Credential in Rural and Remote Health

Dr Nikki Duncan is one of seven doctors to receive the Rural and Remote Health Credential award 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. 

Nikki currently works as a Rural Hospital Doctor at the Galloway Community Hospital (GCH) in Stranraer on the southwest coast of Scotland. 

Nikki initially trained as a cardiothoracic surgeon up to specialist registrar level. However, due to a lack of consultant posts available for all UK trainees, she looked at other options. Although she loved Cardiothoracics, Nikki decided that it would be more sensible to pursue a career in General Practice and completed GP training in 2010. She is a member of the Royal College of Surgeons of Edinburgh, Royal College of General Practitioners and an associate member of Royal College of Emergency Medicine. 

Relecting on that decision, Nikki said: 

“I missed the acute medical and surgical aspects of managing patients. Towards the end of my GP training, I received information about the Rural Fellowship. This was an exciting development, encouraging trainees to consider working in the remote and rural areas, The Fellowship offered the opportunities of a great lifestyle combined with working in the acute medical sector and rural general practice. 

“Looking for that work-life balance and wanting to use the skills I gained working as a hospital doctor/surgeon as well as those gained in General Practice, I applied for and was subsequently appointed as a Rural Fellow. The more substantive post of Rural Hospital doctor in Stranraer then followed. I also worked in an excellent rural practice in Wigtown as a part-time salaried GP.  

“A move back to Glasgow came next due to family commitments. I worked in A&E there with two sessions a week allowed for GP locum work. I was working towards gaining consultant recognition in Emergency Medicine via the CESR route when family and work circumstances changed again and I returned to Stranraer. 

“During the COVID-19 pandemic, I was asked to become the clinical director for the hospital. In addition to developing treatment plans and protocols for our patient population, I was responsible for restructuring our workforce, developing a new way of working and successfully recruited several doctors and other staff, improving the care we give. I also developed a professional development programme whereby we rotated our staff out to Dumfries & Galloway Royal Infirmary (DGRI) to maintain and improve skills and competencies, and overall standards. This programme attracted several new recruits to GCH and I knew then that having a more formalised, recognised credential would improve our recruitment and retention.  

“The development programme competencies were based on those for the Acute Care Rural Fellowship in General Practice and some from emergency medicine and anaesthetics. They are the same as the competencies that form the basis and standards of the Rural and Remote Health Credential: unscheduled and urgent care. 

“Credentialing is the first step to recognising rural and remote acute medicine as a specialty. It ensures we all have a set standard and level of competencies that will improve patient care, ensure we manage them safely and will be crucial and essential in recruiting others to work in rural and remote areas. 

“The Credential will provide medical professionals and patients with the confidence that they are giving/receiving an equity and standard of care that is optimal no matter where they live. This will make working in such areas more attractive, encouraging more health professionals to want to work in such fantastic settings like Dumfries and Galloway and enjoy all these areas offer.” 

“I enjoy my current role. It is challenging, interesting and can at times be stressful. It is varied, and like Cardiothoracic surgery, involves managing some patients with cardiovascular issues, respiratory problems, resuscitating acutely unwell patients, stabilising them before either, admitting them and subsequently then managing them on the acute medical ward, or transferring them on to more specialist care. It can include major trauma, some minor surgery, some anaesthetics and some intensive care - while waiting for the Emergency Medical Retrieval Service (EMRS) to transfer to another hospital. And can take an entire shift.” 

To find out more about the credential learner and recognition routes, visit Credential in Rural and Remote Health | Turas | Learn.