship.

Charlie created the Orkney Isles Network of Care to support recruitment of GPs and Advanced Nurse Practitioners (ANPs) to single-handed practices on the outer islands of Orkney and established a new General Practice in Kirkwall. He spent 7 years working as a single-handed GP on the outer island of Westray for 3 weeks out of every 9, alongside his role as NHS Orkney Lead GP. He is also a Fellow of the Royal College of Physicians Edinburgh.

Since 2022 he has worked as a Rural Emergency Physician in the Emergency Department of Caithness General Hospital, working two weeks in Wick and spending two weeks at home in Orkney

Looking back, Charlie said:

“My career has revolved around delivering healthcare to remote and rural communities both as a GP and hospital doctor. My time in Antarctica was extremely informative and started me thinking about how to provide medical services to remote areas. I also did research around telemedicine and trained lay people to be able to support me in emergencies.

“Providing emergency and inpatient services in rural hospitals requires a broad range of knowledge and skills, alongside the ability to tolerate uncertainty and work

with a high degree of clinical exposure. Hospital jobs have traditionally been the remit of consultants, although GPs have always delivered aspects of care in rural hospitals.

“For the latter part of my career, I have tried to create systems to support people to do that work, support the training of individuals to do the work for which there was no recognised training pathway and create teams that are mutually supportive of each other.

“The Credential, however, is not just about your skills and whether you can do this, that or the other. It’s as much about your experience and ability to manage things in the context in which you're doing it. There is an enormous difference between managing a critically unwell patient if you're the registrar within a team, or if you're managing it and you know you have a whole bank of hospital specialists behind you to help. That is quite different to when you're managing uncertainty. You are the senior. Your team may be just one junior doctor and the nursing staff.

“You’re dealing with clinical issues and making decisions with limited access to investigations. In addition, there is all the planning and managing the risk of transfer or whatever else you're trying to do at the same time. That requires experience and maturity. Otherwise, it is potentially overwhelming.

““I enjoyed doing the GMC Credential in Remote and Rural Healthcare via the recognition route. It gave me the opportunity to reflect on my skill set and experience. Reviewing my career and patient cases helped me create evidence for the GMC about the suitability of my qualifications and experience to undertake my role. And also, to demonstrate my attitudes, thought processes and values around continuity of care and addressing health inequalities.

“I have found the credential curriculum helpful for reviewing my ongoing learning needs and to help structure training for a new generation of doctors.

“The Credential validates the work we do. It provides clinical credibility which is important to me in the service I deliver and the patients I care for.

“Recruitment to rural communities has always been difficult. The development of the credential provides a supporting training framework for those wishing to work in remote and rural communities, hopefully making it easier for them to find a pathway to undertake the work they love, like me.”