Professor James Buchan is an international expert on health care workforce policy, having worked on recent EU, OECD and WHO policy projects on this subject. With a background in the NHS, he has also worked as an adviser to the Australian federal government health workforce agency, and was a co-author for our recent report ‘Staffing matters; funding counts’.
He shares his thoughts on the 10 things you need to be aware of when building a health care workforce that meets the needs of populations in more isolated parts of the UK.
1. Get them young, get them local
There is strong evidence that a focus on attracting and encouraging local school students to consider health care sector employment through local outreach has a payback in terms of workforce stability. Local people have roots in the community, and already understand rural/remote living. Countries like Canada, Australia and Japan have addressed this by specifically developing medical schools targeted at remote areas. A certain population base is necessary to warrant that level of financial investment, but the UK could certainly look more at the undergraduate provision of training for health care professionals to ensure the curriculum covers issues relating to remote and rural health care, and provide more training placements in rural areas. If as a student you discover you love working in this type of community, it might change the way you choose to develop your career.
2. Accentuate the positives of remote area working, but plan for turnover
Working in health care in remote and rural areas can often give a broader range of clinical experiences, combined with a lifestyle that appeals to some individuals. Recruitment efforts need to press these buttons, but be realistic about length of stay. Some workers will love rural living, and stay long term, but others will move on relatively quickly. Succession planning will be a challenge, and turnover patterns are likely to be skewed.
3. Recruitment is (often) not just about the individual worker
You’ve got to remember that many potential recruits will have partners and families whose needs might not fit with a rural move. Careers of partners, schooling for children, suitable accommodation – if these needs are not met, they can be major stumbling blocks to effective recruitment.
4. Address concerns about workload and stress
Working alone or as part of a small team in remote areas means that the workload of staff is likely to be more unpredictable, with more time on-call, making it harder to maintain work-life balance. In some remote communities practitioners can essentially be the only first responder, meaning they’ll need the skills and abilities to address a broader range of challenges than would be normal for someone working as part of a bigger team. Effective referral and call-out protocols, combined with scheduled respite time and co-ordinated use of locum staff can help manage the stress.
5. Address concerns about professional isolation
There is a risk that health care workers in remote areas become professionally isolated, or feel distanced from their peers. They should be supported to engage fully in professional development activities, involved in team building, and enabled to have peer-to-peer connectivity with others working in remote areas. Some parts of the UK are doing more than others. For example there is more emphasis on remote medicine in Scotland because of the geography, and the NHS is trying to reduce professional isolation by creating formal networks and support across geographies.
6. Be clear what types of incentives will best match workforce needs and concerns, and be transparent about eligibility criteria
It’s not just about paying people more to work in underserved areas. You might need to cover additional costs relating to a move, for example providing suitable accommodation, support for children’s education, or money for travel. Other countries do this. Australia has classified five levels of designated rurality and remoteness, and the more remote the higher the incentives. If you’re a medical student in Australia you know if you work somewhere like Mount Isa or the Northern Territory you’ll have access to extra support.
7. Work with local communities and other agencies to support workforce sustainability
Rural and remote communities are often well organised, and have a real stake in recruiting and retaining health care workers. So do other local agencies, and local businesses. This good will, and enlightened self-interest, can be harnessed to provide mutual support, and inter-agency cooperation can help address some of the technology challenges of remote working and living.
8. Get smarter about the use of technology to support rural health care
The UK is somewhat behind Scandinavia, Canada and Australia in terms of how IT is used to support service efficiencies, remote health care provision, and also to enable patients to self-manage. The challenge for the NHS is that often telemedicine has upfront capital costs and it’s not always possible to demonstrate immediate cost benefit.
9. Skill mix should meet local priorities and reflect local circumstances
You need to be looking at creating and sustaining a skill and staff mix that reflects the needs of local populations more closely and effectively, while accepting that not every remote village can have its own GP. This means more emphasis on advanced practice roles in nursing and allied health care. Those sorts of roles are likely to be at the forefront of remote health care delivery in future.
10. It’s not just about the workforce
While enabling access to health care in remote communities is in part about achieving ‘right staff, right place, right time’, the driver has to be providing high quality services, and that’s not just, or always about recruiting more staff. You need to look at service configuration and technology. What skills are required? Could you solve the problem by developing different approaches to care provision? Can remote working be better enabled by IT? Do you have optimum referral protocols and systems?